Abstract
BackgroundAfter breast-conserving radiation therapy most patients experience acute skin toxicity to some degree. This may impair patients’ quality of life, cause pain and discomfort. In this study, we investigated treatment and patient-related factors, including genetic polymorphisms, that can modify the risk for severe radiation-induced skin toxicity in breast cancer patients.MethodsWe studied 377 patients treated at Ghent University Hospital and at ST.-Elisabeth Clinic and Maternity in Namur, with adjuvant intensity modulated radiotherapy (IMRT) after breast-conserving surgery for breast cancer. Women were treated in a prone or supine position with normofractionated (25 × 2 Gy) or hypofractionated (15 × 2.67 Gy) IMRT alone or in combination with other adjuvant therapies. Patient- and treatment-related factors and genetic markers in regulatory regions of radioresponsive genes and in LIG3, MLH1 and XRCC3 genes were considered as variables. Acute dermatitis was scored using the CTCAEv3.0 scoring system. Desquamation was scored separately on a 3-point scale (0-none, 1-dry, 2-moist).ResultsTwo-hundred and twenty patients (58%) developed G2+ dermatitis whereas moist desquamation occurred in 56 patients (15%). Normofractionation (both p < 0.001), high body mass index (BMI) (p = 0.003 and p < 0.001), bra cup size ≥ D (p = 0.001 and p = 0.043) and concurrent hormone therapy (p = 0.001 and p = 0.037) were significantly associated with occurrence of acute dermatitis and moist desquamation, respectively. Additional factors associated with an increased risk of acute dermatitis were the genetic variation in MLH1 rs1800734 (p=0.008), smoking during RT (p = 0.010) and supine IMRT (p = 0.004). Patients receiving trastuzumab showed decreased risk of acute dermatitis (p < 0.001).ConclusionsThe normofractionation schedule, supine IMRT, concomitant hormone treatment and patient related factors (high BMI, large breast, smoking during treatment and the genetic variation in MLH1 rs1800734) were associated with increased acute skin toxicity in patients receiving radiation therapy after breast-conserving surgery. Trastuzumab seemed to be protective.
Highlights
After breast-conserving radiation therapy most patients experience acute skin toxicity to some degree
282 breast cancer patients were treated at the Ghent University Hospital (GUH) and 95 patients were treated at ST.-Elisabeth Clinic and Maternity (CMSE) in Namur
The occurrence of dermatitis did not differ between both centres (GUH: 57% (162/282), CSME: 61% (58/95))
Summary
After breast-conserving radiation therapy most patients experience acute skin toxicity to some degree This may impair patients’ quality of life, cause pain and discomfort. Many attempts have been made to reduce the number of patients experiencing acute skin toxicity and inferior cosmetic outcome by introducing improved radiation techniques, such as intensity-modulated radiotherapy (IMRT). This technique has been shown to be superior over conventional wedge-based whole breast irradiation by delivering a more homogenous dose through the breast and removing the radiation hot spots; it results in an approximately 20% reduction of the frequency of moist desquamation [6,7]. Up to now there are no data available to estimate directly the heritability of clinical radiosensitivity based upon family history of radiotherapy toxicity, but it is likely to be somewhat lower than for chromosomal and cellular radiosensitivity, which have been calculated to be 58-78% [9]
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