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Gil-Lianes J, Tena G, Combalia M, Alejo B, Oses G, Combalia A, Iglesias P, Huguet A, Garrido S, Sola J, Malvehy J, Mollà M, Carrera C. Computational Model Based on Optical Coherence Tomography (OCT) Skin Scanning to Identify and Quantify Acute Radiation Dermatitis (ARD): A Prospective Diagnostic Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T752-T760. [PMID: 38964604 DOI: 10.1016/j.ad.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Acute radiation dermatitis (ARD) is the most widely reported radiotherapy-induced adverse event. Currently, there is no objective or reliable method to measure ARD. OBJECTIVE Our main objective was to identify and quantify the effects of radiotherapy with a computational model using optical coherence tomography (OCT) skin scanning. Secondary objectives included determining the ARD impact of different radiotherapeutic schemes and adjuvant topical therapies. METHODS We conducted a prospective, single-center case series study in a tertiary referral center of patients with breast cancer who were eligible for whole breast radiotherapy (WBRT). RESULTS A total of 39 women were included and distributed according to the radiotherapeutic schemes (15, 20, and 25 fractions). A computational model was designed to quantitatively analyze OCT findings. After radiotherapy, OCT scanning was more sensitive revealing vascularization changes in 84.6% of the patients (vs 69.2% of the patients with ARD by clinical examination). OCT quantified an increased vascularization at the end of WBRT (P<.05) and a decrease after 3 months (P=.032). Erythematous skin changes by OCT were more pronounced in the 25-fraction regime. CONCLUSION An OCT computational model allowed for the identification and quantification of vascularization changes on irradiated skin, even in the absence of clinical ARD. This may allow the design of standardized protocols for ARD beyond the skin color of the patients involved.
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Affiliation(s)
- J Gil-Lianes
- Dermatology Department, Hospital Clínic, University of Barcelona, España
| | - G Tena
- Dermatology Department, Hospital Clínic, University of Barcelona, España
| | - M Combalia
- Dermatology Department, Hospital Clínic, University of Barcelona, España
| | - B Alejo
- Dermatology Department, Hospital Clínic, University of Barcelona, España
| | - G Oses
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, España
| | - A Combalia
- Dermatology Department, Hospital Clínic, University of Barcelona, España
| | - P Iglesias
- Dermatology Department, Hospital Clínic, University of Barcelona, España
| | - A Huguet
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, España
| | - S Garrido
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, España
| | - J Sola
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, España
| | - J Malvehy
- Dermatology Department, Hospital Clínic, University of Barcelona, España; IDIBAPS, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, España
| | - M Mollà
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, España
| | - C Carrera
- Dermatology Department, Hospital Clínic, University of Barcelona, España; IDIBAPS, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, España.
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Gil-Lianes J, Tena G, Combalia M, Alejo B, Oses G, Combalia A, Iglesias P, Huguet A, Garrido S, Sola J, Malvehy J, Mollà M, Carrera C. Computational Model Based on Optical Coherence Tomography (OCT) Skin Scanning to Identify and Quantify Acute Radiation Dermatitis (ARD): A Prospective Diagnostic Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:752-760. [PMID: 38554749 DOI: 10.1016/j.ad.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Acute radiation dermatitis (ARD) is the most widely reported radiotherapy-induced adverse event. Currently, there is no objective or reliable method to measure ARD. OBJECTIVE Our main objective was to identify and quantify the effects of radiotherapy with a computational model using optical coherence tomography (OCT) skin scanning. Secondary objectives included determining the ARD impact of different radiotherapeutic schemes and adjuvant topical therapies. METHODS We conducted a prospective, single-center case series study in a tertiary referral center of patients with breast cancer who were eligible for whole breast radiotherapy (WBRT). RESULTS A total of 39 women were included and distributed according to the radiotherapeutic schemes (15, 20, and 25 fractions). A computational model was designed to quantitatively analyze OCT findings. After radiotherapy, OCT scanning was more sensitive revealing vascularization changes in 84.6% of the patients (vs 69.2% of the patients with ARD by clinical examination). OCT quantified an increased vascularization at the end of WBRT (P<.05) and a decrease after 3 months (P=.032). Erythematous skin changes by OCT were more pronounced in the 25-fraction regime. CONCLUSION An OCT computational model allowed for the identification and quantification of vascularization changes on irradiated skin, even in the absence of clinical ARD. This may allow the design of standardized protocols for ARD beyond the skin color of the patients involved.
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Affiliation(s)
- J Gil-Lianes
- Dermatology Department, Hospital Clínic, University of Barcelona, Spain
| | - G Tena
- Dermatology Department, Hospital Clínic, University of Barcelona, Spain
| | - M Combalia
- Dermatology Department, Hospital Clínic, University of Barcelona, Spain
| | - B Alejo
- Dermatology Department, Hospital Clínic, University of Barcelona, Spain
| | - G Oses
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - A Combalia
- Dermatology Department, Hospital Clínic, University of Barcelona, Spain
| | - P Iglesias
- Dermatology Department, Hospital Clínic, University of Barcelona, Spain
| | - A Huguet
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - S Garrido
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - J Sola
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - J Malvehy
- Dermatology Department, Hospital Clínic, University of Barcelona, Spain; IDIBAPS, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - M Mollà
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - C Carrera
- Dermatology Department, Hospital Clínic, University of Barcelona, Spain; IDIBAPS, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain.
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Wu Z, Hou L, Li C, Li X, Li Y. Hypofractionated versus Conventional Postmastectomy Irradiation for Breast Cancer: Comparison of Acute Skin Toxicity. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:423-432. [PMID: 39099624 PMCID: PMC11297561 DOI: 10.2147/bctt.s471901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/24/2024] [Indexed: 08/06/2024]
Abstract
Purpose Breast cancer is the leading cause of cancer mortality among women. Radiotherapy can reduce recurrence and prolong survival of patients accepting breast-conserving surgery (BCS). This study aims to compare acute skin reactions in patients receiving hypofractionated versus conventional radiotherapy at a single institution and to summarize the relevant influencing factors. Methods This study analyzed 152 patients who underwent either hypofractionated or conventional whole-breast irradiation (WBI) after BCS. Acute skin toxicity was assessed according to the Radiation Therapy Oncology Group (RTOG) criteria. Predictive factors for acute skin toxicity were identified using multivariate analysis and visualized using a forest spot. Results Grade 0 reactions occurred in 75.34% vs 70.89%, grade 1 in 16.44% vs 15.19%, grade 2 in 8.22% vs 12.66%, and grade 3 in 0% vs 1.27% of patients receiving hypofractionated and conventional WBI, respectively. There was no statistically significant difference in acute skin reaction in patients treated with hypofractionated radiation compared with conventional radiation (P = 0.62). Multivariate analysis revealed that metastatic lymph nodes (P = 0.021), whole-breast planning target volume (PTV-WB) (P < 0.001), and tumor bed planning target volume (PTV-TB) (P = 0.002) were significantly correlated with higher rates of acute skin toxicity. Conclusion Hypofractionated WBI demonstrated similar acute skin adverse reactions compared to conventional WBI. These findings indicate that hypofractionated radiotherapy offers comparable tolerance, equivalent curative effect, convenience, and economic benefits, supporting its clinical promotion.
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Affiliation(s)
- Zhiyuan Wu
- Department of Radio-Oncology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Lili Hou
- Department of Breast Surgery, Suzhou Wuzhong People’s Hospital, Suzhou, People’s Republic of China
| | - Cheng Li
- Department of Radio-Oncology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Xiaohua Li
- Department of Breast Surgery, Suzhou Wuzhong People’s Hospital, Suzhou, People’s Republic of China
| | - Ying Li
- Department of Radio-Oncology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
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Huang EY, Ho MW, Wang YM. Dosimetric Correlation of Acute Radiation Dermatitis in Patients With Breast Cancer Undergoing Hypofractionated Proton Beam Therapy Using Pencil Beam Scanning. J Breast Cancer 2024; 27:187-200. [PMID: 38769685 PMCID: PMC11221205 DOI: 10.4048/jbc.2024.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/24/2024] [Accepted: 03/31/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE Pencil-beam scanning (PBS) is a modern delivery technique used in proton beam therapy (PBT) to reduce normal tissue reactions. No dosimetric correlation between dermatitis and PBS has been reported for breast cancer. The current study aimed to investigate the factors associated with grade 2 or higher dermatitis in patients with breast cancer undergoing PBT using PBS. METHODS The medical data of 42 patients with breast cancer who underwent adjuvant radiotherapy between December 2019 and September 2023 were reviewed. All patients received hypofractionated radiotherapy (HFRT), either 26 Gy (relative biological effectiveness [RBE])/five fractions or 40.05 or 43.5 Gy (RBE)/15 fractions, for the whole breast/chest wall with or without nodal irradiation. The duration of acute radiation dermatitis was defined as within 90 days from the start of radiotherapy. The Kaplan-Meier method and Cox proportional hazards model were used for univariate and multivariate analyses of the actuarial rates of grade 2-3 dermatitis. RESULTS Twenty-two (52.4%) and 20 (47.6%) patients were diagnosed with grade 1 and 2 dermatitis, respectively. Multivariate analysis revealed a clinical target volume (CTV) ≥ of 320 cc (p = 0.035) and a skin dose of D10cc ≥ 38.3 Gy (RBE) (p = 0.009) as independent factors of grade 2 dermatitis. The 10-week cumulative grade 2 dermatitis rates were 88.2%, 39.4%, and 8.3% (p < 0.001) for patients with both high, either high, and neither high CTV and D10cc, respectively. CONCLUSION To the best of our knowledge, this is the first study on dosimetric correlations for dermatitis in patients with breast cancer who underwent hypofractionated PBT using PBS. In the era of HFRT, skin dose modulation using PBS may reduce the incidence of dermatitis.
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Affiliation(s)
- Eng-Yen Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng Wei Ho
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Ming Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
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Saadatmand P, Mahdavi SR, Nikoofar A, Jazaeri SZ, Ramandi FL, Esmaili G, Vejdani S. A dosiomics model for prediction of radiation-induced acute skin toxicity in breast cancer patients: machine learning-based study for a closed bore linac. Eur J Med Res 2024; 29:282. [PMID: 38735974 PMCID: PMC11089719 DOI: 10.1186/s40001-024-01855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Radiation induced acute skin toxicity (AST) is considered as a common side effect of breast radiation therapy. The goal of this study was to design dosiomics-based machine learning (ML) models for prediction of AST, to enable creating optimized treatment plans for high-risk individuals. METHODS Dosiomics features extracted using Pyradiomics tool (v3.0.1), along with treatment plan-derived dose volume histograms (DVHs), and patient-specific treatment-related (PTR) data of breast cancer patients were used for modeling. Clinical scoring was done using the Common Terminology Criteria for Adverse Events (CTCAE) V4.0 criteria for skin-specific symptoms. The 52 breast cancer patients were grouped into AST 2 + (CTCAE ≥ 2) and AST 2 - (CTCAE < 2) toxicity grades to facilitate AST modeling. They were randomly divided into training (70%) and testing (30%) cohorts. Multiple prediction models were assessed through multivariate analysis, incorporating different combinations of feature groups (dosiomics, DVH, and PTR) individually and collectively. In total, seven unique combinations, along with seven classification algorithms, were considered after feature selection. The performance of each model was evaluated on the test group using the area under the receiver operating characteristic curve (AUC) and f1-score. Accuracy, precision, and recall of each model were also studied. Statistical analysis involved features differences between AST 2 - and AST 2 + groups and cutoff value calculations. RESULTS Results showed that 44% of the patients developed AST 2 + after Tomotherapy. The dosiomics (DOS) model, developed using dosiomics features, exhibited a noteworthy improvement in AUC (up to 0.78), when spatial information is preserved in the dose distribution, compared to DVH features (up to 0.71). Furthermore, a baseline ML model created using only PTR features for comparison with DOS models showed the significance of dosiomics in early AST prediction. By employing the Extra Tree (ET) classifiers, the DOS + DVH + PTR model achieved a statistically significant improved performance in terms of AUC (0.83; 95% CI 0.71-0.90), accuracy (0.70), precision (0.74) and sensitivity (0.72) compared to other models. CONCLUSIONS This study confirmed the benefit of dosiomics-based ML in the prediction of AST. However, the combination of dosiomics, DVH, and PTR yields significant improvement in AST prediction. The results of this study provide the opportunity for timely interventions to prevent the occurrence of radiation induced AST.
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Affiliation(s)
- Pegah Saadatmand
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seied Rabi Mahdavi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Alireza Nikoofar
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyede Zohreh Jazaeri
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Division of NeuroscienceCellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Soheil Vejdani
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Li Q, Feng S, Yu Z, Wang Y, Tian L, Geng H, Guo C, Ning F, Luo J, Liu C. Amelioration of Acute Radiation Dermatitis in Breast Cancer Patients by a Bioadhesive Barrier-Forming Gel (Episil): A Single-Center, Open, Parallel, Randomized, Phase I/II Controlled Trial. Clin Pharmacol Ther 2024; 115:1085-1091. [PMID: 38159264 DOI: 10.1002/cpt.3171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
Episil is a bioadhesive barrier-forming liquid gel that can relieve mucositis caused by radiotherapy (RT) and effectively relieve pain. The purpose of this trial is to compare the efficacy and safety of Episil in improving acute radiation dermatitis (ARD) in patients with breast cancer. This study included patients who met the criteria for postoperative RT for breast cancer. The primary end point was the grade of RD during treatment. A total of 102 patients were included in this study. The patients were grouped in a 2:1 ratio using the randomized number table method: 67 patients received Episil combined with conventional skin care (the Episil group), whereas the remaining 35 patients served as the control group and received conventional skin care only (the control group). According to the grading criteria of the Radiation Therapy Oncology Group (RTOG), the skin reaction rate and severity were significantly better in the Episil group than the control group (24.62%, 72.31%, 3.08, 0, 0 vs. 0, 85.71%, 14.29%, 0, 0, 0) across grades 0 to 4 (P < 0.05). The itchiness score exhibited s significant reduction in the Episil group as compared with the control group (P < 0.05). The results of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) showed that the overall health (z = -5.855, P < 0.001) and overall quality of life (z = -6.583, P < 0.001) were better in the Episil group than the control group after RT. Overall, in patients with breast cancer receiving RT, the topical application of Episil may significantly reduce the grading of ARD, alleviate patient symptoms, and improve the patient's overall quality of life.
