Predictive Factors Increasing the Risk of Radiation Toxicity in Patients with Early Breast Cancer.

Asmaa Abdeltawab,Samia Ali,Hanan Mostafa,Mohamed Hassan

doi:10.31557/apjcp.2021.22.1.145

Asmaa Abdeltawab, Samia Ali + Show 2 more

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https://doi.org/10.31557/apjcp.2021.22.1.145

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Abstract

Objectives:Radiation induces adverse events on healthy tissues which may be augmented by certain factors. This study aimed to assess patients; tumor and treatment-related factors which increase the risk of radiation-induced toxicity in breast cancer patients. Methods:This prospective study included postmenopausal early breast cancer patients treated at the clinical oncology department, Assiut University, Egypt between January 2015 and December 2018. Patients treated with mastectomy followed by conventional radiotherapy (25x 2 Gy) and either concurrent or sequential letrozole. Acute and late radiation toxicity was scored according to EORTC/RTOG and risk factors were analyzed. Results:A total of 75 patients were included in the study. After a median follow-up of 24 months, 12 patients had > grade 2 acute dermatitis, 5 patients had > grade 2 cardiac toxicity and 3 patients had > grade 2 lung toxicity. Multivariate analysis revealed that trastuzumab use was associated with a decrease risk of acute dermatitis (p= 0.01) but boost irradiation was significantly associated with increased risk of acute dermatitis (p= 0.01). Late toxicity > grade 2 was observed in 6 patients, 14 patients, and 2 patients for skin, heart, and lung respectively.Conclusion:The use of boost irradiation was associated with increased risk of acute dermatitis, in the contrary; the use of trastuzumab seemed to be protective as observed in this study.

Highlights

Breast cancer is the second most commonly diagnosed cancer (11.6%) in both sexes after lung, among females, breast cancer is the most commonly diagnosed cancer, and it is the leading cause of cancer death (Bray et al, 2018)
Trastuzumab administration was fond to decrease the incidence of acute dermatitis this was agreed with De Langhe et al, (2014). which reported lower rate of acute dermatitis when trastuzumab used concurrently with radiation
It is in contradiction with the observation of Halyard et al, (2009) who reported no difference in toxicity with trastuzumab administration concurrently with adjuvant radiotherapy

Summary

Introduction

Breast cancer is the second most commonly diagnosed cancer (11.6%) in both sexes after lung, among females, breast cancer is the most commonly diagnosed cancer, and it is the leading cause of cancer death (Bray et al, 2018). Radiotherapy has major advantages in the treatment of breast cancer It reduces the risk of locoregional recurrences and improves overall survival both for early-stage breast cancer after breast-conserving surgery and after mastectomy for locally advanced disease (Darby et al, 2011). These advantages were accompanied by a number of adverse effects to the heart, lungs, and the opposite breast tissue (Jagsi et al, 2007). Patient-related factors as history of smoking, chronic obstructive pulmonary diseases, and interstitial lung disease are all lead to increased risk (Chen et al, 2017). Systemic therapy like chemotherapy, targeted therapy, and immunotherapy has all been played a role in cases of radiation recall pneumonitis (Vogelius et al, 2012; Burris et al, 2010)

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