Radiation dermatitis assessment tools used in breast cancer: A systematic review of measurement properties

Behroozian, Tara; Milton, Lauren; Shear, Neil H.; McKenzie, Erin; Razvi, Yasmeen; Karam, Irene; Pon, Kucy; Lam, Henry; Lam, Emily; Chow, Edward

doi:10.1007/s00520-020-05889-w

Cited by 18 publications

(12 citation statements)

References 29 publications

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“…While blistering and peeling were asked by both patients and staff to determine concordance, the presence of MD was only evaluated by the clinical staff. A recent systematic review of radiation dermatitis assessment tools used in breast cancer described only one PRO measure that evaluated desquamation [ 18 ]. However, this PRO measure Skin Toxicity Assessment Tool (STAT), developed by Berthelet et al [ 19 ], had three components.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Patient-Reported Outcome Measure for Moist Desquamation among Breast Radiotherapy Patients

et al. 2022

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There has been an increasing interest in patient-reported outcome (PRO) measures in both the clinical and research settings to improve the quality of life among patients and to identify when clinical intervention may be needed. The primary purpose of this prospective study was to validate an acute breast skin toxicity PRO measure across a broad sample of patient body types undergoing radiation therapy. Between August 2018 and September 2019, 134 women undergoing adjuvant breast radiotherapy (RT) consented to completing serial PRO measures both during and post-RT treatment and to having their skin assessed by trained trial radiation therapists. There was high patient compliance, with 124 patients (92.5%) returning to the clinic post-RT for at least one staff skin assessment. Rates of moist desquamation (MD) in the infra-mammary fold (IMF) by PRO were compared with skin assessments completed by trial radiation therapists. There was high sensitivity (86.5%) and good specificity (79.4%) between PRO and staff-reported presence of MD in the IMF, and there was a moderate correlation between the peak severity of the MD reported by PRO and assessed by staff (rho = 0.61, p < 0.001). This prospective study validates a new PRO measure to monitor the presence of MD in the IMF among women receiving breast RT.

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Section: Discussionmentioning

confidence: 99%

Validation of a Patient-Reported Outcome Measure for Moist Desquamation among Breast Radiotherapy Patients

et al. 2022

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“…However, the BUS images (Figure 9B,C) showed severe skin thickening and obscuring of the dermis/hypodermis boundary at 6:00 location on the irradiated breast, so a BUS‐G2 based on breast edema was graded. Secondly, most radiation oncologists would agree that the clinician‐‐reported outcome is subjective with low to moderate inter‐observer reliability 25 . BUS is a common, portable and widely‐used breast imaging modality and its radiographic features can be used to evaluate radiation‐induced skin thickening and edema.…”

Section: Discussionmentioning

confidence: 99%

“…CTCAE scores showed minimal to moderate correlation with the skin toxicity assessment tools (ie, erythema, burning, itching, pulling, tenderness) 24 . In a comprehensive review of the published clinician‐reported outcomes of scoring radiation dermatitis, Behroozian et al concluded that there is insufficient evidence to establish a “gold standard” based on CTCAE or any single clinician‐reported outcome to assess the radiation dermatitis 25 …”

