Quantitative assessments of late radiation-induced skin and soft tissue toxicity and correlation with RTOG scales and biological equivalent dose in breast cancer

Abstract

Purpose Radiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer. Methods Patients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration. Results In 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased (p < 0.001, p = 0.016, p = 0.005, respectively). Conclusions The multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT.

Skin and soft tissue diseases and their treatment in society

“…Immunosuppressed people are, by definition, more prone to infection and less able to manage local illness. [38][39][40] Skin and soft tissue infections are widespread, and since they can be brought on by a variety of microbes and typically occur as a result of an infections that has spread widely, they frequently present challenging health situations. [41,42] It's crucial to take measures to safeguard the skin from needless damage, ulceration, and changes to the usual microbial flora when treating immunosuppressed individuals No issue how little or unassuming they may look, wounds should always be thoroughly examined, and the doctor must keep in mind that the reduced inflammation frequently changes the wounds physical appearance.…”

Ultrasound‐Based Grading System for Radiation‐Induced Acute Breast Toxicity

“…To complement the clinicians' evaluation, new techniques were proposed such as reflectance spectrophotometric measurements of the skin pigmentation, 27 thermal imaging biomarkers of the breast temperature, 28 laser Doppler flowmetry of the cutaneous blood flow, 29 and the dielectric method of the skin hydration 30,31 . Although these techniques provide objective measures of radiation toxicity, the tools or instruments required for these studies were rare and not routinely used in clinical practice 32 . Ultrasound is a none‐ionizing and easy‐to‐use modality widely adopted for real‐time breast imaging 33–36 .…”

“…30,31 Although these techniques provide objective measures of radiation toxicity, the tools or instruments required for these studies were rare and not routinely used in clinical practice. 32 Ultrasound is a none-ionizing and easy-to-use modality widely adopted for real-time breast imaging. [33][34][35][36] In the past decades, we and other groups have demonstrated the feasibility of assessing breast radiation toxicity via ultrasound.…”