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Affiliation(s)
- Qian Li
- Binzhou Medical University, Binzhou, Shandong, China
| | - Shanhui Feng
- Binzhou Medical University, Binzhou, Shandong, China
| | - Zeshun Yu
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Yue Wang
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Lijun Tian
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Haitao Geng
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Chen Guo
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Fangling Ning
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Judong Luo
- Tongji Hospital of Tongji University School of Medicine, Shanghai, China
| | - Changmin Liu
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
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Malhotra A, Carpentier EE, Grahame S, Chan EK, Nichol A, Duzenli C. Toward a Skin Dose-Area Metric Predictive of Moist Desquamation Using In Vivo Skin Dosimetry and Skin Assessments. Adv Radiat Oncol 2024; 9:101318. [PMID: 38260224 PMCID: PMC10801659 DOI: 10.1016/j.adro.2023.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/13/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Moist desquamation (MD) is a concerning acute side effect of radiation therapy for breast cancer, often seen in skin folds for patients having large or pendulous breasts. In vivo skin dosimetry, clinical assessments, and patient-reported skin reactions were used to determine a relationship between dose-area metrics and the development of MD, to lend insight into skin tolerances and possibly guide future treatment planning dose constraints. Methods and Materials Skin dose was measured using GafChromic film on the inner surface of an early prototype carbon-fiber accessory for breast support to remove the inframammary fold in 20 patients at high risk of developing MD undergoing adjuvant whole breast radiation therapy. Prescribed doses were 42.5 Gray (Gy) in 16 fractions or 50 Gy in 25 fractions using 6 to 15 MV x-rays. To account for fraction size differences, analysis was performed using the equivalent dose in 2 Gy fractions using α/β = 11 (EQD211). MD was assessed out to 2 weeks post radiation therapy by trained therapists and by a patient-reported outcome questionnaire. Results Statistically significant differences in areas receiving 30 to 48 Gy (EQD211) were observed between patients who did and did not develop MD in the inframammary area. Patients receiving EQD211 maximum dose ≤ 46 Gy and ≥ 38 Gy to ≤ 50 cm2 of their breast skin did not develop MD. Conclusions The findings of this study offer insight into the relationship between skin toxicity and areas of skin irradiated to doses up to 50 Gy. Potential skin dose constraints to test in future studies to prevent MD are suggested.
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Affiliation(s)
- Aria Malhotra
- Department of Medical Physics, BC Cancer, Vancouver, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Emilie E. Carpentier
- Department of Medical Physics, BC Cancer, Vancouver, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Sheri Grahame
- Department of Radiation Therapy, BC Cancer, Vancouver, Canada
| | - Elisa K. Chan
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada
- Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada
| | - Alan Nichol
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada
- Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada
| | - Cheryl Duzenli
- Department of Medical Physics, BC Cancer, Vancouver, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
- Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada
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Que S, Ma X, Yang T, He J. Evaluation of the effect of herbal agents as management of radiodermatitis in breast cancer patients: A systematic review and meta-analysis. Jpn J Nurs Sci 2024; 21:e12559. [PMID: 37816677 DOI: 10.1111/jjns.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/19/2023] [Accepted: 07/03/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of herbal agents in the prevention and therapy of radiodermatitis in breast cancer patients. METHODS Randomized controlled trials were searched from databases such as PubMed, Web of Science, Embase, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI) to assess the effectiveness of herbal agents compared to a standard medication or placebo in prevention or treatment of radiodermatitis in breast cancer. RESULTS Data from 16 studies involving 1994 patients were included. This meta-analysis included 10 clinical trials of 562 breast cancer patients treated with calendula, silymarin, or aloe vera for the prevention of radiodermatitis. Silymarin showed positive effects in ameliorating the damage of radiodermatitis, whereas the efficacy of calendula and aloe vera in the treatment of radiodermatitis lacks sufficient evidence. CONCLUSIONS Herbal medicine may show therapeutic effects on radiodermatitis in breast cancer, but more comprehensive investigations and clinical trials are required in the future.
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Affiliation(s)
- Suyun Que
- Dali Bai Autonomous Prefecture People's Hospital, Dali, China
| | - Xuanlei Ma
- Dali Bai Autonomous Prefecture People's Hospital, Dali, China
| | - Tao Yang
- Dali Bai Autonomous Prefecture People's Hospital, Dali, China
| | - Jiangtao He
- Dali Bai Autonomous Prefecture People's Hospital, Dali, China
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9
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Zureick AH, Zakalik D, Quinn TJ, Rangarajan TS, Grzywacz VP, Rotenbakh LR, Chen PY, Dilworth JT. Breast Irradiation Is Well Tolerated in Carriers of a Pathogenic ATM Variant. Pract Radiat Oncol 2024; 14:e29-e39. [PMID: 37742832 DOI: 10.1016/j.prro.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE There are mixed and limited data regarding radiation therapy (RT) tolerance in carriers of a germline pathogenic or likely pathogenic (P/LP) ATM variant. We investigated RT-related toxic effects in carriers of an ATM variant who received treatment for breast cancer. METHODS AND MATERIALS We identified 71 patients treated with adjuvant RT for breast cancer who were carriers of a variant in ATM: 15 were classified as P/LP and 56 classified as variants of unknown significance (VUS). We additionally identified 205 consecutively treated patients during a similar timeframe who were either confirmed ATM wild type or had no prior genetic testing. RT plans were reviewed. Acute and chronic toxic effects were evaluated using Common Terminology Criteria for Adverse Events version 4.0 criteria. Fisher's exact tests for count data were performed to compare toxic effects between the cohorts (P/LP vs VUS vs control). Wilcoxon rank-sum testing was performed to assess for differences in patient characteristics. RESULTS The median toxicity follow-up was 19.4 months; median follow-up for the subcohorts was 13.3 months (P/LP), 12.6 months (VUS), and 23.3 months (control). There were no significant differences in radiation plan heterogeneity, receipt of a boost, or size of breast/chest wall planning target volume. There was greater use of hypofractionated RT in the control cohort (P = .023). After accounting for patient- and treatment-related factors that may affect toxic effects, we found no significant differences with respect to acute dermatitis, hyperpigmentation, moist desquamation, breast/chest wall pain, or breast edema. Additionally, we found no significant differences with respect to chronic breast/chest wall pain, induration, telangiectasia, or cosmetic outcome. CONCLUSIONS RT as part of the management of breast cancer was well tolerated in carriers of a P/LP ATM variant, with toxic effect profiles that were similar to those seen in patients without known ATM mutations. High rates of excellent or good cosmesis were observed in carriers of a P/LP ATM variant who underwent breast conservation.
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Affiliation(s)
- Andrew H Zureick
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, Michigan
| | - Dana Zakalik
- Nancy and James Grosfeld Cancer Genetics Center, William Beaumont University Hospital, Royal Oak, Michigan; Department of Radiation Oncology, Oakland University, William Beaumont School of Medicine, Rochester, Michigan
| | - Thomas J Quinn
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, Michigan
| | - Tara S Rangarajan
- Nancy and James Grosfeld Cancer Genetics Center, William Beaumont University Hospital, Royal Oak, Michigan
| | - Vincent P Grzywacz
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, Michigan
| | - Leah R Rotenbakh
- Department of Radiation Oncology, Oakland University, William Beaumont School of Medicine, Rochester, Michigan
| | - Peter Y Chen
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, Michigan; Department of Radiation Oncology, Oakland University, William Beaumont School of Medicine, Rochester, Michigan
| | - Joshua T Dilworth
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, Michigan; Department of Radiation Oncology, Oakland University, William Beaumont School of Medicine, Rochester, Michigan.
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10
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Eggert MC, Yu NY, Rades D. Radiation Dermatitis and Pneumonitis in Patients Irradiated for Breast Cancer. In Vivo 2023; 37:2654-2661. [PMID: 37905621 PMCID: PMC10621417 DOI: 10.21873/invivo.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM Adjuvant radiotherapy (RT) for breast cancer can be associated with acute dermatitis (ARD) and pneumonitis (RP). Prevalence and risk factors were characterized. PATIENTS AND METHODS This study included 489 breast cancer patients receiving adjuvant RT with conventional fractionation (CF) ± sequential or simultaneous integrated boost, or hypo-fractionation ± sequential boost. RT-regimen and 15 characteristics were investigated for grade ≥2 ARD and RP. RESULTS Prevalence of grade ≥2 ARD and RP was 25.3% and 2.5%, respectively. On univariate analyses, ARD was significantly associated with CF and radiation boost (p<0.0001), age ≤60 years (p=0.008), Ki-67 ≥15% (p=0.012), and systemic treatment (p=0.002). On multivariate analysis, RT-regimen (p<0.0001) and age (p=0.009) were associated with ARD. Chronic inflammatory disease was significantly associated with RP on univariate (p=0.007) and multivariate (p=0.016) analyses. CONCLUSION Risk factors for grade ≥2 ARD and RP were determined that may help identify patients who require closer monitoring during and after RT.
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Affiliation(s)
- Marie C Eggert
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
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11
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Layer K, Layer JP, Glasmacher AR, Sarria GR, Böhner AMC, Layer YL, Dejonckheere CS, Garbe S, Feyer P, Baumert BG, Schendera A, Baumann R, Krug D, Köksal MA, Koch D, Scafa D, Leitzen C, Hölzel M, Giordano FA, Schmeel LC. Risk assessment, surveillance, and nonpharmaceutical prevention of acute radiation dermatitis: results of a multicentric survey among the German-speaking radiation oncology community. Strahlenther Onkol 2023; 199:891-900. [PMID: 37099166 PMCID: PMC10542714 DOI: 10.1007/s00066-023-02074-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/05/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Radiation dermatitis (RD) represents one of the most frequent side effects in radiotherapy (RT). Despite technical progress, mild and moderate RD still affects major subsets of patients and identification and management of patients with a high risk of severe RD is essential. We sought to characterize surveillance and nonpharmaceutical preventive management of RD in German-speaking hospitals and private centers. METHODS We conducted a survey on RD among German-speaking radiation oncologists inquiring for their evaluation of risk factors, assessment methods, and nonpharmaceutical preventive management of RD. RESULTS A total of 244 health professionals from public and private institutions in Germany, Austria, and Switzerland participated in the survey. RT-dependent factors were deemed most relevant for RD onset followed by lifestyle factors, emphasizing the impact of treatment conceptualization and patient education. While a broad majority of 92.8% assess RD at least once during RT, 59.0% of participants report RD at least partially arbitrarily and 17.4% stated to classify RD severity solely arbitrarily. 83.7% of all participants were unaware of patient-reported outcomes (PROs). Consensus exists on some lifestyle recommendations like avoidance of sun exposure (98.7%), hot baths (95.1%), and mechanical irritation (91.8%) under RT, while deodorant use (63.4% not at all, 22.1% with restrictions) or application of skin lotion (15.1% disapproval) remain controversial and are not recommended by guidelines or evidence-based practices. CONCLUSION Identification of patients at an increased risk of RD and subsequent implementation of adequate preventive measures remain relevant and challenging aspects of clinical routines. Consensus exists on several risk factors and nonpharmaceutical prevention recommendations, while RT-dependent risk factors, e.g., the fractionation scheme, or hygienic measures like deodorant use remain controversial. Surveillance is widely lacking methodology and objectivity. Intensifying outreach in the radiation oncology community is needed to improve practice patterns.
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Affiliation(s)
- Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Andrea R Glasmacher
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander M C Böhner
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Yonah L Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Petra Feyer
- Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubünden, Graubünden, Switzerland
| | - Anke Schendera
- Department of Radiation Oncology, Community Hospital Mittelrhein, Koblenz, Germany
| | - René Baumann
- Department of Radiation Oncology, St. Marien Hospital Siegen, Siegen, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Mümtaz A Köksal
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Leonard Christopher Schmeel
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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12
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Vakaet V, Deseyne P, Bultijnck R, Post G, West C, Azria D, Bourgier C, Farcy-Jacquet MP, Rosenstein B, Green S, de Ruysscher D, Sperk E, Veldwijk M, Herskind C, De Santis MC, Rancati T, Giandini T, Chang-Claude J, Seibold P, Lambrecht M, Weltens C, Janssens H, Vega A, Taboada-Valladares MB, Aguado-Barrera ME, Reyes V, Altabas M, Gutiérrez-Enríquez S, Monten C, Van Hulle H, Veldeman L. Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes. Acta Oncol 2023; 62:1036-1044. [PMID: 37548182 DOI: 10.1080/0284186x.2023.2240486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/15/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Most patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data. METHODS REQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone (n = 268) versus supine (n = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years. RESULTS At the last treatment fraction, there was no significant difference in dermatitis (p = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema (p < .001). At 2 years, patients treated in prone position had less atrophy (p = .01), and higher body image (p < .001), and social functioning (p < .001) scores. The photographic assessment showed no difference in cosmesis at 2 years (p = .22). In prone position, mean heart dose (MHD) was significantly lower for left-sided patients (1.29 Gy vs 2.10 Gy, p < .001) and ipsilateral mean lung dose (MLD) was significantly lower for all patients (2.77 Gy vs 5.89 Gy, p < .001). CONCLUSIONS Prone radiotherapy showed lower MLD and MHD compared to supine position, although the risk of developing breast oedema during radiotherapy was higher. At 2 years the photographic assessment showed no difference in the cosmetic outcome, but less atrophy was seen in prone-treated patients and this seems to have a positive influence on the HRQoL domain of body image.