Section: Introductionmentioning

confidence: 99%

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

Wang

Zhou

Yang

et al. 2022

J of Ultrasound Medicine

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Objectives To introduce an ultrasound‐based scoring system for radiation‐induced breast toxicity and test its reliability. Methods Breast ultrasound (BUS) was performed on 32 patients receiving breast radiotherapy (RT) to assess the radiation‐induced acute toxicity. For each patient, both the untreated and irradiated breasts were scanned at five locations: 12:00, 3:00, 6:00, 9:00, and tumor bed to evaluate for heterogenous responses to radiation within the entire breast. In total, 314 images were analyzed. Based on ultrasound findings such as skin thickening, dermis boundary irregularity, and subcutaneous edema, a 4‐level, Likert‐like grading scheme is proposed: none (G0), mild (G1), moderate (G2), and severe (G3) toxicity. Two ultrasound experts graded the severity of breast toxicity independently and reported the inter‐ and intra‐observer reliability of the grading system. Imaging findings were compared with standard clinical toxicity assessments using Common Terminology Criteria for Adverse Events (CTCAE). Results The inter‐observer Pearson correlation coefficient (PCC) was 0.87 (95% CI: 0.83–0.90, P < .001). For intra‐observer repeatability, the PCC of the repeated scores was 0.83 (95% CI: 0.78–0.87, P < .001). Imaging findings were compared with standard clinical toxicity assessments using CTCAE scales. The PCC between BUS scores and CTCAE results was 0.62 (95% CI: 0.35–0.80, P < .001). Among all locations, 6:00 and tumor bed showed significantly greater toxicity compared with 12:00 (P = .04). Conclusions BUS can investigate the cutaneous and subcutaneous tissue changes after RT. This BUS‐based grading system can complement subjective clinical assessments of radiation‐induced breast toxicity with cutaneous and subcutaneous sonographic information.

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“…In a large retrospective study comprising 666 salivary gland cancers, the ACE-27 score was found to significantly correlate with OS, whereas the disease-specific survival was not affected [ 30 ]. In our study, both ECOG performance status and CCI were able to discriminate the survival rates of elderly patients with salivary gland cancer after (chemo)radiotherapy; however, a standardized survey of the patients’ comorbidities using the CCI or ACE-27 may reduce the intra- and interobserver variability that is known to be an issue regarding the assessment of the performance status [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Radiation-induced toxicities and outcomes after radiotherapy are independent of patient age in elderly salivary gland cancer patients: results from a matched-pair analysis of a rare disease

Rühle

Rothhaar

Haehl

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose This study analyzed survival and toxicity after (chemo)radiotherapy for primary salivary gland cancer patients aged ≥ 65 years and compared these results with younger patients using a matched-pair analysis. Methods Twenty-nine elderly patients with primary salivary gland carcinomas treated with (chemo)radiotherapy from 2008 to 2020 at University of Freiburg Medical Center were analyzed for oncological outcomes and therapy-associated toxicities. Local/locoregional control (LRC), progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method, and the influence of clinical parameters on patient outcomes was assessed. A matched-pair analysis was performed after matching with patients < 65 years. Results Nine patients (31.0%) received definitive (chemo)radiotherapy, and 20 patients (69.0%) were treated in the adjuvant setting. 2-year LRC, PFS and OS ranged at 82.4%, 53.7% and 71.8%, respectively. Smoking (HR 3.980, p = 0.020), reduced performance status (HR 3.735, p = 0.016) and higher comorbidity burden (HR 4.601, p = 0.005) correlated with inferior OS. Using a matched-pair analysis with younger patients, elderly patients exhibited a trend towards reduced OS (HR 3.015, p = 0.065), but not PFS (HR 1.474, p = 0.371) or LRC (HR 1.324, p = 0.633). Acute and chronic grade 3 toxicities occurred in 31.0% and 12.5% of elderly patients, respectively, and the matched-pair analysis revealed no significant differences between age groups regarding treatment-related toxicities. Conclusion Treatment-related toxicities as well as LRC and PFS were comparable for salivary gland cancer patients undergoing radiotherapy. Therefore, concerns for more pronounced toxicities or reduced local/locoregional response rates should not guide treatment decisions in affected elderly patients.

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Radiation dermatitis assessment tools used in breast cancer: A systematic review of measurement properties

Cited by 18 publications

References 29 publications

Validation of a Patient-Reported Outcome Measure for Moist Desquamation among Breast Radiotherapy Patients

Validation of a Patient-Reported Outcome Measure for Moist Desquamation among Breast Radiotherapy Patients

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

Radiation-induced toxicities and outcomes after radiotherapy are independent of patient age in elderly salivary gland cancer patients: results from a matched-pair analysis of a rare disease

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