Quantitative Ultrasonic Evaluation of Radiation-Induced Late Tissue Toxicity: Pilot Study of Breast Cancer Radiotherapy

Liu, Tian; Zhou, Jun; Yoshida, Emi; Woodhouse, S.A.; Schiff, Peter B.; Wang, Tony J. C.; Lu, Zheng Feng; Pile-Spellman, Eliza; Zhang, Pengpeng; Kutcher, Gerald J.

doi:10.1016/j.ijrobp.2009.08.071

Cited by 35 publications

(39 citation statements)

References 27 publications

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“…12,13 Ultrasound parameters were computed from RF data using in-house MATLAB software. Skin thickness was determined from the product of the ultrasound wave propagation speed in breast tissue, and the time interval between RF signal interaction between the epidermis and hypodermis.…”

Section: Quantitative Toxicity Assessmentmentioning

confidence: 99%

“…[11][12][13][14] Skin thickening is a well-known response to radiation that may be measured by the distance between the radio-frequency (RF) echo from the skin's surface and from that of the hypodermis. Radiation-induced damage to the basal layer of dermal cells results in a blurred and irregular dermal-hypodermal interface on B-mode ultrasound images.…”

Section: Introductionmentioning

confidence: 99%

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Spectrophotometer and ultrasound evaluation of late toxicity following breast-cancer radiotherapy

et al. 2011

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Purpose: Radiation-induced normal-tissue toxicities are common, complex, and distressing side effects that affect 90% of patients receiving breast-cancer radiotherapy and 40% of patients post radiotherapy. In this study, the authors investigated the use of spectrophotometry and ultrasound to quantitatively measure radiation-induced skin discoloration and subcutaneous-tissue fibrosis. The study's purpose is to determine whether skin discoloration correlates with the development of fibrosis in breast-cancer radiotherapy. Methods: Eighteen breast-cancer patients were enrolled in our initial study. All patients were previously treated with a standard course of radiation, and the median follow-up time was 22 months. The treated and untreated breasts were scanned with a spectrophotometer and an ultrasound. Two spectrophotometer parameters-melanin and erythema indices-were used to quantitatively assess skin discoloration. Two ultrasound parameters-skin thickness and Pearson coefficient of the hypodermis-were used to quantitatively assess severity of fibrosis. These measurements were correlated with clinical assessments (RTOG late morbidity scores). Results: Significant measurement differences between the treated and contralateral breasts were observed among all patients: 27.3% mean increase in skin thickness (p < 0.001), 34.1% mean decrease in Pearson coefficient (p < 0.001), 27.3% mean increase in melanin (p < 0.001), and 22.6% mean increase in erythema (p < 0.001). All parameters except skin thickness correlated with RTOG scores. A moderate correlation exists between melanin and erythema; however, spectrophotometer parameters do not correlate with ultrasound parameters. Conclusions: Spectrophotometry and quantitative ultrasound are objective tools that assess radiationinduced tissue injury. Spectrophotometer parameters did not correlate with those of quantitative ultrasound suggesting that skin discoloration cannot be used as a marker for subcutaneous fibrosis. These tools may prove useful for the reduction of radiation morbidities and improvement of patient quality of life.

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Section: Quantitative Toxicity Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spectrophotometer and ultrasound evaluation of late toxicity following breast-cancer radiotherapy

et al. 2011

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“…As mentioned previously, the STRA has correlated with RTOG grading criteria of radiotherapy-induced skin toxicity in breast cancer patients. (18,21) Therefore, STRA served as an objective measure of XRT-induced skin toxicity in our study.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Axillary Lymph Node Surgery on Breast Skin Thickening During and After Radiation Therapy for Breast Cancer

