Radiodermatitis and Fibrosis in the Context of Breast Radiation Therapy: A Critical Review.

Youlia Kirova,Sofiane Allali

doi:10.3390/cancers13235928

Abstract

Radiation therapy has been progressively improved in order to maintain a satisfactory tumour response, while reducing toxicity. We will review the incidence of radiodermatitis and fibrosis according to the various radiation and fractionation techniques. We will then focus on the various methods used to manage, prevent, and quantify this toxicity. More than 1753 articles were identified using the various search terms. We selected 53 articles to answer the questions addressed in this study according to criteria set in advance. The literature reports lower acute toxicity with IMRT compared to 3DCRT, but no significant differences in terms of late toxicities. Partial breast irradiation appears to be less effective in terms of local control with a higher rate of late toxicity. Intra operative radiation therapy appears to provide good results in terms of both local control and late toxicity. The hypofractionation has equivalent efficacy and safety to the normofractionated regimen, but with lower rates of radiodermatitis and fibrosis. The adddition of a boost, particularly a sequential boost, increases the risk of fibrosis and radiodermatitis during treatment. The development of IMRT has significantly reduced acute toxicity and has improved tolerability during treatment. Modified fractionation has reduced treatment time, as well as adverse effects.

Highlights

Result: The literature reports lower acute toxicity with intensity-modulated radiation therapy (IMRT) compared to 3DCRT, but no significant differences in terms of late toxicities
Considerable progress has been made in the field of radiation therapy over recent years, both in terms of medical physics, by replacing the use of cobalt by other particles or radiation such as photons, protons, and other forms of particle therapy, and in terms of radiation techniques, with two-dimensional (2D) and three-dimensional (3D) conformal radiation therapy, followed by intensity-modulated radiation therapy (IMRT) [1] and the use of additional techniques such as lateral decubitus position [2] or deep inspiration breath hold [3,4]
Radiodermatitis constitutes an important factor affecting treatment tolerability, as it determines the normal course of radiation therapy, and more severe radiodermatitis may require discontinuation of treatment [8,9]

Summary

Introduction

Considerable progress has been made in the field of radiation therapy over recent years, both in terms of medical physics, by replacing the use of cobalt by other particles or radiation such as photons, protons, and other forms of particle therapy, and in terms of radiation techniques, with two-dimensional (2D) and three-dimensional (3D) conformal radiation therapy, followed by intensity-modulated radiation therapy (IMRT) [1] and the use of additional techniques such as lateral decubitus position [2] or deep inspiration breath hold [3,4]. Radiation therapy has been progressively improved in order to maintain a satisfactory tumour response, while reducing toxicity and preserving the appearance of the breast. The main skin toxicities of radiation therapy of eBC are classified into two categories: acute toxicities (

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Discussion

Conclusion