Compared with intensity-modulated radiotherapy, image-guided radiotherapy reduces severity of acute radiation-induced skin toxicity during radiotherapy in patients with breast cancer.

Jang‐Chun Lin,Ming‐Hsien Li,Wei‐Hsiu Liu,Yu‐Ching Chou,Jo‐Ting Tsai

doi:10.1002/cam4.1630

Abstract

Radiotherapy (RT) is an effective treatment for breast cancer. The side effects of breast irradiation, including skin toxicity in the irradiation field, cause considerable discomfort. This study compared the severity of skin toxicity caused by image‐guided RT (IGRT) and intensity‐modulated RT (IMRT) combined with an electronic portal imaging device (EPID) in breast cancer. This study retrospectively analyzed 458 patients with breast cancer who had received RT. The patients were divided into two groups: 302 and 156 patients in the IMRT and IGRT groups. In the IGRT group, 8 and 148 patients had received helical tomotherapy irradiation and IMRT with cone‐beam computed tomography. Simple and multiple logistic regression analyses were used to estimate the relationship between RT technique and the severity of radiation skin toxicity. In our study, 284, 97, and 6 patients exhibited grades I, II, and III radiation dermatitis (RD). Moreover, 75 patients in the IMRT group (24.80%) and 22 patients in the IGRT group (14.10%) exhibited grade II RD. All patients with grade III RD were in the IMRT group (2.00%). No patient exhibited grade IV RD. The patients in the IGRT group exhibited less severity of RD than in the IMRT group. The severity of acute RD due to IGRT is significantly lower than that due to IMRT with EPID.

Highlights

Breast cancer is commonly detected in its early stage because of the extensive availability of mammography.[1]
The Intensity-modulated RT (IMRT) group consisted of 302 patients; the image- guided RT (IGRT) group consisted of 156 patients including 8 patients who had undergone TOMO and 148 patients who had undergone RT and cone-beam CT (CBCT)
Numerous studies have been designed with the objective of reducing the adverse effects of acute radiation skin toxicity using hygiene regimes or creams; these studies have not presented an effective strategy for preventing skin reactions.[19]

Summary

Introduction

Breast cancer is commonly detected in its early stage because of the extensive availability of mammography.[1]. Adjuvant whole-breast RT provides increased local tumor control and considerably reduces the risk of death.[2] Early stage breast cancer after breast-c onserving surgery (BCS) or advanced breast cancer after modified radical mastectomy (MRM) with positive lymph nodes[3] should be treated using adjuvant RT, which can increase the. A prospective randomized trial comparing standard RT and IMRT reported that the breast appearance changed more visibly with standard RT than with IMRT in 233 patients with breast cancer.[9]

Methods

Results

Conclusion