Appropriate evaluation of and risk factors for radiation dermatitis in breast cancer patients receiving hypofractionated whole-breast irradiation after breast-conserving surgery

Background: Radiation-induced dermatitis (RID) is frequent in breast cancer patients undergoing radiotherapy (RT). Spectrophotometry (SP) is an objective and reliable tool for assessing RID severity. Despite intensive research efforts during the past decades, no sustainable prophylactic and treatment strategies have been found. Estimation of new and reevaluation of established risk factors leading to severe RID is therefore of major importance. Methods: 142 early breast cancer patients underwent whole-breast irradiation following breast-conserving surgery. RID was evaluated by physician-assessed Common Terminology Criteria of Adverse Events (CTCAE v4.03). Spectrophotometers provided additional semi quantification of RID using the L*a*b color-space. A total of 24 patient- and treatment-related parameters as well as subjective patient-assessed symptoms were analyzed. Results: Values for a*max strongly correlated with the assessment of RID severity by physicians. Breast volume, initial darker skin, boost administration, and treatment technique were identified as risk factors for severe RID. RID severity positively correlated with the patients’ perception of pain, burning, and reduction of everyday activities. Conclusions: Physician-assessed RID gradings correlate with objective SP skin measurements. Treatment technique and high breast volumes were identified as objective and significant predictors of RID. Our data provide a solid benchmark for future studies on RID with objective SP.

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A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery

Scientific Reports ◽

10.1038/s41598-021-97520-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ting Yu ◽

Yankang Li ◽

Tao Sun ◽

Min Xu ◽

Wei Wang ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Breast Conserving Surgery ◽

Simultaneous Integrated Boost ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients ◽

Sequential Boost ◽

Integrated Boost ◽

Hypofractionated Whole Breast Irradiation

AbstractThis study explored the dosimetric difference between hypofractionated whole-breast irradiation (HFWBI) with sequential boost (SEB) and simultaneous integrated boost (SIB) based on supine and prone positions to identify the superior boost mode and superior position. Thirty breast cancer patients eligible for HFWBI after breast-conserving surgery were enrolled. All patients underwent 3DCT simulation scanning in both supine and prone positions. For the SEB-HFWBI plan, the dose prescribed for the planning target volume (PTV) of whole breast (WB) was 2.67 Gy per fraction with a total of 15 fractions, followed by a sequential boost of 3.2 Gy per fraction to the PTV of tumor bed (TB) in 3 fractions. For the SIB-HFWBI plan, the dose prescribed for the PTV of WB was 2.67 Gy per fraction with a total of 15 fractions, with a simultaneously integrated boost of 3.2 Gy per fraction to the PTV of TB with a total of 15 fractions. Regardless of the position, for the PTV of TB, the conformal index (CI) in the SIB-HFWBI plans was greater than those in the SEB-HFWBI plans (T = − 8.114, − 8.114; both P < 0.05). The CI for the PTV of WB increased significantly in the prone position relative to the supine position in both two plans(Z = − 3.340, − 3.501; all P < 0.05). The study suggested that prone SIB-HFWBI might be more suitable for postoperative radiotherapy after breast-conserving surgery for early-stage breast cancer patients.

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252 Prospective trial for Japanese breast cancer patients treated with accelerated hypofractionated whole breast irradiation for breast conserving treatment

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(10)70278-0 ◽

2010 ◽

Vol 8 (3) ◽

pp. 131-132

Author(s):

Y. Kagami ◽

A. Imai ◽

M. Morota ◽

H. Mayahara ◽

Y. Ito ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Prospective Trial ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients ◽

Breast Conserving Treatment ◽

Hypofractionated Whole Breast Irradiation

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Endocrine therapy with or without whole breast irradiation in low-risk breast cancer patients after breast-conserving surgery: 10-year results of the Austrian Breast and Colorectal Cancer Study Group 8A trial

European Journal of Cancer ◽

10.1016/j.ejca.2019.11.024 ◽

2020 ◽

Vol 127 ◽

pp. 12-20 ◽

Cited By ~ 1

Author(s):

Gerd Fastner ◽

Felix Sedlmayer ◽

Joachim Widder ◽

Martina Metz ◽

Hans Geinitz ◽

...

Keyword(s):

Breast Cancer ◽

Colorectal Cancer ◽

Cancer Patients ◽

Breast Conserving Surgery ◽

Study Group ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients ◽

Cancer Study Group ◽

Risk Breast Cancer

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Hydrofilm Polyurethane Films Reduce Radiation Dermatitis Severity in Hypofractionated Whole-Breast Irradiation: An Objective, Intra-Patient Randomized Dual-Center Assessment

Polymers ◽

10.3390/polym11122112 ◽

2019 ◽

Vol 11 (12) ◽

pp. 2112 ◽

Cited By ~ 3

Author(s):

Leonard Schmeel ◽

David Koch ◽

Frederic Schmeel ◽

Bettina Bücheler ◽

Christina Leitzen ◽

...

Keyword(s):

Breast Cancer ◽

Wound Care ◽

Treatment Strategies ◽

Preventive Treatment ◽

Radiation Dermatitis ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients ◽

Radiation Induced ◽

Hypofractionated Whole Breast Irradiation

Radiation-induced skin injury represents the most frequent side effect in breast cancer patients undergoing whole-breast irradiation (WBI). Numerous clinical studies on systemic and topical treatments for radiation dermatitis have failed to provide sustainable treatment strategies. While protective skin products such as dressings are undoubtedly the standard of care in wound care management, their utilization as preventive treatment in radiotherapy has been somewhat neglected in recent years. In this prospective, intra-patient randomized observational study, Hydrofilm polyurethane films were prophylactically applied to either the medial or lateral breast-half of 74 patients with breast cancer undergoing hypofractionated whole-breast irradiation following breast-preserving surgery. Maximum radiation dermatitis severity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.03 toxicity scores, photospectrometric erythema and pigmentation measurements and patient-assessed modified Radiation-Induced Skin Reaction Assessment Scale (RISRAS) scale. Phantom studies revealed a clinically negligible dose build-up of less than 0.1% with Hydrofilm. Compared to the control compartments physician-assessed radiation dermatitis severity was reduced in the hydrofilm compartments (mean 0.54 vs. 1.34; p = < 0.001). Objective photospectrometric skin measurements showed decreased erythema (p = 0.0001) and hyperpigmentation (p = 0.002) underneath Hydrofilm. Hydrofilm also completely prevented moist desquamation, and significantly reduced patients’ treatment-related symptoms of itching, burning, pain, and limitations of day-to-day-activities. Significant beneficial effects were observed in terms of radiation dermatitis severity, erythema, hyperpigmentation as well as subjective treatment-related symptom experiences, while adverse reactions were rare and minor. Therefore, a prophylactic application of Hydrofilm polyurethane films can be suggested in hypofractionated WBI.

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