Jean-Philippe Pignol1, Thi Trinh Thuc Vu2, Gunita Mitera3, Sandy Bosnic4, Helena M Verkooijen5, Pauline Truong6. 1. Department of Radiation Oncology, University of Toronto at Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: j.p.pignol@erasmusmc.nl. 2. Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada. 3. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 4. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. 5. Imaging Division, University Medical Centre Utrecht, Utrecht, The Netherlands. 6. Department of Radiation Oncology, BC Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, Canada.
Abstract
PURPOSE: To prospectively capture acute toxicities and pain associated with postmastectomy radiation therapy (PMRT), to analyze patient and treatment risk factors for severe side effects. METHODS AND MATERIALS: Women referred for PMRT were prospectively enrolled and assessed weekly during and after radiation therapy. The endpoint included severe National Cancer Institute Common Terminology Criteria for Adverse Effects grade 3 moist desquamation, other skin symptoms, and pain. RESULTS: Of 257 patients, 73 (28.4%) experienced extensive moist desquamation, 84 (32.7%) Common Terminology Criteria for Adverse Effects skin toxicity grade 3, and 57 (22.2%) a pain impacting on daily life activities. Among symptoms only grade 3 moist desquamation was significantly associated with severe pain (P<.001). On multivariate analysis, smoking, high-energy photons, and skin bolus were significantly associated with severe moist desquamation. Skin toxicity doubled for smokers, with 40% severe pain, 48% grade 3 moist desquamation, and 64% grade 3 skin toxicity. Without skin bolus 4.2% had severe pain, none moist desquamation, and 2.1% grade 3 skin toxicity. When skin bolus was used on alternate days, the frequency increased to 15% for pain, 22% for moist desquamation, and 26% for grade 3 skin toxicity. When bolus was used daily, 32% had pain, 41% moist desquamation, and 47% grade 3 skin toxicity. Symptoms peaked 1 to 2 weeks after the end of PMRT. CONCLUSIONS: The present cohort study suggests excessive radiation toxicity after PMRT. Among factors associated with an increase of toxicity are smoking habits and the use of skin bolus.
PURPOSE: To prospectively capture acute toxicities and pain associated with postmastectomy radiation therapy (PMRT), to analyze patient and treatment risk factors for severe side effects. METHODS AND MATERIALS: Women referred for PMRT were prospectively enrolled and assessed weekly during and after radiation therapy. The endpoint included severe National Cancer Institute Common Terminology Criteria for Adverse Effects grade 3 moist desquamation, other skin symptoms, and pain. RESULTS: Of 257 patients, 73 (28.4%) experienced extensive moist desquamation, 84 (32.7%) Common Terminology Criteria for Adverse Effects skin toxicity grade 3, and 57 (22.2%) a pain impacting on daily life activities. Among symptoms only grade 3 moist desquamation was significantly associated with severe pain (P<.001). On multivariate analysis, smoking, high-energy photons, and skin bolus were significantly associated with severe moist desquamation. Skin toxicity doubled for smokers, with 40% severe pain, 48% grade 3 moist desquamation, and 64% grade 3 skin toxicity. Without skin bolus 4.2% had severe pain, none moist desquamation, and 2.1% grade 3 skin toxicity. When skin bolus was used on alternate days, the frequency increased to 15% for pain, 22% for moist desquamation, and 26% for grade 3 skin toxicity. When bolus was used daily, 32% had pain, 41% moist desquamation, and 47% grade 3 skin toxicity. Symptoms peaked 1 to 2 weeks after the end of PMRT. CONCLUSIONS: The present cohort study suggests excessive radiation toxicity after PMRT. Among factors associated with an increase of toxicity are smoking habits and the use of skin bolus.
Authors: Tara Behroozian; Lauren T Milton; Neil H Shear; Erin McKenzie; Yasmeen Razvi; Irene Karam; Kucy Pon; Henry Lam; Emily Lam; Edward Chow Journal: Support Care Cancer Date: 2020-11-17 Impact factor: 3.603
Authors: Guido Henke; Michael Knauer; Karin Ribi; Stefanie Hayoz; Marie-Aline Gérard; Thomas Ruhstaller; Daniel R Zwahlen; Simone Muenst; Markus Ackerknecht; Hanne Hawle; Florian Fitzal; Michael Gnant; Zoltan Mátrai; Bettina Ballardini; Andreas Gyr; Christian Kurzeder; Walter P Weber Journal: Trials Date: 2018-12-04 Impact factor: 2.279