Risk Factors for the Development of Acute Radiation Dermatitis in Breast Cancer Patients

Abstract

Long-term follow-up of several large randomized trials of women with invasive breast cancer have shown breast conserving surgery followed by radiation was as effective as mastectomy without significant differences in survival. With adjuvant radiation though comes the risk of possible acute skin reactions, namely radiation dermatitis. We aimed to identify possible patient and treatment characteristics that may increase the risk of developing acute dermatitis. Understanding which factors are most highly associated with dermatitis could help individualize the prevention and management of radiation-induced skin toxicities in patients undergoing breast cancer treatment. We analyzed 209 women with invasive and non-invasive breast cancer who received adjuvant radiation therapy for acute radiation dermatitis. We selected the following characteristics to evaluate their correlation: age, histology, tumor stage, chemotherapy, hormonal therapy, breast position, whole breast fractionation schedule and dose, tumor bed boost dose, diuretics use, smoking status, type 2 diabetes mellitus, autoimmune disease, chronic immunosuppression, and BMI. Univariate logistic regression was used to compare each factor across grade 1, grade 2, and grade 3 dermatitis groups. Significant factors were then analyzed in a multivariate logistic regression. On univariate analysis, the risk of grade 3 dermatitis increased for every 10 pounds increase over the grade 1 mean weight of 159.8 lbs (OR 1.13, p=0.02). In addition, for a 1 unit increase in BMI over 27.0, grade 3 dermatitis was more likely (OR 1.09, p=0.008). For every 100 cGy increase in whole breast dose over 4367 cGy, grades 2 and 3 dermatitis were more likely (OR 1.15 and 1.14, p=0.015. Total dose over 5818 cGy resulted in a higher risk of grade 2 and grade 3 dermatitis (OR 1.11 and 1.40, p=0.003). Age, smoking status, years smoked, chemotherapy, hormone therapy, diabetes, autoimmune disease, and chronic immunosuppression did not affect risk for development of dermatitis. On multivariate analysis, there was a higher risk of grade 2 (OR 1.07, p=0.024) and grade 3 dermatitis (OR 1.18, p=<0.001) with increasing BMI. Total dose also increased the risk of grade 2 (OR 1.13, p=0.007) and grade 3 dermatitis as well (OR 1.59, p=<0.001). Age, smoking status, years smoked, chemotherapy, hormone therapy, diabetes, autoimmune disease, and chronic immunosuppression were not significant risk factors within our patient population. BMI and dose are the most significant risk factors for the development of moderate and severe grades of dermatitis in the early and advanced invasive breast cancer patients examined.