Abstract
PurposeRadiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer.MethodsPatients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration.ResultsIn 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased (p < 0.001, p = 0.016, p = 0.005, respectively).ConclusionsThe multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT.
Highlights
The incidence of breast cancer has increased in recent years and is expected to continue to rise in the decade [1]
The results showed that the laser Doppler flowmetry (LDF) microcirculation index was correlated with the Common Terminology Criteria for Adverse Events (CTCAE) scale score
Our objective measurement tool can be used in the assessment of Radiation-induced toxicity (RIT) as a research tool for use in clinical trials and may be more sensitive than the Radiation Therapy Oncology Group (RTOG) scale, as it can detect slight changes in RIT that are difficult to determine by visual or tactile examination
Summary
The incidence of breast cancer has increased in recent years and is expected to continue to rise in the decade [1]. Despite the advances in radiotherapy planning and treatment technology, approximately 30–40% of irradiated patients will suffer late RIT, with complications including dermatitis, fibrosis, desquamation (moist or dry) and even necrosis. 5- and 10-year survival rates observed over the past decade (approximately 90% and 80%, respectively), patients could live for many years with RIT [3]. With improvements in radiotherapy planning, many different fractionation schedules and techniques have been applied in clinical practice over the past decade, ranging from classical doses of 2 Gy to new standard daily moderate hypofractionations of 2.7–2.85 Gy [4], or more foreshortened treatment of 26 Gy in 5 consecutive fractions [5]. Accelerated partial-breast irradiation (APBI) is accepted as an attractive treatment strategy and has been introduced into clinical practice, shortening the duration of treatment and the extent of the irradiated volume, the toxicity outcomes are not yet clear and variable between different studies [6,7,8]
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