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Affiliation(s)
- Vincent Vakaet
- Department of Human Structure and Repair, Ghent University, Gent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Gent, Belgium
| | - Pieter Deseyne
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Gent, Belgium
| | - Giselle Post
- Department of Human Structure and Repair, Ghent University, Gent, Belgium
| | - Catharine West
- Christie Hospital, University of Manchester, Manchester, UK
| | - David Azria
- Department of Radiation Oncology, University of Montpellier, Montpellier, France
| | - Celine Bourgier
- Department of Radiation Oncology, University of Montpellier, Montpellier, France
| | | | - Barry Rosenstein
- Departments of Radiation Oncology and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sheryl Green
- Departments of Radiation Oncology and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro), GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Marlon Veldwijk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
- Radiation Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Giandini
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Hilde Janssens
- Department of Radiation Oncology, UZ Leuven, Leuven, Belgium
| | - Ana Vega
- Instituto de Investigacion Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Victoria Reyes
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manuel Altabas
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Christel Monten
- Department of Radiation Oncology, Ghent University Hospital, Gent, Belgium
| | | | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Gent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Gent, Belgium
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13
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Wang J, Zhou B, Yang X, Tridandapani S, Lin J, Torres MA, Liu T. Ultrasound-Based Grading System for Radiation-Induced Acute Breast Toxicity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1307-1317. [PMID: 36583524 DOI: 10.1002/jum.16144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/11/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To introduce an ultrasound-based scoring system for radiation-induced breast toxicity and test its reliability. METHODS Breast ultrasound (BUS) was performed on 32 patients receiving breast radiotherapy (RT) to assess the radiation-induced acute toxicity. For each patient, both the untreated and irradiated breasts were scanned at five locations: 12:00, 3:00, 6:00, 9:00, and tumor bed to evaluate for heterogenous responses to radiation within the entire breast. In total, 314 images were analyzed. Based on ultrasound findings such as skin thickening, dermis boundary irregularity, and subcutaneous edema, a 4-level, Likert-like grading scheme is proposed: none (G0), mild (G1), moderate (G2), and severe (G3) toxicity. Two ultrasound experts graded the severity of breast toxicity independently and reported the inter- and intra-observer reliability of the grading system. Imaging findings were compared with standard clinical toxicity assessments using Common Terminology Criteria for Adverse Events (CTCAE). RESULTS The inter-observer Pearson correlation coefficient (PCC) was 0.87 (95% CI: 0.83-0.90, P < .001). For intra-observer repeatability, the PCC of the repeated scores was 0.83 (95% CI: 0.78-0.87, P < .001). Imaging findings were compared with standard clinical toxicity assessments using CTCAE scales. The PCC between BUS scores and CTCAE results was 0.62 (95% CI: 0.35-0.80, P < .001). Among all locations, 6:00 and tumor bed showed significantly greater toxicity compared with 12:00 (P = .04). CONCLUSIONS BUS can investigate the cutaneous and subcutaneous tissue changes after RT. This BUS-based grading system can complement subjective clinical assessments of radiation-induced breast toxicity with cutaneous and subcutaneous sonographic information.
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Affiliation(s)
- Jing Wang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Boran Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, Alabama, USA
| | - Jolinta Lin
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Mylin A Torres
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Tian Liu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
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14
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Chen W, Lu W, Yuan Y, Li L, Deng H, Ye X. The role of ultrasound quantitative parameters in the assessment of acute radiodermatitis after breast-conserving surgery. JOURNAL OF RADIATION RESEARCH 2023:7153713. [PMID: 37154691 DOI: 10.1093/jrr/rrad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/14/2022] [Indexed: 05/10/2023]
Abstract
This study aimed to assess the severity of acute radiodermatitis (ARD) by ultrasound quantitative parameters and to try to identify the influencing factors of skin toxicity. A total of 55 patients who underwent radiotherapy after unilateral breast-conserving surgery (BCS) were included in the study. The irradiated side of the breast was used as the research object and the quantitative ultrasound parameters (skin thickness, shear wave elasticity) were evaluated before radiotherapy, every week during radiotherapy. Two weeks after radiotherapy, the patients were divided into two groups, according to the World Health Organization scoring standard: mild (0-2 grade) and severe (3-4 grade). The differences in the parameters between the groups and the changes during radiotherapy were compared, and the relationship between these parameters and the severity of ARD was analyzed. In addition, some clinical factors that may affect ARD were also included in our study. Ninety-eight percent of patients developed different degrees of ARD, and Group 2 accounted for ~31%. At the end of 5 weeks of radiotherapy, the difference in thickness between the two groups was statistically significant (P < 0.05). There was no significant change in the elastic modulus of breast skin between the two groups (P > 0.05). Body mass index >25 kg/m2, breast thickness ≥18 mm, skin basic elastic modulus <23 kPa and skin thickness increment >0.3 mm were considered to be associated with severe skin reactions (P < 0.05). Ultrasound can be a useful tool for the non-invasive and objective assessment of skin changes during radiotherapy, documenting quantitative changes in the skin of breast cancer patients following BCS undergoing radiotherapy.
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Affiliation(s)
- Wenqin Chen
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Wenjuan Lu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Ya Yuan
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Lu Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Hongyan Deng
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xinhua Ye
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
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15
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Bromberger L, Heise B, Felbermayer K, Leiss-Holzinger E, Ilicic K, Schmid TE, Bergmayr A, Etzelstorfer T, Geinitz H. Radiation-induced alterations in multi-layered, in-vitro skin models detected by optical coherence tomography and histological methods. PLoS One 2023; 18:e0281662. [PMID: 36862637 PMCID: PMC9980765 DOI: 10.1371/journal.pone.0281662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/28/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Inflammatory skin reactions and skin alterations are still a potential side effect in radiation therapy (RT), which also need attention for patients' health care. METHOD In a pre-clinical study we consider alterations in irradiated in-vitro skin models of epidermal and dermal layers. Typical dose regimes in radiation therapy are applied for irradiation. For non-invasive imaging and characterization optical coherence tomography (OCT) is used. Histological staining method is additionally applied for comparison and discussion. RESULTS Structural features, such as keratinization, modifications in epidermal cell layer thickness and disorder in the layering-as indications for reactions to ionizing radiation and aging-could be observed by means of OCT and confirmed by histology. We were able to recognize known RT induced changes such as hyper-keratosis, acantholysis, and epidermal hyperplasia as well as disruption and/or demarcation of the dermo-epidermal junction. CONCLUSION The results may pave the way for OCT to be considered as a possible adjunctive tool to detect and monitor early skin inflammation and side effects of radiotherapy, thus supporting patient healthcare in the future.
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Affiliation(s)
- Luisa Bromberger
- Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern (BHS), Linz, Austria
| | - Bettina Heise
- Institute for Mathematical Methods in Medicine and Data Based Modelling, Johannes Kepler University (JKU), Linz, Austria
- Research Center for Non-Destructive Testing (RECENDT)-GmbH, Linz, Austria
- * E-mail:
| | | | | | - Katarina Ilicic
- Department of Radiation Oncology, Klinikum rechts der Isar (MRI), TUM München, München, Germany
| | - Thomas Ernst Schmid
- Department of Radiation Oncology, Klinikum rechts der Isar (MRI), TUM München, München, Germany
| | - Alexandra Bergmayr
- Department of Pathology, Ordensklinikum Linz Barmherzige Schwestern (BHS), Linz, Austria
| | - Tanja Etzelstorfer
- Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern (BHS), Linz, Austria
| | - Hans Geinitz
- Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern (BHS), Linz, Austria
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Lomma C, Chih H, Chan A. Adjuvant Dose Dense Chemotherapy in patients with obesity: short-term toxicities and breast cancer outcome. Clin Breast Cancer 2023:S1526-8209(23)00077-0. [PMID: 37169686 DOI: 10.1016/j.clbc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/03/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Dose dense adjuvant chemotherapy is associated with improved outcomes in breast cancer compared to standard dosing. Despite current guidelines recommending that chemotherapy is dosed according to actual body weight, reviews have shown patients with obesity often receive a capped chemotherapy dose. The latter is commonly undertaken as clinicians have concerns that adverse events are more frequent if full doses are administered. This study assessed surgical, radiotherapy and chemotherapy related adverse events between patients with and without obesity receiving dose dense adjuvant chemotherapy for breast cancer. MATERIALS AND METHODS A retrospective review of prospective collected data for patients receiving adjuvant chemotherapy from 30 April 2018 from a single institution was analyzed. Data collected included demographic data, height, weight, pathological information, comorbidities, surgical, radiotherapy chemotherapy treatment, and toxicity. Primary outcomes were surgical complications at 30 days, radiotherapy skin toxicity at 30 days and chemotherapy side-effects. Secondary outcomes were rates of recurrence and time to recurrence. RESULTS A total of 280 patients were included in the analysis: 55 obese and 225 nonobese. Obese status was associated with higher rates of grade >2 skin toxicity and this difference was significant after adjusting for age, comorbidity and radiotherapy field (P = .017). Obese status was not associated with higher rates of surgical or chemotherapy related adverse events. All patients regardless of obese status received adequate dose intensity with similar rates of recurrence and time to recurrence. CONCLUSION Patients with obesity who receive dose dense adjuvant chemotherapy do not experience higher rates of surgical or chemotherapy related adverse events although they do experience higher rates of grade >2 radiotherapy related skin toxicity. This supports the use of dose dense chemotherapy being based on actual body weight in patients with obesity.
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17
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Cilla S, Romano C, Macchia G, Boccardi M, Pezzulla D, Buwenge M, Castelnuovo AD, Bracone F, Curtis AD, Cerletti C, Iacoviello L, Donati MB, Deodato F, Morganti AG. Machine-learning prediction model for acute skin toxicity after breast radiation therapy using spectrophotometry. Front Oncol 2023; 12:1044358. [PMID: 36686808 PMCID: PMC9853396 DOI: 10.3389/fonc.2022.1044358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose Radiation-induced skin toxicity is a common and distressing side effect of breast radiation therapy (RT). We investigated the use of quantitative spectrophotometric markers as input parameters in supervised machine learning models to develop a predictive model for acute radiation toxicity. Methods and materials One hundred twenty-nine patients treated for adjuvant whole-breast radiotherapy were evaluated. Two spectrophotometer variables, i.e. the melanin (IM) and erythema (IE) indices, were used to quantitatively assess the skin physical changes. Measurements were performed at 4-time intervals: before RT, at the end of RT and 1 and 6 months after the end of RT. Together with clinical covariates, melanin and erythema indices were correlated with skin toxicity, evaluated using the Radiation Therapy Oncology Group (RTOG) guidelines. Binary group classes were labeled according to a RTOG cut-off score of ≥ 2. The patient's dataset was randomly split into a training and testing set used for model development/validation and testing (75%/25% split). A 5-times repeated holdout cross-validation was performed. Three supervised machine learning models, including support vector machine (SVM), classification and regression tree analysis (CART) and logistic regression (LR), were employed for modeling and skin toxicity prediction purposes. Results Thirty-four (26.4%) patients presented with adverse skin effects (RTOG ≥2) at the end of treatment. The two spectrophotometric variables at the beginning of RT (IM,T0 and IE,T0), together with the volumes of breast (PTV2) and boost surgical cavity (PTV1), the body mass index (BMI) and the dose fractionation scheme (FRAC) were found significantly associated with the RTOG score groups (p<0.05) in univariate analysis. The diagnostic performances measured by the area-under-curve (AUC) were 0.816, 0.734, 0.714, 0.691 and 0.664 for IM, IE, PTV2, PTV1 and BMI, respectively. Classification performances reported precision, recall and F1-values greater than 0.8 for all models. The SVM classifier using the RBF kernel had the best performance, with accuracy, precision, recall and F-score equal to 89.8%, 88.7%, 98.6% and 93.3%, respectively. CART analysis classified patients with IM,T0 ≥ 99 to be associated with RTOG ≥ 2 toxicity; subsequently, PTV1 and PTV2 played a significant role in increasing the classification rate. The CART model provided a very high diagnostic performance of AUC=0.959. Conclusions Spectrophotometry is an objective and reliable tool able to assess radiation induced skin tissue injury. Using a machine learning approach, we were able to predict grade RTOG ≥2 skin toxicity in patients undergoing breast RT. This approach may prove useful for treatment management aiming to improve patient quality of life.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy,*Correspondence: Savino Cilla, ;
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | | | | | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Francesca Bracone
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy,Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | | | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy,Istituto di Radiologia, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
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Ben Amor R, Bohli M, Naimi Z, Aissaoui D, Mejri N, Yahyaoui J, Hamdoun A, Kochbati L. Hypofractionated radiotherapy after breast-conserving surgery: Clinical and dosimetric factors predictive of acute skin toxicity. Strahlenther Onkol 2023; 199:48-54. [PMID: 35943552 DOI: 10.1007/s00066-022-01985-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/07/2022] [Indexed: 01/18/2023]
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.
