Abstract
Purpose/ObjectivesStandard 3D-CRT after BCS may cause skin toxicity with a wide range of intensity including acute effects like erythema or late effects. In order to reduce these side effects it is mandatory to identify potential factors of influence in breast cancer patients undergoing standard three-dimensional conformal radiation therapy (3D-CRT) of the breast and modern systemic therapy.Materials/MethodsBetween 2006 and 2010 a total of 211 breast cancer patients (median age 52,4 years, range 24–77) after BCS consecutively treated in our institution with 3D-CRT (50 Gy whole breast photon radiotherapy followed by 16 Gy electron boost to the tumorbed) were evaluated with special focus on documented skin toxicity at the end of the 50 Gy-course. Standardized photodocumentation of the treated breast was done in each patient lying on the linac table with arms elevated. Skin toxicity was documented according to the common toxicity criteria (CTC)-score. Potential influencing factors were classified in three groups: patient-specific (smoking, age, breast size, body mass index = BMI, allergies), tumor-specific (tumorsize) and treatment-specific factors (antihormonal therapy with tamoxifen or aromatase inhibitors, chemotherapy). Uni- and multivariate statistical analyses were done using IBM SPSS version 19.ResultsAfter 50 Gy 3D-CRT to the whole breast 28.9% of all 211 patients had no erythema, 62.2% showed erythema grade 1 (G1) and 8.5% erythema grade 2. None of the patients had grade 3/4 (G3/4) erythema.In univariate analyses a significant influence or trend on the development of acute skin toxicities (erythema G0 versus G1 versus G2) was observed for larger breast volumes (p=0,004), smoking during radiation therapy (p=0,064) and absence of allergies (p=0,014) as well as larger tumorsize (p=0,009) and antihormonal therapy (p=0.005).Neither patient age, BMI nor choice of chemotherapy showed any significant effect on higher grade toxicity. In the multivariate analysis, factors associated with higher grade skin toxicity were larger breast target volume (p=0,003), smoking (p=0,034) and absence of allergies (p=0,002).ConclusionPatients treated in this study showed less objectively documented skin toxicity after 50 Gy 3D-CRT compared to similar patient cohorts. Factors associated with higher grade skin toxicity were smoking during 3D-CRT, absence of allergies and larger breast volumes.
Highlights
Adjuvant external beam radiotherapy (EBRT) to the breast is standard of care after breast-conserving surgery (BCS) for patients with early-stage breast cancer, in order to achieve equivalent survival rates compared to those patients treated with mastectomy [1]. potential side effects can be reduced by using modern treatment techniques and fractionation schedules, skin erythema, breast edema and breast fibrosis are the most common side effects after EBRT
Patients treated in this study showed less objectively documented skin toxicity after 50 Gy 3D-CRT compared to similar patient cohorts
Radiotherapy treatment related factors such as fractionation dose, beam energy and treatment technique can influence the severity of skin toxicity as can patient related factors such as breast size, breast geometry and smoking: Patients with larger breast volumes developed more severe skin toxicity during radiotherapy compared to patients with smaller breast volumes and wound-healing of women, who were smoking during EBRT, was delayed, compared to that of non-smokers [4]
Summary
Adjuvant external beam radiotherapy (EBRT) to the breast is standard of care after breast-conserving surgery (BCS) for patients with early-stage breast cancer, in order to achieve equivalent survival rates compared to those patients treated with mastectomy [1]. potential side effects can be reduced by using modern treatment techniques and fractionation schedules, skin erythema, breast edema and breast fibrosis are the most common side effects after EBRT. Radiotherapy treatment related factors such as fractionation dose, beam energy and treatment technique can influence the severity of skin toxicity as can patient related factors such as breast size, breast geometry and smoking: Patients with larger breast volumes developed more severe skin toxicity during radiotherapy compared to patients with smaller breast volumes and wound-healing of women, who were smoking during EBRT, was delayed, compared to that of non-smokers [4]. This present study was designed to assess influencing factors during EBRT of the breast in a patient cohort treated in our institution. All patients included in this study were treated with 3 –dimensional, CT (computer tomography) - planned conformal radiotherapy (3D-CRT) and, according to receptor status and individual risk, modern systemic therapy
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