Comprehensive Evaluation of Personal, Clinical, and Radiation Dosimetric Parameters for Acute Skin Reaction during Whole Breast Radiotherapy.

Dae Sik Yang,Young Je Park,Won Sup Yoon,Nam Kwon Lee,Suk Lee,Chul Yong Kim,Gil Soo Son,Jung Ae Lee

doi:10.1155/2016/3656574

Abstract

Skin reaction is major problem during whole breast radiotherapy. To identify factors related to skin reactions during whole breast radiotherapy, various personal, clinical, and radiation dosimetric parameters were evaluated. From January 2012 to December 2013, a total of 125 patients who underwent breast conserving surgery and adjuvant whole breast irradiation were retrospectively reviewed. All patients had both whole breast irradiation and boost to the tumour bed. Skin reaction was measured on the first day of boost therapy based on photography of the radiation field and medical records. For each area of axilla and inferior fold, the intensity score of erythema (score 1 to 5) and extent (score 0 to 1) were summed. The relationship of various parameters to skin reaction was evaluated using chi-square and linear regression tests. The V 100 (volume receiving 100% of prescribed radiation dose, p < 0.001, both axilla and inferior fold) and age (p = 0.039 for axilla and 0.026 for inferior fold) were significant parameters in multivariate analyses. The calculated axilla dose (p = 0.003) and breast separation (p = 0.036) were also risk factors for axilla and inferior fold, respectively. Young age and large V 100 are significant factors for acute skin reaction that can be simply and cost-effectively measured.

Highlights

Breast conserving surgery is an initial approach for treating early breast cancer because it preserves cosmetic appearance and reduces major surgical sequelae
Progress in techniques used to calculate radiation dose distribution and accurate delivery of the radiation beams has resulted in modified radiotherapy techniques, such as the field-in-field technique that can be applied to whole breast irradiation
Among various parameters including individual/clinical and radiotherapy dosimetric characteristics, younger age and a higher V100 were related to severe acute skin reactions, as higher calculated point dose on the radiotherapy planning system and shorter breast separation were related to axilla and inferior fold skin reactions, respectively

Summary

Introduction

Breast conserving surgery is an initial approach for treating early breast cancer because it preserves cosmetic appearance and reduces major surgical sequelae. Adjuvant radiotherapy after breast conserving surgery reduces local recurrence and improves overall survival by irradiating the remaining cancer cell foci [1]. Adjuvant radiotherapy after breast conserving surgery is standard treatment for early stage breast cancer. Conventional radiotherapy to whole breast uses the opposed tangential fields with an appropriate wedge filter. Progress in techniques used to calculate radiation dose distribution and accurate delivery of the radiation beams has resulted in modified radiotherapy techniques, such as the field-in-field technique that can be applied to whole breast irradiation. Recent trials have reported that these methods reduce the occurrence of moist desquamation, changes in breast appearance, and palpable induration [2, 3]

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