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Affiliation(s)
- Raouia Ben Amor
- Faculty of Medicine, University of Tunis El Manar, 1007, Tunis, Tunisia. .,Department of Radiation Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia.
| | - Meriem Bohli
- Faculty of Medicine, University of Tunis El Manar, 1007, Tunis, Tunisia.,Department of Radiation Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia
| | - Zeineb Naimi
- Faculty of Medicine, University of Tunis El Manar, 1007, Tunis, Tunisia.,Department of Radiation Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia
| | - Dorra Aissaoui
- Faculty of Medicine, University of Tunis El Manar, 1007, Tunis, Tunisia.,Department of Radiation Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia
| | - Nesrine Mejri
- Faculty of Medicine, University of Tunis El Manar, 1007, Tunis, Tunisia.,Department of Medical Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia
| | - Jamel Yahyaoui
- Department of Radiation Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia
| | - Awatef Hamdoun
- Department of Radiation Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia
| | - Lotfi Kochbati
- Faculty of Medicine, University of Tunis El Manar, 1007, Tunis, Tunisia.,Department of Radiation Oncology, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia
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Hussein FA, Manan HA, Mustapha AWMM, Sidek K, Yahya N. Ultrasonographic Evaluation of Skin Toxicity Following Radiotherapy of Breast Cancer: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13439. [PMID: 36294025 PMCID: PMC9603505 DOI: 10.3390/ijerph192013439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
The present review aimed to systematically review skin toxicity changes following breast cancer radiotherapy (RT) using ultrasound (US). PubMed and Scopus databases were searched according to PRISMA guidelines. The characteristics of the selected studies, measured parameters, US skin findings, and their association with clinical assessments were extracted. Seventeen studies were included with a median sample size of 29 (range 11-166). There were significant US skin changes in the irradiated skin compared to the nonirradiated skin or baseline measurements. The most observed change is skin thickening secondary to radiation-induced oedema, except one study found skin thinning after pure postmastectomy RT. However, eight studies reported skin thickening predated RT attributed to axillary surgery. Four studies used US radiofrequency (RF) signals and found a decrease in the hypodermis's Pearson correlation coefficient (PCC). Three studies reported decreased dermal echogenicity and poor visibility of the dermis-subcutaneous fat boundary (statistically analysed by one report). The present review revealed significant ultrasonographic skin toxicity changes in the irradiated skin most commonly skin thickening. However, further studies with large cohorts, appropriate US protocol, and baseline evaluation are needed. Measuring other US skin parameters and statistically evaluating the degree of the association with clinical assessments are also encouraged.
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Affiliation(s)
- Fatimah Alaa Hussein
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervensi, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Aida W. M. Mohd Mustapha
- Department of Radiology, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Khairiyah Sidek
- Department of Radiotherapy, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, School of Diagnostic & Applied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
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20
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Iida H, Yamaguchi S, Goyagi T, Sugiyama Y, Taniguchi C, Matsubara T, Yamada N, Yonekura H, Iida M. Consensus statement on smoking cessation in patients with pain. J Anesth 2022; 36:671-687. [PMID: 36069935 PMCID: PMC9666296 DOI: 10.1007/s00540-022-03097-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/13/2022] [Indexed: 11/30/2022]
Abstract
Smoking is closely associated with the development of various cancers and tobacco-related illnesses such as cardiovascular and respiratory disorders. However, data are scarce on the relationship between smoking and both acute and chronic pain. In addition to nicotine, tobacco smoke contains more than 4000 different compounds. Although nicotine is not the sole cause of smoking-induced diseases, it plays a critical role in pain-related pathophysiology. Despite the acute analgesic effects of nicotine, long-term exposure leads to tolerance and increased pain sensitivity due to nicotinic acetylcholine receptor desensitization and neuronal plastic changes. The purpose of smoking cessation interventions in smoking patients with pain is primarily not only to reduce their pain and associated limitations in activities of daily living, but also to improve the outcomes of underlying pain-causing conditions and reduce the risks of tobacco-related disorders. This statement aims to summarize the available evidence on the impact of smoking on pain and to inform medical professionals of the significance of smoking cessation in patients with pain.
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Affiliation(s)
- Hiroki Iida
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan. .,Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan. .,Anesthesiology and Pain Relief Center, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan.
| | - Shigeki Yamaguchi
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Toru Goyagi
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology, Akita University Hospital, Akita, Japan
| | - Yoko Sugiyama
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Woman Doctor Active Support in Perioperative Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.,Anesthesiology and Pain Relief Center, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan
| | - Chie Taniguchi
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,College of Nursing, Aichi Medical University, Nagakute, Japan
| | - Takako Matsubara
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe , Japan
| | - Naoto Yamada
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology, Iwate Medical University Hospital, Iwate, Japan
| | - Hiroshi Yonekura
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Mami Iida
- Working Group on the Role of Smoking Cessation in Pain Relief, The Japan Society of Pain Clinicians (JSPC), Tokyo, Japan.,Department of Internal Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
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21
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Robijns J, Nair RG, Lodewijckx J, Arany P, Barasch A, Bjordal JM, Bossi P, Chilles A, Corby PM, Epstein JB, Elad S, Fekrazad R, Fregnani ER, Genot MT, Ibarra AMC, Hamblin MR, Heiskanen V, Hu K, Klastersky J, Lalla R, Latifian S, Maiya A, Mebis J, Migliorati CA, Milstein DMJ, Murphy B, Raber-Durlacher JE, Roseboom HJ, Sonis S, Treister N, Zadik Y, Bensadoun RJ. Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022. Front Oncol 2022; 12:927685. [PMID: 36110957 PMCID: PMC9468822 DOI: 10.3389/fonc.2022.927685] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
DisclaimerThis article is based on recommendations from the 12th WALT Congress, Nice, October 3-6, 2018, and a follow-up review of the existing data and the clinical observations of an international multidisciplinary panel of clinicians and researchers with expertise in the area of supportive care in cancer and/or PBM clinical application and dosimetry. This article is informational in nature. As with all clinical materials, this paper should be used with a clear understanding that continued research and practice could result in new insights and recommendations. The review reflects the collective opinion and, as such, does not necessarily represent the opinion of any individual author. In no event shall the authors be liable for any decision made or action taken in reliance on the proposed protocols.ObjectiveThis position paper reviews the potential prophylactic and therapeutic effects of photobiomodulation (PBM) on side effects of cancer therapy, including chemotherapy (CT), radiation therapy (RT), and hematopoietic stem cell transplantation (HSCT).BackgroundThere is a considerable body of evidence supporting the efficacy of PBM for preventing oral mucositis (OM) in patients undergoing RT for head and neck cancer (HNC), CT, or HSCT. This could enhance patients’ quality of life, adherence to the prescribed cancer therapy, and treatment outcomes while reducing the cost of cancer care.MethodsA literature review on PBM effectiveness and dosimetry considerations for managing certain complications of cancer therapy were conducted. A systematic review was conducted when numerous randomized controlled trials were available. Results were presented and discussed at an international consensus meeting at the World Association of photobiomoduLation Therapy (WALT) meeting in 2018 that included world expert oncologists, radiation oncologists, oral oncologists, and oral medicine professionals, physicists, engineers, and oncology researchers. The potential mechanism of action of PBM and evidence of PBM efficacy through reported outcomes for individual indications were assessed.ResultsThere is a large body of evidence demonstrating the efficacy of PBM for preventing OM in certain cancer patient populations, as recently outlined by the Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Building on these, the WALT group outlines evidence and prescribed PBM treatment parameters for prophylactic and therapeutic use in supportive care for radiodermatitis, dysphagia, xerostomia, dysgeusia, trismus, mucosal and bone necrosis, lymphedema, hand-foot syndrome, alopecia, oral and dermatologic chronic graft-versus-host disease, voice/speech alterations, peripheral neuropathy, and late fibrosis amongst cancer survivors.ConclusionsThere is robust evidence for using PBM to prevent and treat a broad range of complications in cancer care. Specific clinical practice guidelines or evidence-based expert consensus recommendations are provided. These recommendations are aimed at improving the clinical utilization of PBM therapy in supportive cancer care and promoting research in this field. It is anticipated these guidelines will be revised periodically.
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Affiliation(s)
- Jolien Robijns
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Raj G. Nair
- Oral Medicine, Oral Pathology and Oral Oncology, Griffith University, Department of Haematology and Oncology, Gold Coast University Hospital, Gold Coast, QL, Australia
| | - Joy Lodewijckx
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Praveen Arany
- School of Dental Medicine, Oral Biology and Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Andrei Barasch
- Harvard School of Dental Medicine, Division of Oral Medicine and Dentistry, Boston, MA, United States
| | - Jan M. Bjordal
- Physiotherapy Research Group, IGS, University of Bergen, Bergen, Norway
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Anne Chilles
- Radiotherapy Department, Institut Curie, Paris, France
| | - Patricia M. Corby
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, United States
| | - Joel B. Epstein
- City of Hope Duarte, CA and Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Sharon Elad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Reza Fekrazad
- Department of Periodontology, Dental Faculty – Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
| | | | - Marie-Thérèse Genot
- Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Brussels, Belgium
| | - Ana M. C. Ibarra
- Postgraduate Program on Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, Brazil
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Vladimir Heiskanen
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Ken Hu
- Department of Radiation Oncology, NYU Langone Health, New York, NY, United States
| | | | - Rajesh Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, United States
| | - Sofia Latifian
- Department of Medicine, Institut Jules Bordet, Universiteí Libre de Bruxelles, Brussels, Belgium
| | - Arun Maiya
- Manipal College of Health Professions, MAHE, Manipal, India
| | - Jeroen Mebis
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Cesar A. Migliorati
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida, United States
| | - Dan M. J. Milstein
- Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Barbara Murphy
- Department of Oncology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Judith E. Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Hendrik J. Roseboom
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine; Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine; Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Yehuda Zadik
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - René-Jean Bensadoun
- Department of Radiation Oncology, Centre de Haute Energie, Nice, France
- *Correspondence: René-Jean Bensadoun,
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22
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Mulliez T, De Ridder M. Pre-OPerative Accelerated breast Radio Therapy (POPART): a largely unknown world. Radiother Oncol 2022; 174:170. [PMID: 35843308 DOI: 10.1016/j.radonc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Thomas Mulliez
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiotherapy, Institut Andrée Dutreix, Dunkerque, France
| | - Mark De Ridder
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
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23
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Vesprini D, Davidson M, Bosnic S, Truong P, Vallieres I, Fenkell L, Comsa D, El-Mallah M, Garcia L, Stevens C, Nakonechny K, Tran W, Kiss A, Rakovitch E, Pignol JP. Effect of Supine vs Prone Breast Radiotherapy on Acute Toxic Effects of the Skin Among Women With Large Breast Size: A Randomized Clinical Trial. JAMA Oncol 2022; 8:994-1000. [PMID: 35616948 DOI: 10.1001/jamaoncol.2022.1479] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Women with large breast size treated with adjuvant breast radiotherapy (RT) have a high rate of acute toxic effects of the skin. Breast RT in the prone position is one strategy that may decrease these toxic effects. Objective To determine if breast RT in the prone position reduces acute toxic effects of the skin when compared with treatment in the supine position. Design, Setting, and Participants This phase 3, multicenter, single-blind randomized clinical trial accrued patients from 5 centers across Canada from April 2013 to March 2018 to compare acute toxic effects of breast RT for women with large breast size (bra band ≥40 in and/or ≥D cup) in the prone vs supine positions. A total of 378 patients were referred for adjuvant RT and underwent randomization. Seven patients randomized to supine position were excluded (5 declined treatment and 2 withdrew consent), and 14 patients randomized to prone position were excluded (4 declined treatment, 3 had unacceptable cardiac dose, and 7 were unable to tolerate being prone). Data were analyzed from April 2019 through September 2020. Interventions Patients were randomized to RT in the supine or prone position. From April 2013 until June 2016, all patients (n = 167) received 50 Gy in 25 fractions (extended fractionation) with or without boost (range, 10-16 Gy). After trial amendment in June 2016, the majority of patients (177 of 190 [93.2%]) received the hypofractionation regimen of 42.5 Gy in 16 fractions. Main Outcomes and Measures Main outcome was moist desquamation (desquamation). Results Of the 357 women (mean [SD] age, 61 [9.9] years) included in the analysis, 182 (51.0%) were treated in the supine position and 175 (49.0%) in prone. There was statistically significantly more desquamation in patients treated in the supine position compared with prone (72 of 182 [39.6%] patients vs 47 of 175 [26.9%] patients; OR, 1.78; 95% CI, 1.24-2.56; P = .002), which was confirmed on multivariable analysis (OR, 1.99; 95% CI, 1.48-2.66; P < .001), along with other independent factors: use of boost (OR, 2.71; 95% CI, 1.95-3.77; P < .001), extended fractionation (OR, 2.85; 95% CI, 1.41-5.79; P = .004), and bra size (OR, 2.56; 95% CI, 1.50-4.37; P < .001). Conclusions and Relevance This randomized clinical trial confirms that treatment in the prone position decreases desquamation in women with large breast size receiving adjuvant RT. It also shows increased toxic effects using an RT boost and conventional fractionation. Trial Registration ClinicalTrials.gov Identifier: NCT01815476.
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Affiliation(s)
- Danny Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Davidson
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sandi Bosnic
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Pauline Truong
- Department of Radiation Oncology, University of British Columbia, BC Cancer Victoria, Victoria, British Columbia, Canada
| | - Isabelle Vallieres
- Department of Radiation Oncology, University of British Columbia, BC Cancer Victoria, Victoria, British Columbia, Canada
| | - Louis Fenkell
- Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Daria Comsa
- Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Medhat El-Mallah
- Department of Radiation Oncology, Durham Regional Cancer Centre, Oshawa, Ontario, Canada
| | - Lourdes Garcia
- Department of Radiation Oncology, Durham Regional Cancer Centre, Oshawa, Ontario, Canada
| | - Christiaan Stevens
- Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Radiation Oncology, Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada
| | - Keith Nakonechny
- Radiation Oncology, Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada
| | - William Tran
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alex Kiss
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eileen Rakovitch
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jean-Phillippe Pignol
- Department of Physics and Atmospheric Science, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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24
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Issoufaly I, Petit C, Guihard S, Eugène R, Jung L, Clavier JB, Servagi Vernat S, Bellefqih S, Verret B, Bonnet N, Deutsch É, Rivera S. Favorable safety profile of moderate hypofractionated over normofractionated radiotherapy in breast cancer patients: a multicentric prospective real-life data farming analysis. Radiat Oncol 2022; 17:80. [PMID: 35443729 PMCID: PMC9019802 DOI: 10.1186/s13014-022-02044-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Moderately hypofractionated whole-breast radiotherapy (HFRT) has proven to be as safe and efficient as normofractionated radiotherapy (NFRT) in randomized trials resulting in major changes in clinical practice. Toxicity rates observed in selected clinical trial patients may differ from those observed in unselected patients with possible comorbidities and frailty in real-life. This study aimed to examine the influence of HFRT versus NFRT on acute toxicity and identify risks factors of dermatitis in real-life patients.