Torres

Yang

Noreen

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose This prospective study was conducted to determine predictors of epidermal thickening during and after whole breast radiotherapy (XRT) using objective measurements acquired with ultrasound. Methods and Materials Following breast conserving surgery, 70 women received a definitive course of whole breast XRT (50 Gy plus boost). Prior to XRT, at week 6 of XRT, and 6 weeks post XRT, subjects underwent objective ultrasound measurements of epidermal thickness over the lumpectomy cavity and all four quadrants of the treated breast. A skin thickness ratio (STRA) was then generated normalizing for corresponding measurements taken of the untreated breast. Results Baseline measurements indicated that 87% of patients had skin thickening in the treated versus untreated breast (mean increase of 27%, SD of 0.29) prior to XRT. The STRA increased significantly by week 6 of XRT (mean 25% (SD .46) and continued to increase significantly 6 weeks post XRT (mean 33% (SD .46) above baseline measurements (p<0.001 for both timepoints). In multivariable analysis, breast volume (p=0.003) and surgical evaluation of the axilla with full lymph node dissection (p<0.05) predicted for more severe changes in STRA 6 weeks after XRT compared with baseline. STRA measurements correlated with physician ratings of skin toxicity according to RTOG grading criteria. Conclusions This is one of the first studies to objectively document that lymph node surgery impacts XRT-induced skin thickening in breast cancer patients. Surgical evaluation of the axilla with a complete lymph node dissection was associated with the most severe XRT-induced skin changes following XRT completion. These results may inform future studies aimed at minimizing side effects of XRT and surgery, particularly when surgical lymph node assessments may not alter breast cancer management or outcome.

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“…Although recognized for decades, the assessment of skin toxicity is carried out subjectively by physicians through visual evaluation and palpation. We, along with other researchers (Huang et al 2007; Liu et al 2010; Warszawski et al 1998; Zhou et al 2009), have recently reported that ultrasound can be used to quantitatively assess skin toxicity after radiotherapy for breast cancer. In particular, skin thickening was observed in almost all post-radiotherapy patients (Huang et al 2007; Liu et al 2010), making it an important parameter in ultrasonic evaluation of skin toxicity.…”

Section: Introductionmentioning

confidence: 92%

Automated Skin Segmentation in Ultrasonic Evaluation of Skin Toxicity in Breast Cancer Radiotherapy

Gao

Tannenbaum

Hao

et al. 2013

Ultrasound in Medicine & Biology

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Skin toxicity is the most common side effect of breast cancer radiotherapy and impairs the quality of life of many breast cancer survivors. We, along with other researchers, have recently found quantitative ultrasound to be effective as a skin toxicity assessment tool. Although more reliable than standard clinical evaluations (visual observation and palpation), the current procedure for ultrasound-based skin toxicity measurements requires manual delineation of the skin layers (i.e., epidermis-dermis and dermis-hypodermis interfaces) on each ultrasound B-mode image. Manual skin segmentation is time consuming and subjective. Moreover, radiation-induced skin injury may decrease image contrast between the dermis and hypodermis, which increases the difficulty of delineation. Therefore, we have developed an automatic skin segmentation tool (ASST) based on the active contour model with two significant modifications: (i) The proposed algorithm introduces a novel dual-curve scheme for the double skin layer extraction, as opposed to the original single active contour method. (ii) The proposed algorithm is based on a geometric contour framework as opposed to the previous parametric algorithm. This ASST algorithm was tested on a breast cancer image database of 730 ultrasound breast images (73 ultrasound studies of 23 patients). We compared skin segmentation results obtained with the ASST with manual contours performed by two physicians. The average percentage differences in skin thickness between the ASST measurement and that of each physician were less than 5% (4.8 ± 17.8% and −3.8 ± 21.1%, respectively). In summary, we have developed an automatic skin segmentation method that ensures objective assessment of radiation-induced changes in skin thickness. Our ultrasound technology offers a unique opportunity to quantify tissue injury in a more meaningful and reproducible manner than the subjective assessments currently employed in the clinic.

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Quantitative Ultrasonic Evaluation of Radiation-Induced Late Tissue Toxicity: Pilot Study of Breast Cancer Radiotherapy

Cited by 35 publications

References 27 publications

Spectrophotometer and ultrasound evaluation of late toxicity following breast-cancer radiotherapy

Spectrophotometer and ultrasound evaluation of late toxicity following breast-cancer radiotherapy

The Impact of Axillary Lymph Node Surgery on Breast Skin Thickening During and After Radiation Therapy for Breast Cancer

Automated Skin Segmentation in Ultrasonic Evaluation of Skin Toxicity in Breast Cancer Radiotherapy

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