Raouia Ben Amor1,2, Meriem Bohli3,4, Zeineb Naimi3,4, Dorra Aissaoui3,4, Nesrine Mejri3,5, Jamel Yahyaoui4, Awatef Hamdoun4, Lotfi Kochbati3,4. 1. Faculty of Medicine, University of Tunis El Manar, 1007, Tunis, Tunisia. raouia_ben_amor@hotmail.fr. 2. Department of Radiation Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia. raouia_ben_amor@hotmail.fr. 3. Faculty of Medicine, University of Tunis El Manar, 1007, Tunis, Tunisia. 4. Department of Radiation Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia. 5. Department of Medical Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia.
Abstract
PURPOSE: The purpose of this study was to evaluate acute skin toxicity in early breast cancer patients treated with hypofractionated radiotherapy (HFRT) after breast-conserving surgery and to identify factors predictive for grade ≥ 2 acute skin toxicity. MATERIALS AND METHODS: A monocentric retrospective study was carried out using cases treated between December 2017 and November 2020. We analyzed data from 202 patients with early breast cancer treated with 3D hypofractionated RT (40.05 Gy in 15 fractions) to the whole breast with or without regional lymph nodes, followed by 13.35 Gy in 5 fractions to the tumor bed. Acute skin toxicity was monitored during RT according to CTCAE (common toxicity criteria for adverse events) scale. Univariate and multivariate analyses were performed to assess predictive factors of acute skin toxicity. RESULTS: Overall, there was no erythema in 9%, grade 1 erythema in 64.5%, grade 2 in 24%, and grade 3 in 2.5%. No grade 4 erythema was seen. Median delay between RT initiating and maximum skin reaction was 22 days (range 4-44 days). No patient interrupted treatment. In univariate analysis, the rate of acute skin toxicity grade 2---3 (G2-3) was significantly higher for patients with larger tumor size (p = 0.02), body mass index > 27 (p = 0.04), and time between chemotherapy (CT) and RT less than 20 days (p = 0.01). Dosimetric risk factors for acute skin toxicity G2‑3 were breast volume > 800 cc (p = 0.000), boost volume > 18 cc (p = 0.002), V105% > 40 cc (p = 0.03), and Dmax > 56 Gy (p = 0.007). CT, trastuzumab, regional lymph node radiation, and age were not correlated with increased skin toxicity. In multivariate analysis, acute skin toxicity correlated with T stage (p = 0.032), breast volume > 800 cc (p = 0.012), boost volume > 18 cc (p = 0.04), and Dmax > 56 Gy (p = 0.035). CONCLUSION: Our results confirm that whole breast with or without lymph nodes hypofractionated RT is safe and well tolerated. The factors strongly associated with a decreased risk of G2‑3 skin toxicity are T1, breast volume < 800 c, boost volume < 18 cc, and Dmax < 56 Gy. Long-term follow-up is needed to evaluate late toxicity.
PURPOSE: The purpose of this study was to evaluate acute skin toxicity in early breast cancer patients treated with hypofractionated radiotherapy (HFRT) after breast-conserving surgery and to identify factors predictive for grade ≥ 2 acute skin toxicity. MATERIALS AND METHODS: A monocentric retrospective study was carried out using cases treated between December 2017 and November 2020. We analyzed data from 202 patients with early breast cancer treated with 3D hypofractionated RT (40.05 Gy in 15 fractions) to the whole breast with or without regional lymph nodes, followed by 13.35 Gy in 5 fractions to the tumor bed. Acute skin toxicity was monitored during RT according to CTCAE (common toxicity criteria for adverse events) scale. Univariate and multivariate analyses were performed to assess predictive factors of acute skin toxicity. RESULTS: Overall, there was no erythema in 9%, grade 1 erythema in 64.5%, grade 2 in 24%, and grade 3 in 2.5%. No grade 4 erythema was seen. Median delay between RT initiating and maximum skin reaction was 22 days (range 4-44 days). No patient interrupted treatment. In univariate analysis, the rate of acute skin toxicity grade 2---3 (G2-3) was significantly higher for patients with larger tumor size (p = 0.02), body mass index > 27 (p = 0.04), and time between chemotherapy (CT) and RT less than 20 days (p = 0.01). Dosimetric risk factors for acute skin toxicity G2‑3 were breast volume > 800 cc (p = 0.000), boost volume > 18 cc (p = 0.002), V105% > 40 cc (p = 0.03), and Dmax > 56 Gy (p = 0.007). CT, trastuzumab, regional lymph node radiation, and age were not correlated with increased skin toxicity. In multivariate analysis, acute skin toxicity correlated with T stage (p = 0.032), breast volume > 800 cc (p = 0.012), boost volume > 18 cc (p = 0.04), and Dmax > 56 Gy (p = 0.035). CONCLUSION: Our results confirm that whole breast with or without lymph nodes hypofractionated RT is safe and well tolerated. The factors strongly associated with a decreased risk of G2‑3 skin toxicity are T1, breast volume < 800 c, boost volume < 18 cc, and Dmax < 56 Gy. Long-term follow-up is needed to evaluate late toxicity.
Authors: Anna Zygogianni; Vassilios Kouloulias; Christos Antypas; Christina Armpilia; George Kyrgias; John Kouvaris Journal: Breast J Date: 2013-11-18 Impact factor: 2.431
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Authors: Simona F Shaitelman; Pamela J Schlembach; Isidora Arzu; Matthew Ballo; Elizabeth S Bloom; Daniel Buchholz; Gregory M Chronowski; Tomas Dvorak; Emily Grade; Karen E Hoffman; Patrick Kelly; Michelle Ludwig; George H Perkins; Valerie Reed; Shalin Shah; Michael C Stauder; Eric A Strom; Welela Tereffe; Wendy A Woodward; Joe Ensor; Donald Baumann; Alastair M Thompson; Diana Amaya; Tanisha Davis; William Guerra; Lois Hamblin; Gabriel Hortobagyi; Kelly K Hunt; Thomas A Buchholz; Benjamin D Smith Journal: JAMA Oncol Date: 2015-10 Impact factor: 31.777
Authors: Sofie De Langhe; Thomas Mulliez; Liv Veldeman; Vincent Remouchamps; Annick van Greveling; Monique Gilsoul; Eline De Schepper; Kim De Ruyck; Wilfried De Neve; Hubert Thierens Journal: BMC Cancer Date: 2014-09-25 Impact factor: 4.430