Materials and methods Prospective data from breast cancer patients, treated with locoregional radiotherapy were collected between November 2015 and February 2020 in 3 comprehensive cancer centers. Through a systematic data-farming strategy, acute toxicity evaluation forms (CTCAEv4.0) were prospectively completed and extracted electronically. The results from each center were then anonymously merged into a single database for analysis. A Chi-2 test was used to compare HFRT and NFRT. Furthermore, risk factors of dermatitis were identified in a sub-study (622 patients) by multivariate logistic regression analysis.
Results In total, 3518 T0-4 N0-3 mostly M0 (85.8%) breast cancer patients with a median age of 60.7 (24–96 years old) were analyzed. Acute grade 2–3 dermatitis, grade 1–3 breast oedema, and grade 1–2 hyperpigmentation were less frequent with HFRT versus NFRT: respectively 8.9% versus 35.1% (Chi-2 = 373.7; p < 0.001), 29.0% versus 37.0% (Chi-2 = 23.1; p < 0.001) and 27.0% versus 55.8% (Chi-2 = 279.2; p < 0.001). Fewer patients experienced pain with HFRT versus NFRT: 33.4% versus 53.7% respectively (Chi-2 = 137.1; p < 0.001). Factors such as high BMI (OR = 2.30 [95% CI, 1.28–4.26], p < 0.01), large breast size (OR = 1.88 [95% CI, 1.07–3.28], p < 0.01) and lumpectomy over mastectomy (OR = 0.52 [95% CI, 0.27–0.97], p < 0.05) were associated with greater risk factors of grade 2–3 dermatitis in multivariate analysis regardless of NFRT or HFRT. Conclusion The results of this study suggests that breast HFRT may be a better option even for patients with a high BMI or large breast size. Acute toxicity was low to mild, and lower with HFRT compared to NFRT. Results from real-life data were robust, and support the use of HFRT beyond randomized study populations. Long-term real-life data awaits further investigation.
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Affiliation(s)
- Irfane Issoufaly
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Claire Petit
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | | | | | - Loic Jung
- Radiotherapy, Paul Strauss, Strasbourg, France
| | | | | | | | - Benjamin Verret
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Naïma Bonnet
- Unicancer Radiation and Oncology Group, Paris, France
| | - Éric Deutsch
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France.,UMR 1030, Molecular Radiotherapy and Therapeutic Innovation, INSERM, 94805, Villejuif, France
| | - Sofia Rivera
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France. .,UMR 1030, Molecular Radiotherapy and Therapeutic Innovation, INSERM, 94805, Villejuif, France.
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Assumpção JAF, Pasquarelli-do-Nascimento G, Duarte MSV, Bonamino MH, Magalhães KG. The ambiguous role of obesity in oncology by promoting cancer but boosting antitumor immunotherapy. J Biomed Sci 2022; 29:12. [PMID: 35164764 PMCID: PMC8842976 DOI: 10.1186/s12929-022-00796-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/07/2022] [Indexed: 12/13/2022] Open
Abstract
Obesity is nowadays considered a pandemic which prevalence's has been steadily increasingly in western countries. It is a dynamic, complex, and multifactorial disease which propitiates the development of several metabolic and cardiovascular diseases, as well as cancer. Excessive adipose tissue has been causally related to cancer progression and is a preventable risk factor for overall and cancer-specific survival, associated with poor prognosis in cancer patients. The onset of obesity features a state of chronic low-grade inflammation and secretion of a diversity of adipocyte-derived molecules (adipokines, cytokines, hormones), responsible for altering the metabolic, inflammatory, and immune landscape. The crosstalk between adipocytes and tumor cells fuels the tumor microenvironment with pro-inflammatory factors, promoting tissue injury, mutagenesis, invasion, and metastasis. Although classically established as a risk factor for cancer and treatment toxicity, recent evidence suggests mild obesity is related to better outcomes, with obese cancer patients showing better responses to treatment when compared to lean cancer patients. This phenomenon is termed obesity paradox and has been reported in different types and stages of cancer. The mechanisms underlying this paradoxical relationship between obesity and cancer are still not fully described but point to systemic alterations in metabolic fitness and modulation of the tumor microenvironment by obesity-associated molecules. Obesity impacts the response to cancer treatments, such as chemotherapy and immunotherapy, and has been reported as having a positive association with immune checkpoint therapy. In this review, we discuss obesity's association to inflammation and cancer, also highlighting potential physiological and biological mechanisms underlying this association, hoping to clarify the existence and impact of obesity paradox in cancer development and treatment.
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Affiliation(s)
| | | | - Mariana Saldanha Viegas Duarte
- Immunology and Tumor Biology Program - Research Coordination, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Martín Hernan Bonamino
- Immunology and Tumor Biology Program - Research Coordination, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Vice - Presidency of Research and Biological Collections (VPPCB), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Kelly Grace Magalhães
- Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia, Brasília, DF, Brazil.
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Dilworth JT, Griffith KA, Pierce LJ, Jagsi R, Quinn TJ, Walker EM, Radawski JD, Dominello MM, Gustafson GS, Moran JM, Hayman JA, Vicini FA. The impact of chemotherapy on toxicity and cosmetic outcome in patients receiving whole breast irradiation: an analysis within a state-wide quality consortium. Int J Radiat Oncol Biol Phys 2022; 113:266-277. [PMID: 35157997 DOI: 10.1016/j.ijrobp.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE We investigated whether the use of chemotherapy prior to whole breast irradiation (WBI) using either conventional fractionation (CWBI) or hypofractionation (HWBI) is associated with increased toxicity or worse cosmetic outcome compared to WBI alone. METHODS AND MATERIALS We identified 6,754 patients who received WBI alone (without a third field covering the superior axillary and supraclavicular nodal regions) with data prospectively collected in a state-wide consortium. We reported rates of four toxicity outcomes: physician-reported acute moist desquamation, patient-reported acute moderate/severe breast pain, a composite acute toxicity measure (including moist desquamation and either patient-reported or physician-reported moderate/significant breast pain), and physician-reported impaired cosmetic outcome at one year following WBI. Successive multivariable models were constructed to estimate the impact of chemotherapy on these outcomes. RESULTS Rates of moist desquamation, patient-reported pain, composite acute toxicity, and impaired cosmetic outcome were 23%, 34%, 42%, and 10% for 2,859 patients receiving CWBI and 13%, 28%, 31%, and 11% for 3,895 patients receiving HWBI. Receipt of chemotherapy prior to CWBI was not associated with higher rates of patient-reported pain, composite acute toxicity, or impaired cosmetic outcome compared to CWBI without chemotherapy but was associated with more moist desquamation (OR=1.32 [1.07-1.63], p=0.01). Receipt of chemotherapy prior to HWBI was not associated with higher rates of any of the four toxicity outcomes compared to HWBI alone. CONCLUSIONS In this cohort, use of chemotherapy prior to WBI was generally well tolerated. CWBI with chemotherapy, but not to HWBI with chemotherapy, was associated with higher rates of moist desquamation. Rates of acute breast pain and impaired cosmetic outcome at one year were comparable in patients receiving chemotherapy prior to either CWBI or HWBI. These data support the use of HWBI following chemotherapy.
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Affiliation(s)
| | - Kent A Griffith
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lori J Pierce
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Reshma Jagsi
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | | | | | | | - Michael M Dominello
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - Jean M Moran
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | - James A Hayman
- University of Michigan School of Medicine, Ann Arbor, Michigan
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27
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Córdoba EE, Lacunza E, Güerci AM. Clinical factors affecting the determination of radiotherapy-induced skin toxicity in breast cancer. Radiat Oncol J 2022; 39:315-323. [PMID: 34986553 PMCID: PMC8743461 DOI: 10.3857/roj.2020.00395] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Radiotherapy is essential for the treatment of breast cancer (BC). However, adverse effects may occur in healthy tissue, during treatment and even after several months. Although it is known that this clinical radiosensitivity is multifactorial, the factors involved are unknown yet. In this study, we evaluated the effect of these factors on the development of radiodermatitis in patients undergoing radiotherapy. Materials and Methods Demographic and lifestyle data collected during face-to-face interviews of 122 BC patients and data from clinical records were investigated. Most patients underwent conventional three-dimensional radiotherapy treatment. A total dose of 50 Gy was administered (2 Gy/day), followed by a boost in a tumor bed with a total dose of 18 Gy (2 Gy/day). Radiotoxicity was evaluated weekly using the Radiation Therapy Oncology Group classification system (range, 0 to 4, according to the severity). Results In the present study, 75.4% of patients presented acute skin toxic effects with different degrees of severity. In 25% of cases, these effects manifested at the end of the fourth week at a cumulative dose of 40 Gy. The association of grade ≥2 acute skin reactions with body mass index (BMI) and breast size and between grade 3–4 and age was positive compared with controls. However, the role of the other factors could not be confirmed. Conclusion Analysis of the factors related to individual radiosensitivity suggests that age, BMI and breast size play an important role in the development of acute skin toxicity during treatment. Particular attention to patients who present these characteristics would help to control treatment effectiveness and therefore optimize their quality of life.
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Affiliation(s)
- Elisa Eugenia Córdoba
- Department of Physics, School of Exact Sciences, National University of La Plata, Argentina.,Veterinary Genetics Institute (National Scientific and Technical Research Council-National University of La Plata) School of Veterinary Sciences, La Plata, Argentina
| | - Ezequiel Lacunza
- Basic and Applied Immunological Research Center, School of Medicine, National University of La Plata, Argentina
| | - Alba Mabel Güerci
- Department of Physics, School of Exact Sciences, National University of La Plata, Argentina.,Veterinary Genetics Institute (National Scientific and Technical Research Council-National University of La Plata) School of Veterinary Sciences, La Plata, Argentina
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28
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Pasquarelli-do-Nascimento G, Machado SA, de Carvalho JMA, Magalhães KG. Obesity and adipose tissue impact on T-cell response and cancer immune checkpoint blockade therapy. IMMUNOTHERAPY ADVANCES 2022; 2:ltac015. [PMID: 36033972 PMCID: PMC9404253 DOI: 10.1093/immadv/ltac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
Many different types of cancer are now well known to have increased occurrence or severity in individuals with obesity. The influence of obesity on cancer and the immune cells in the tumor microenvironment has been thought to be a pleiotropic effect. As key endocrine and immune organs, the highly plastic adipose tissues play crucial roles in obesity pathophysiology, as they show alterations according to environmental cues. Adipose tissues of lean subjects present mostly anti-inflammatory cells that are crucial in tissue remodeling, favoring uncoupling protein 1 expression and non-shivering thermogenesis. Oppositely, obese adipose tissues display massive proinflammatory immune cell infiltration, dying adipocytes, and enhanced crown-like structure formation. In this review, we discuss how obesity can lead to derangements and dysfunctions in antitumor CD8+ T lymphocytes dysfunction. Moreover, we explain how obesity can affect the efficiency of cancer immunotherapy, depicting the mechanisms involved in this process. Cancer immunotherapy management includes monoclonal antibodies targeting the immune checkpoint blockade. Exhausted CD8+ T lymphocytes show elevated programmed cell death-1 (PD-1) expression and highly glycolytic tumors tend to show a good response to anti-PD-1/PD-L1 immunotherapy. Although obesity is a risk factor for the development of several neoplasms and is linked with increased tumor growth and aggressiveness, obesity is also related to improved response to cancer immunotherapy, a phenomenon called the obesity paradox. However, patients affected by obesity present higher incidences of adverse events related to this therapy. These limitations highlight the necessity of a deeper investigation of factors that influence the obesity paradox to improve the application of these therapies.
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Affiliation(s)
| | - Sabrina Azevedo Machado
- Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia , DF , Brazil
| | | | - Kelly Grace Magalhães
- Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia , DF , Brazil
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29
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Aldraimli M, Osman S, Grishchuck D, Ingram S, Lyon R, Mistry A, Oliveira J, Samuel R, Shelley LE, Soria D, Dwek MV, Aguado-Barrera ME, Azria D, Chang-Claude J, Dunning A, Giraldo A, Green S, Gutiérrez-Enríquez S, Herskind C, van Hulle H, Lambrecht M, Lozza L, Rancati T, Reyes V, Rosenstein BS, de Ruysscher D, de Santis MC, Seibold P, Sperk E, Symonds RP, Stobart H, Taboada-Valadares B, Talbot CJ, Vakaet VJ, Vega A, Veldeman L, Veldwijk MR, Webb A, Weltens C, West CM, Chaussalet TJ, Rattay T. Development and optimisation of a machine-learning prediction model for acute desquamation following breast radiotherapy in the multi-centre REQUITE cohort. Adv Radiat Oncol 2022; 7:100890. [PMID: 35647396 PMCID: PMC9133391 DOI: 10.1016/j.adro.2021.100890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Some patients with breast cancer treated by surgery and radiation therapy experience clinically significant toxicity, which may adversely affect cosmesis and quality of life. There is a paucity of validated clinical prediction models for radiation toxicity. We used machine learning (ML) algorithms to develop and optimise a clinical prediction model for acute breast desquamation after whole breast external beam radiation therapy in the prospective multicenter REQUITE cohort study. Methods and Materials Using demographic and treatment-related features (m = 122) from patients (n = 2058) at 26 centers, we trained 8 ML algorithms with 10-fold cross-validation in a 50:50 random-split data set with class stratification to predict acute breast desquamation. Based on performance in the validation data set, the logistic model tree, random forest, and naïve Bayes models were taken forward to cost-sensitive learning optimisation. Results One hundred and ninety-two patients experienced acute desquamation. Resampling and cost-sensitive learning optimisation facilitated an improvement in classification performance. Based on maximising sensitivity (true positives), the “hero” model was the cost-sensitive random forest algorithm with a false-negative: false-positive misclassification penalty of 90:1 containing m = 114 predictive features. Model sensitivity and specificity were 0.77 and 0.66, respectively, with an area under the curve of 0.77 in the validation cohort. Conclusions ML algorithms with resampling and cost-sensitive learning generated clinically valid prediction models for acute desquamation using patient demographic and treatment features. Further external validation and inclusion of genomic markers in ML prediction models are worthwhile, to identify patients at increased risk of toxicity who may benefit from supportive intervention or even a change in treatment plan.
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30
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Shastri AA, Lombardo J, Okere SC, Higgins S, Smith BC, DeAngelis T, Palagani A, Hines K, Monti DA, Volpe S, Mitchell EP, Simone NL. Personalized Nutrition as a Key Contributor to Improving Radiation Response in Breast Cancer. Int J Mol Sci 2021; 23:175. [PMID: 35008602 PMCID: PMC8745527 DOI: 10.3390/ijms23010175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Understanding metabolic and immune regulation inherent to patient populations is key to improving the radiation response for our patients. To date, radiation therapy regimens are prescribed based on tumor type and stage. Patient populations who are noted to have a poor response to radiation such as those of African American descent, those who have obesity or metabolic syndrome, or senior adult oncology patients, should be considered for concurrent therapies with radiation that will improve response. Here, we explore these populations of breast cancer patients, who frequently display radiation resistance and increased mortality rates, and identify the molecular underpinnings that are, in part, responsible for the radiation response and that result in an immune-suppressive tumor microenvironment. The resulting immune phenotype is discussed to understand how antitumor immunity could be improved. Correcting nutrient deficiencies observed in these populations should be considered as a means to improve the therapeutic index of radiation therapy.
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Affiliation(s)
- Anuradha A. Shastri
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Joseph Lombardo
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Samantha C. Okere
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Stephanie Higgins
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Brittany C. Smith
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Tiziana DeAngelis
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Ajay Palagani
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Kamryn Hines
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Daniel A. Monti
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Stella Volpe
- Department of Human Nutrition, Foods and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA 24061, USA;
| | - Edith P. Mitchell
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Nicole L. Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
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Xie Y, Wang Q, Hu T, Chen R, Wang J, Chang H, Cheng J. Risk Factors Related to Acute Radiation Dermatitis in Breast Cancer Patients After Radiotherapy: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:738851. [PMID: 34912704 PMCID: PMC8667470 DOI: 10.3389/fonc.2021.738851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background Acute radiation dermatitis (ARD) is the most common acute response after adjuvant radiotherapy in breast cancer patients and negatively affects patients’ quality of life. Some studies have reported several risk factors that can predict breast cancer patients who are at a high risk of ARD. This study aimed to identify patient- and treatment-related risk factors associated with ARD. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and WanFang literature databases were searched for studies exploring the risk factors in breast cancer patients. The pooled effect sizes, relative risks (RRs), and 95% CIs were calculated using the random-effects model. Potential heterogeneity and sensitivity analyses by study design, ARD evaluation scale, and regions were also performed. Results A total of 38 studies composed of 15,623 breast cancer patients were included in the analysis. Of the seven available patient-related risk factors, four factors were significantly associated with ARD: body mass index (BMI) ≥25 kg/m2 (RR = 1.11, 95% CI = 1.06–1.16, I2 = 57.1%), large breast volume (RR = 1.02, 95% CI = 1.01–1.03, I2 = 93.2%), smoking habits (RR = 1.70, 95% CI = 1.24–2.34, I2 = 50.7%), and diabetes (RR = 2.24, 95% CI = 1.53–3.27, I2 = 0%). Of the seven treatment-related risk factors, we found that hypofractionated radiotherapy reduced the risk of ARD in patients with breast cancer compared with that in conventional fractionated radiotherapy (RR = 0.28, 95% CI = 0.19–0.43, I2 = 84.5%). Sequential boost and bolus use was significantly associated with ARD (boost, RR = 1.91, 95% CI = 1.34–2.72, I2 = 92.5%; bolus, RR = 1.94, 95% CI = 1.82–4.76, I2 = 23.8%). However, chemotherapy regimen (RR = 1.17, 95% CI = 0.95–1.45, I2 = 57.2%), hormone therapy (RR = 1.35, 95% CI = 0.94–1.93, I2 = 77.1%), trastuzumab therapy (RR = 1.56, 95% CI = 0.18–1.76, I2 = 91.9%), and nodal irradiation (RR = 1.57, 95% CI = 0.98–2.53, I2 = 72.5%) were not correlated with ARD. Sensitivity analysis results showed that BMI was consistently associated with ARD, while smoking, breast volume, and boost administration were associated with ARD depending on study design, country of study, and toxicity evaluation scale used. Hypofractionation was consistently shown as protective. The differences between study design, toxicity evaluation scale, and regions might explain a little of the sources of heterogeneity. Conclusion The results of this systematic review and meta-analysis indicated that BMI ≥ 25 kg/m2 was a significant predictor of ARD and that hypofractionation was consistently protective. Depending on country of study, study design, and toxicity scale used, breast volume, smoking habit, diabetes, and sequential boost and bolus use were also predictive of ARD.
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Affiliation(s)
- Yuxiu Xie
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiong Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Hu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renwang Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jue Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haiyan Chang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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A Comprehensive Prospective Comparison of Acute Skin Toxicity after Hypofractionated and Normofractionated Radiation Therapy in Breast Cancer. Cancers (Basel) 2021; 13:cancers13225826. [PMID: 34830981 PMCID: PMC8616262 DOI: 10.3390/cancers13225826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/13/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Moderate hypofractionated radiotherapy (HF) has become the standard fractionation scheme for most breast cancer patients. Despite comprehensive data from large, randomized trials, standardized assessment of patient reported outcome (PRO) and physiological changes after HF are largely missing. In this prospective trial focusing on radiodermatitis, HF and conventional normofractionated radiotherapy (CF) were compared using standardized Skindex-16 questionnaire in addition to CTCAE assessment and ultrasound measurement of the skin. The results of the current study complement and confirm existing evidence that HF leads to a lower degree of acute radiodermatitis and better patient reported outcome compared to CF. Abstract The current study aims to determine whether hypofractionated radiotherapy (HF) leads to lower rates of acute radiodermatitis compared to conventional normofractionated radiotherapy (CF). A total of 166 patients with invasive breast cancer or DCIS were included in a prospective cohort study. Evaluation of acute radiodermatitis was obtained before radiotherapy, at the end of the treatment (T1), and 6 weeks after the treatment (T2) using CTCAE (v5.0) scores, the Skindex-16 questionnaire, and ultrasound measurement of the skin. CTCAE and Skindex-16 scores in the CF-group were significantly higher compared to the HF group indicating more pronounced side effects at the end of the treatment (CTCAE: CF-RT 1.0 (IQR: 0.0) vs. HF-RT 0.0 (0.25); p = 0.03; Skindex-16: CF: 20.8 (IQR: 25.8); HF: 8.3 (27.1); p = 0.04). At 6 weeks after the treatment, no significant differences between the two fractionation schemes were observed. Ultrasound based assessment showed that the skin thickness in the treated breast was higher compared to the healthy breast at all time-points. However, no significant difference between HF and CF was seen either at T1 or T2. The current study complements and confirms pre-existing evidence that HF leads to a lower degree of acute radiodermatitis and better patient reported outcome compared to CF at the end of treatment. This should be considered whenever fractionation of adjuvant breast cancer treatment is being discussed.
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Martelletti LBSDJ, Aguiar BRLD, Vieira LAC, Menêses AGD, Bontempo PDSM, Ferreira EB, Reis PEDD. Incidence of acute radiodermatitis in women with breast cancer undergoing hypofractionated radiotherapy. Rev Bras Enferm 2021; 75:e20210118. [PMID: 34614087 DOI: 10.1590/0034-7167-2021-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the incidence and degree of acute radiodermatitis at the end and after the end of treatment in women with breast cancer undergoing hypofractionated radiotherapy. METHODS Observational, prospective, and longitudinal study, conducted between March 2019 and January 2020, in a radiotherapy outpatient clinic. RESULTS Thirty-two women participated in the study, among whom, in the last session of hypofractionated radiotherapy, 15 (46.9%) had radiodermatitis, erythema in 13 (40.6%), and wet peeling in 2 (6.3%). In the post-treatment evaluation, 27 (84.4%) had radiodermatitis, erythema in 17 (53.1%), dry peeling in 8 (25%), and wet peeling in 2 (6.3%). CONCLUSION The general incidence of radiodermatitis after hypofractionated radiotherapy in women with breast cancer was 37.5%, erythema, 12.5%, and dry peeling, 25%. The development of care protocols for the management of radiodermatitis after treatment is of paramount importance.
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Bourgier C, Cowen D, Castan F, Lemanski C, Gourgou S, Rivera S, Labib A, Peignaux K, Blanc-Onfroy ML, Benyoucef A, Mege A, Douadi-Gaci Z, Racadot S, Latorzeff I, Schick U, Jacquot S, Massabeau C, Guilbert P, Geffrelot J, Ellis S, Lecouillard I, Breton-Callu C, Richard-Tallet A, Boulbair F, Cretin J, Belkacémi Y, Bons F, Azria D, Fenoglietto P. Quality assurance program and early toxicities in the phase III BONBIS randomized trial evaluating the role of a localized radiation boost in ductal carcinoma in situ. Radiother Oncol 2021; 164:57-65. [PMID: 34571090 DOI: 10.1016/j.radonc.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the quality assurance (QA) program and early toxicities in the phase III randomized trial BONBIS (NCT00907868) on the role of a localized radiation boost in ductal carcinoma in situ (DCIS). MATERIALS AND METHODS From November 2008 to July 2014, 2004 patients were randomized in arm A (only whole breast radiotherapy, WBRT) and arm B (WBRT + boost). The QA program involved 44 participant centers that performed the dummy run (DR). Compliance and uniformity of clinical target volume (CTV) delineations, and dose prescription and delivery according to the BONBIS trial radiotherapy guidelines were analyzed. Acute toxicities (during and up to 3 months after radiotherapy completion, NCI-CTCAE v3.0 classification) were evaluated in 1929 patients. RESULTS The differences in whole breast CTV (CTV1) and planning target volume (PTV1) were ≤10%, and the differences in boost CTV (CTV2) and PTV (PTV2) were ≥20% compared with the reference DR values; 95% of the prescribed dose encompassed 98.7% and 100% of the median CTV1 and CTV2. Grade ≥2 breast erythema (38.3% vs. 22.4% of grade 2 and 5.4% vs. 2.1% of grade 3, p < 0.001), grade ≥2 dermatitis (2.8% vs. 0.7%, p < 0.001), and grade 2 hyperpigmentation (6.9% vs. 3.6%, p = 0.005) were more frequent in arm B than arm A. No acute lung or cardiac toxicity was observed. Smoking history, large breast size, and large breast CTV were strong predictive factors of grade ≥2 acute skin toxicities. CONCLUSIONS The QA program showed deviations in breast and tumor bed delineation. The boost significantly increased acute skin toxicities.
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Affiliation(s)
- Celine Bourgier
- Univ Montpellier, Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France; Fédération Universitaire d'Oncologie Radiothérapie d'Occitanie Méditerranée, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Didier Cowen
- Aix Marseille Univ, APHM, Hôpital Timone-Hôpital Nord, Département de Radiothérapie, Marseille, France
| | - Florence Castan
- Unité de Biométrie, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Claire Lemanski
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France; Fédération Universitaire d'Oncologie Radiothérapie d'Occitanie Méditerranée, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Sophie Gourgou
- Unité de Biométrie, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Sofia Rivera
- Gustave Roussy, Département d'oncologie radiothérapie, Villejuif, France; Université Paris-Saclay, Inserm, U1030, Villejuif, France
| | | | - Karine Peignaux
- Département d'Oncologie Radiothérapie Centre Georges-François LECLERC, Dijon, France
| | | | - Ahmed Benyoucef
- Département de Radiothérapie et de Physique médicale, Centre Henri Becquerel, Rouen, France
| | - Alice Mege
- Sainte Catherine, Institut du Cancer Avignon-Provence, Avignon, France
| | | | | | - Igor Latorzeff
- Département de radiothérapie-oncologie, Clinique Pasteur, Toulouse, France
| | - Ulrike Schick
- Department of Radiation Oncology, University Hospital of Brest, UBO, LaTIM UMR 1101, Brest, France
| | - Stephane Jacquot
- Centre de Cancerologie du Grand Montpellier, Montpellier, France
| | - Carole Massabeau
- Département de Radiotherapie, Institut Claudius Regaud IUCT-O, Toulouse, France
| | | | - Julien Geffrelot
- Service de Radiothérapie, Centre François Baclesse, Caen, France
| | - Stephen Ellis
- Service de Radiothérapie, Centre Catalan d'Oncologie, Perpignan, France
| | | | | | - Agnès Richard-Tallet
- Institut Paoli-Calmettes, département d'Oncologie Radiothérapie, Marseille, France; Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM UMR 1068, Marseille, France
| | | | | | - Yazid Belkacémi
- Department of Radiation Oncology and Henri Mondor Breast Center, AP HP - Henri Mondor University Hospital, University of Paris-Est (UPEC), INSERM Unit 955, Team 21-IMRB, Creteil, France
| | - Françoise Bons
- Fédération Universitaire d'Oncologie Radiothérapie d'Occitanie Méditerranée, Institut régional du Cancer Montpellier (ICM), Montpellier, France; Service de Radiothérapie, CHU Nîmes, France
| | - David Azria
- Univ Montpellier, Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France; Fédération Universitaire d'Oncologie Radiothérapie d'Occitanie Méditerranée, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Pascal Fenoglietto
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France; Fédération Universitaire d'Oncologie Radiothérapie d'Occitanie Méditerranée, Institut régional du Cancer Montpellier (ICM), Montpellier, France
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Laytragoon Lewin N, Oliva D, Nilsson M, Andersson BÅ, Löfgren S, Lewin F. Survival Time among Young and Old Breast Cancer Patients in Relation to Circulating Blood-Based Biomarkers, Acute Radiation Skin Reactions, and Tumour Recurrence. Oncology 2021; 99:740-746. [PMID: 34515174 DOI: 10.1159/000518184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It has been suggested that age could influence the treatment-induced side effects and survival time of cancer patients. The influence of age on blood-based biomarkers, acute radiation skin reactions (ARSRs), and survival time of breast cancer patients was analysed. MATERIALS AND METHODS Two hundred ninety-three individuals, 119 breast cancer patients, and 174 healthy blood donors were included. RESULTS Before radiotherapy (RT), decreased levels of lymphocytes, interleukin 2, platelet-derived growth factors, and tumour necrosis factor but increased levels of monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, C-reactive protein, and macrophage inflammatory protein 1b (MIP1b) were detected in the patient group. All of the patients developed ARSRs and intensity of ARSRs was inversely related to the MIP1b level before RT. Fifteen out of 119 (13%) patients deceased during follow-up time. No influence of age (≤50 compared to >50 years) on survival time was detected (p = 0.442). Tumour recurrence, found in 11 out of 119 (9%) patients, had impact on survival time of these patients (p < 0.001). CONCLUSIONS The level of circulating MIP1b before RT was associated with intensity of ARSRs. Tumour recurrence, but not age, was associated with poor survival time. Analysis of circulating MIP1b was low cost, rapid, and could be done in routine laboratory facility. Since RT almost always induces ARSRs, the possibility of using MIP1b as a prognostic biomarker for ARSRs is of interests for further investigation.
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Affiliation(s)
- Nongnit Laytragoon Lewin
- Department of Laboratory Medicine, Ryhov Hospital, Jönköping, Sweden, .,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,
| | - Delmy Oliva
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Oncology, Ryhov Hospital, Jönköping, Sweden
| | - Mats Nilsson
- Futurum, Academy of Health and Care, Jönköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Bengt-Åke Andersson
- Department of Laboratory Medicine, Ryhov Hospital, Jönköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sture Löfgren
- Department of Laboratory Medicine, Ryhov Hospital, Jönköping, Sweden
| | - Freddi Lewin
- Department of Oncology, Ryhov Hospital, Jönköping, Sweden
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Möllerberg ML, Langegård U, Johansson B, Ohlsson-Nevo E, Fransson P, Ahlberg K, Witt-Nyström P, Sjövall K. Evaluation of skin reactions during proton beam radiotherapy - Patient-reported versus clinician-reported. Tech Innov Patient Support Radiat Oncol 2021; 19:11-17. [PMID: 34195393 PMCID: PMC8233127 DOI: 10.1016/j.tipsro.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Skin reaction is a common side-effect of radiotherapy and often only assessed as clinician-reported outcome (CRO). The aim was to examine and compare patient-reported outcome (PRO) of skin reactions with CRO for signs of acute skin reactions for patients with primary brain tumour receiving proton beam radiotherapy (PBT). A further aim was to explore patients' experiences of the skin reactions. METHODS Acute skin reactions were assessed one week after start of treatment, mid-treatment and end of treatment among 253 patients with primary brain tumour who underwent PBT. PRO skin reactions were assessed with the RSAS and CRO according to the RTOG scale. Fleiss' kappa was performed to measure the inter-rater agreement of the assessments of skin reactions. RESULTS The results showed a discrepancy between PRO and CRO acute skin reactions. Radiation dose was associated with increased skin reactions, but no correlations were seen for age, gender, education, occupation, other treatment or smoking. There was a poor agreement between patients and clinicians (κ = -0.016) one week after the start of PBT, poor (κ = -0.045) to (κ = 0.396) moderate agreement at mid treatment and poor (κ = -0.010) to (κ = 0.296) moderate agreement at end of treatment. Generally, patients' symptom distress toward skin reactions was low at all time points. CONCLUSION The poor agreement between PRO and CRO shows that the patient needs to be involved in assessments of skin reactions for a more complete understanding of skin reactions due to PBT. This may also improve patient experience regarding involvement in their own care.
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Affiliation(s)
| | - Ulrica Langegård
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Birgitta Johansson
- Experimental Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala University Hospital, Sweden
| | - Emma Ohlsson-Nevo
- University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, and Department of Cancercentrum, Norrlands University Hospital, Umeå, Sweden
| | - Karin Ahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Petra Witt-Nyström
- Danish Centre for Particle Therapy, Aarhus, Palle Juul-Jensens Boulevard 25, DK-8200 Aarhus, Denmark
| | - Katarina Sjövall
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden
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Aldraimli M, Soria D, Grishchuck D, Ingram S, Lyon R, Mistry A, Oliveira J, Samuel R, Shelley LEA, Osman S, Dwek MV, Azria D, Chang-Claude J, Gutiérrez-Enríquez S, De Santis MC, Rosenstein BS, De Ruysscher D, Sperk E, Symonds RP, Stobart H, Vega A, Veldeman L, Webb A, Talbot CJ, West CM, Rattay T, Chaussalet TJ. A data science approach for early-stage prediction of Patient's susceptibility to acute side effects of advanced radiotherapy. Comput Biol Med 2021; 135:104624. [PMID: 34247131 DOI: 10.1016/j.compbiomed.2021.104624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022]
Abstract
The prediction by classification of side effects incidence in a given medical treatment is a common challenge in medical research. Machine Learning (ML) methods are widely used in the areas of risk prediction and classification. The primary objective of such algorithms is to use several features to predict dichotomous responses (e.g., disease positive/negative). Similar to statistical inference modelling, ML modelling is subject to the class imbalance problem and is affected by the majority class, increasing the false-negative rate. In this study, seventy-nine ML models were built and evaluated to classify approximately 2000 participants from 26 hospitals in eight different countries into two groups of radiotherapy (RT) side effects incidence based on recorded observations from the international study of RT related toxicity "REQUITE". We also examined the effect of sampling techniques and cost-sensitive learning methods on the models when dealing with class imbalance. The combinations of such techniques used had a significant impact on the classification. They resulted in an improvement in incidence status prediction by shifting classifiers' attention to the minority group. The best classification model for RT acute toxicity prediction was identified based on domain experts' success criteria. The Area Under Receiver Operator Characteristic curve of the models tested with an isolated dataset ranged from 0.50 to 0.77. The scale of improved results is promising and will guide further development of models to predict RT acute toxicities. One model was optimised and found to be beneficial to identify patients who are at risk of developing acute RT early-stage toxicities as a result of undergoing breast RT ensuring relevant treatment interventions can be appropriately targeted. The design of the approach presented in this paper resulted in producing a preclinical-valid prediction model. The study was developed by a multi-disciplinary collaboration of data scientists, medical physicists, oncologists and surgeons in the UK Radiotherapy Machine Learning Network.
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Affiliation(s)
- Mahmoud Aldraimli
- The Health Innovation Ecosystem, University of Westminster, London, UK.
| | - Daniele Soria
- School of Computing, University of Kent, Canterbury, UK
| | | | - Samuel Ingram
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Robert Lyon
- Department of Computer Science, Edge Hill University, Ormskirk, Lancashire, UK
| | - Anil Mistry
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Robert Samuel
- University of Leeds, Leeds Cancer Centre, St. James's University Hospital, Leeds, UK
| | - Leila E A Shelley
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, UK
| | - Sarah Osman
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Miriam V Dwek
- School of Life Sciences, University of Westminster, London, UK
| | | | - Jenny Chang-Claude
- German Cancer Research Center (DKFZ) Division of Cancer Epidemiology, Unit of Genetic Epidemiology, Heidelberg, Germany
| | | | - Maria Carmen De Santis
- Dept of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Dirk De Ruysscher
- Maastricht Radiation Oncology (MAASTRO Clinic) University Hospital Maastricht, the Netherlands
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | | | - Ana Vega
- Fundación Publica Galega Medicina Xenomica, Santiago de Compostela, Spain
| | - Liv Veldeman
- Department of Basic Medical Sciences, University Hospital Ghent, Belgium
| | - Adam Webb
- Department of Genetics and Genome Biology, University of Leicester, UK
| | | | - Catharine M West
- Institute of Cancer Sciences, Christie Hospital, Wilmslow Road, Manchester, UK
| | - Tim Rattay
- Cancer Research Centre, University of Leicester, Leicester, UK
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Rezaeean H, Kaydani GA, Saki N, Razmjoo S, Labibzadeh M, Yaghooti H. The IFN-Ɣ + 874 A/T polymorphism is associated with malignant breast cancer in a population from the southwest of Iran. BMC Res Notes 2021; 14:147. [PMID: 33879226 PMCID: PMC8056653 DOI: 10.1186/s13104-021-05543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/24/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Breast cancer (BC) is one of the most common diseases in women globally, with an increasing number of deaths associated with it. Recently the role of polymorphisms in the genes encoding cytokines and immune cells has been demonstrated. This study aimed to evaluate the association of IFN-Ɣ + 874 A/T polymorphism with BC clinical symptoms. Results The study included 88 women with BC and 88 healthy women who had no history of cancer and were matched for age and sex. Allele-specific oligonucleotide-polymerase chain reaction technique was used to investigate the IFN-Ɣ polymorphism. Clinical data were obtained from the patients’ records. Our results showed that the frequencies of genotypes in the BC patients were not significantly different from the control subjects. However, in the patients, the AT genotype was associated with the risk of malignant BC. The age at BC diagnosis was not different in patients with AA and AT genotypes; however, it was significantly earlier in HER2 negative subjects (p = 0.002). Given the higher frequency of AT in malignant BC patients, our results confirm the association of the IFN-Ɣ polymorphism with the disease’s progression to a malignant state. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05543-6.
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Affiliation(s)
- Hadi Rezaeean
- High Institute for Education and Research in Transfusion Medicine, Tehran, Iran
| | - Gholam Abbas Kaydani
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmaldin Saki
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sasan Razmjoo
- Department of Clinical Oncology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Labibzadeh
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamid Yaghooti
- Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Cunningham L, Penfold S, Giles E, Le H, Short M. Impact of Breast Size on Dosimetric Indices in Proton Versus X-ray Radiotherapy for Breast Cancer. J Pers Med 2021; 11:jpm11040282. [PMID: 33917818 PMCID: PMC8068250 DOI: 10.3390/jpm11040282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Deep inspiration breath hold (DIBH) radiotherapy is a technique used to manage early stage left-sided breast cancer. This study compared dosimetric indices of patient-specific X-ray versus proton therapy DIBH plans to explore differences in target coverage, radiation doses to organs at risk, and the impact of breast size. Radiotherapy plans of sixteen breast cancer patients previously treated with DIBH radiotherapy were re-planned with hybrid inverse-planned intensity modulated X-ray radiotherapy (h-IMRT) and intensity modulated proton therapy (IMPT). The total prescribed dose was 40.05 Gy in 15 fractions for all cases. Comparisons between the clinical, h-IMRT, and IMPT evaluated doses to target volumes, organs at risk, and correlations between doses and breast size. Although no differences were observed in target volume coverage between techniques, the h-IMRT and IMPT were able to produce more even dose distributions and IMPT delivered significantly less dose to all organs at risk than both X-ray techniques. A moderate negative correlation was observed between breast size and dose to the target in X-ray techniques, but not IMPT. Both h-IMRT and IMPT produced plans with more homogeneous dose distribution than forward-planned IMRT and IMPT achieved significantly lower doses to organs at risk compared to X-ray techniques.
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Affiliation(s)
- Lisa Cunningham
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide 5000, Australia; (L.C.); (S.P.); (H.L.)
| | - Scott Penfold
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide 5000, Australia; (L.C.); (S.P.); (H.L.)
| | - Eileen Giles
- Cancer Research Institute, University of South Australia, Adelaide 5001, Australia;
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide 5000, Australia; (L.C.); (S.P.); (H.L.)
- Cancer Research Institute, University of South Australia, Adelaide 5001, Australia;
| | - Michala Short
- Cancer Research Institute, University of South Australia, Adelaide 5001, Australia;
- Correspondence: ; Tel.: +61-8-83022089
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40
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Correlation between toxicity and dosimetric parameters for adjuvant intensity modulated radiation therapy of breast cancer: a prospective study. Sci Rep 2021; 11:3626. [PMID: 33574446 PMCID: PMC7878810 DOI: 10.1038/s41598-021-83159-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
ORCID: 0000–0001-6019–7309. In the treatment of breast cancer, intensity-modulated radiation therapy (IMRT) reportedly reduces the high-dose irradiation of at-risk organs and decreases the frequency of adverse events (AEs). Comparisons with conventional radiotherapy have shown that IMRT is associated with lower frequencies of acute and late-onset AEs. Here, we extended a prospective, observational, single-center study of the safety of IMRT to a second investigating center. Patients scheduled for adjuvant IMRT after partial or total mastectomy were given a dose of 50 Gy (25 fractions of 2 Gy over 5 weeks), with a simultaneous integrated boost in patients having undergone conservative surgery. 300 patients were included in the study, and 288 were analyzed. The median follow-up period was 2.1 years. The 2-year disease-free survival rate [95% CI] was 93.4% [89.2–96.0%]. Most AEs were mild. The most common AEs were skin-related—mainly radiodermatitis [in 266 patients (92.4%)] and hyperpigmentation (in 178 (61.8%)). 35% and 6% of the patients presented with grade 2 acute skin and esophageal toxicity, respectively. Only 4 patients presented with a grade 3 event (radiodermatitis). Smoking (odds ratio) [95% CI] = 2.10 [1.14–3.87]; p = 0.017), no prior chemotherapy (0.52 [0.27–0.98]; p = 0.044), and D98% for subclavicular skin (1.030 [1.001–1.061]; p = 0.045) were associated with grade ≥ 2 acute AEs. In a univariate analysis, the mean dose, (p < 0.0001), D2% (p < 0.0001), D50% (p = 0.037), D95% (p = 0.0005), D98% (p = 0.0007), V30Gy (p < 0.0001), and V45Gy (p = 0.0001) were significantly associated with grade ≥ 1 acute esophageal AEs. In a multivariate analysis, D95% for the skin (p < 0.001), D98% for the subclavicular skin and low D95% for the internal mammary lymph nodes were associated with grade ≥ 1 medium-term AEs. The safety profile of adjuvant IMRT after partial or total mastectomy is influenced by dosimetric parameters. Trial registration: ClinicalTrials.gov NCT02281149.
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Dicuonzo S, Leonardi MC, Raimondi S, Corrao G, Bagnardi V, Gerardi MA, Morra A, Zerella MA, Zaffaroni M, Pansini F, Cattani F, Luraschi R, Fodor C, Veronesi P, Orecchia R, Rojas DP, Jereczek-Fossa BA. Acute and intermediate toxicity of 3-week radiotherapy with simultaneous integrated boost using TomoDirect: prospective series of 287 early breast cancer patients. Clin Transl Oncol 2021; 23:1415-1428. [PMID: 33537865 DOI: 10.1007/s12094-020-02538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
AIMS To report toxicity of a hypofractionated scheme of whole-breast (WB) intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to the tumor bed (TB) using Tomotherapy® with Direct modality. METHODS Patients with early breast cancer, undergoing radiotherapy (RT) in 15 daily fractions to WB (prescription dose 40.05 Gy) and SIB to the TB (48 Gy), between 2013 and 2017, was analyzed. Primary endpoint was acute and intermediate toxicity assessed at the end and within 6 months from RT, according to Radiation Therapy Oncology Group (RTOG) scale. Secondary endpoints included early chronic toxicity at 12-months follow-up, using the Late Effects Normal Tissue Task Subjective, Objective, Management, and Analytic (LENT-SOMA) scale, and cosmesis using Harvard criteria. RESULTS The study population was of 287 patients. Acute and intermediate toxicity was collected among 183 patients with data available at the end of RT and within 6 months, 85 (46%) experienced G2 toxicity and 84 (46%) G1 toxicity, while 14 (8%) did not report toxicity at any time. A significant reduction of any grade toxicity was observed between the two time points, with the majority of patients reporting no clinically relevant toxicity at 6 months. At univariate analysis, age < 40 years, breast volume > 1000 cm3 and Dmax ≤ 115% of prescription dose were predictive factors of clinically relevant acute toxicity (G ≥ 2) at any time. At multivariable analysis, only age and breast volume were confirmed as predictive factors, with Relative Risks (95% Confidence Intervals): 2.02 (1.13-3.63) and 1.84 (1.26-2.67), respectively. At 12-month follow-up, 113 patients had complete information on any toxicity with 53% of toxicity G < 2, while cosmetic evaluation, available for 102 patients, reported a good-excellent result for 86% of patients. CONCLUSIONS Hypofractionated WB IMRT with a SIB to the TB, delivered with TomoDirect modality, is safe and well-tolerated. Most patients reported no toxicity after 6 months and good-excellent cosmesis. Predictive factors of clinically relevant toxicity might be considered during treatment planning in order to further reduce side effects.
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Affiliation(s)
- S Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - M C Leonardi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - S Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Corrao
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - M A Gerardi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - A Morra
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - M A Zerella
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - M Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - F Pansini
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Luraschi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Fodor
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - P Veronesi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Orecchia
- Scientific Directorate, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - D P Rojas
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - B A Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Chen SN, Ramachandran P, Deb P. Dosimetric comparative study of 3DCRT, IMRT, VMAT, Ecomp, and Hybrid techniques for breast radiation therapy. Radiat Oncol J 2021; 38:270-281. [PMID: 33389982 PMCID: PMC7785843 DOI: 10.3857/roj.2020.00619] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To assess and compare the dosimetric parameters obtained between three-dimensional conformal radiotherapy (3DCRT), three-dimensional field-in-field (3DFIF), 5-field intensity-modulated radiotherapy (IMRT MF5), tangential IMRT (tIMRT), tangential volumetric modulated arc therapy (tVMAT), electronic tissue compensation (Ecomp), and Hybrid treatment plans. Material and Methods Thirty planning computed tomography datasets obtained from patients previously treated with whole breast radiation therapy (WBRT) were utilized in this study. Treatment plans were created for 3DCRT, 3DFIF, IMRT MF5, tIMRT, tVMAT, Ecomp, and Hybrid techniques using Eclipse Treatment Planning System (version 13.6) with a prescribed dose of 42.5 Gy in 16 fractions. Results Techniques with tangential beams produced statistically significantly better organs-at-risk (OARs) dosimetry (p < 0.001). Planning target volume Homogeneity Index (HI) was found to be significantly different among all techniques (p < 0.001), with Ecomp resulting in better HI (1.061 ± 0.029). Ecomp was also observed to require relatively shorter planning time (p < 0.001). Conclusions Techniques using tangential fields arrangements produced improved OARs dosimetry. Of all the treatment planning techniques employed in this study, Ecomp was found to be relatively easy to plan and produce acceptable dosimetry for WBRT in a short time.
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Affiliation(s)
- Semaya Natalia Chen
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Prabhakar Ramachandran
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Princess Alexandra Hospital, Queensland, Australia
| | - Pradip Deb
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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Abdeltawab AA, Ali SA, Mostafa HG, Hassan MA. Predictive Factors Increasing the Risk of Radiation Toxicity in Patients with Early Breast Cancer. Asian Pac J Cancer Prev 2021; 22:145-149. [PMID: 33507692 PMCID: PMC8184170 DOI: 10.31557/apjcp.2021.22.1.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/22/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Radiation induces adverse events on healthy tissues which may be augmented by certain factors. This study aimed to assess patients; tumor and treatment-related factors which increase the risk of radiation-induced toxicity in breast cancer patients. METHODS This prospective study included postmenopausal early breast cancer patients treated at the clinical oncology department, Assiut University, Egypt between January 2015 and December 2018. Patients treated with mastectomy followed by conventional radiotherapy (25x 2 Gy) and either concurrent or sequential letrozole. Acute and late radiation toxicity was scored according to EORTC/RTOG and risk factors were analyzed. RESULTS A total of 75 patients were included in the study. After a median follow-up of 24 months, 12 patients had > grade 2 acute dermatitis, 5 patients had > grade 2 cardiac toxicity and 3 patients had > grade 2 lung toxicity. Multivariate analysis revealed that trastuzumab use was associated with a decrease risk of acute dermatitis (p= 0.01) but boost irradiation was significantly associated with increased risk of acute dermatitis (p= 0.01). Late toxicity > grade 2 was observed in 6 patients, 14 patients, and 2 patients for skin, heart, and lung respectively. CONCLUSION The use of boost irradiation was associated with increased risk of acute dermatitis, in the contrary; the use of trastuzumab seemed to be protective as observed in this study.
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Affiliation(s)
- Asmaa A Abdeltawab
- Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Evaluating the Effectiveness of a Novel Skin Barrier Protectant in a Patient with Acute Radiodermatitis of the Vulva: A Case Report. Adv Skin Wound Care 2020; 34:49-55. [PMID: 33323803 DOI: 10.1097/01.asw.0000722768.95461.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the use of a novel skin barrier protectant in a patient treated with radiotherapy for vulvar cancer. METHODS This case report was conducted in a radiotherapy department with two women undergoing radiotherapy for vulvar carcinoma. A novel skin barrier protectant was evaluated in one patient; the other underwent the institutional standard skin care protocol. Skin reactions and pain were evaluated using the Radiotherapy Oncology Group Criteria. MAIN RESULTS The patient who was treated with the skin protectant showed accelerated healing toward the end of radiotherapy, and this was accompanied with a decrease in pain (maximum pain score 6/10). In comparison, the patient treated with the standard skin care protocol had an extended healing process, experienced a higher pain level (maximum pain score 9/10), and required more nursing care. CONCLUSIONS This case report is the first to suggest that this novel skin barrier protectant could effectively manage acute radiodermatitis in patients with cancer. This case report hopes to lay the foundation for future randomized controlled trials with a larger and broader patient population.
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Rattay T, Seibold P, Aguado-Barrera ME, Altabas M, Azria D, Barnett GC, Bultijnck R, Chang-Claude J, Choudhury A, Coles CE, Dunning AM, Elliott RM, Farcy Jacquet MP, Gutiérrez-Enríquez S, Johnson K, Müller A, Post G, Rancati T, Reyes V, Rosenstein BS, De Ruysscher D, de Santis MC, Sperk E, Stobart H, Symonds RP, Taboada-Valladares B, Vega A, Veldeman L, Webb AJ, West CM, Valdagni R, Talbot CJ. External Validation of a Predictive Model for Acute Skin Radiation Toxicity in the REQUITE Breast Cohort. Front Oncol 2020; 10:575909. [PMID: 33216838 PMCID: PMC7664984 DOI: 10.3389/fonc.2020.575909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/15/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Acute skin toxicity is a common and usually transient side-effect of breast radiotherapy although, if sufficiently severe, it can affect breast cosmesis, aftercare costs and the patient's quality-of-life. The aim of this study was to develop predictive models for acute skin toxicity using published risk factors and externally validate the models in patients recruited into the prospective multi-center REQUITE (validating pREdictive models and biomarkers of radiotherapy toxicity to reduce side-effects and improve QUalITy of lifE in cancer survivors) study. Methods: Patient and treatment-related risk factors significantly associated with acute breast radiation toxicity on multivariate analysis were identified in the literature. These predictors were used to develop risk models for acute erythema and acute desquamation (skin loss) in three Radiogenomics Consortium cohorts of patients treated by breast-conserving surgery and whole breast external beam radiotherapy (n = 2,031). The models were externally validated in the REQUITE breast cancer cohort (n = 2,057). Results: The final risk model for acute erythema included BMI, breast size, hypo-fractionation, boost, tamoxifen use and smoking status. This model was validated in REQUITE with moderate discrimination (AUC 0.65), calibration and agreement between predicted and observed toxicity (Brier score 0.17). The risk model for acute desquamation, excluding the predictor tamoxifen use, failed to validate in the REQUITE cohort. Conclusions: While most published prediction research in the field has focused on model development, this study reports successful external validation of a predictive model using clinical risk factors for acute erythema following radiotherapy after breast-conserving surgery. This model retained discriminatory power but will benefit from further re-calibration. A similar model to predict acute desquamation failed to validate in the REQUITE cohort. Future improvements and more accurate predictions are expected through the addition of genetic markers and application of other modeling and machine learning techniques.
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Affiliation(s)
- Tim Rattay
- Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Miguel E Aguado-Barrera
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Altabas
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Azria
- Fédération Universitaire d'Oncologie Radiothérapie d'Occitanie Méditérranée, Département d'Oncologie Radiothérapie, ICM Montpellier, INSERM U1194 IRCM, University of Montpellier, Montpellier, France
| | - Gillian C Barnett
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ananya Choudhury
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, Strangeways Research Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca M Elliott
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Marie-Pierre Farcy Jacquet
- Fédération Universitaire d'Oncologie Radiothérapie d'Occitanie Méditérranée, Département d'Oncologie Radiothérapie, CHU Carémeau, Nîmes, France
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Kerstie Johnson
- Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Anusha Müller
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Giselle Post
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Victoria Reyes
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Barry S Rosenstein
- Department of Radiation Oncology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dirk De Ruysscher
- MAASTRO Clinic, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Radiation Oncology, University Hospitals Leuven/KU Leuven, Leuven, Belgium
| | - Maria C de Santis
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsklinikum Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hilary Stobart
- Independent Cancer Patients' Voice, London, United Kingdom
| | - R Paul Symonds
- Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Begoña Taboada-Valladares
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain.,Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Ana Vega
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Adam J Webb
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Catharine M West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Riccardo Valdagni
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Spain.,Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Hematology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Christopher J Talbot
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
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Ramseier JY, Ferreira MN, Leventhal JS. Dermatologic toxicities associated with radiation therapy in women with breast cancer. Int J Womens Dermatol 2020; 6:349-356. [PMID: 33898697 PMCID: PMC8060663 DOI: 10.1016/j.ijwd.2020.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
Breast-conserving surgery with adjuvant radiation therapy has become the standard of care for women with early stage breast cancer, and as a result, a large number of patients are affected by the cutaneous sequelae of radiation therapy. These dermatologic toxicities may present during treatment or years later and can significantly impact patients’ quality of life. In this review, we discuss the clinical presentation, prevention, and management of radiation-induced cutaneous toxicities in women with breast cancer, including radiation dermatitis, radiation recall, radiation-induced morphea, radiation-induced fibrosis, and cutaneous malignancies in irradiated skin.
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Affiliation(s)
- Julie Y Ramseier
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Michelle N Ferreira
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Jonathan S Leventhal
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
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Wong G, Lam E, Karam I, Yee C, Drost L, Tam S, Lam H, McCarvell A, McKenzie E, Chow E. The impact of smoking on adjuvant breast cancer radiation treatment: A systematic review. Cancer Treat Res Commun 2020; 24:100185. [PMID: 32593846 DOI: 10.1016/j.ctarc.2020.100185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The influence of cigarette smoking on cancer risk has been well-studied. Similarly, exposure to ionizing radiation from radiotherapy (RT) can produce detrimental effects on an individual's health. In patients administered RT, there has been an observed relationship in other primary carcinomas. The purpose of this systematic review was to summarize the influence of cigarette smoking on outcomes post adjuvant RT in breast cancer patients. METHODS OVID Medline, Cochrane and Embase were searched and 1893 articles were identified. A total of 71 articles were included in the review. Study type, published year and sample size, age, systemic therapies, RT techniques and treatment side effects were collected if available. RESULTS The review found 198 different outcomes which fell into 7 categories and similar outcomes were recorded. 40% of skin reaction outcomes, 50% of cardiovascular outcomes, 71% of reconstruction outcomes, 29% of pulmonary function outcomes, 33% of mortality outcomes and 42% of secondary recurrence outcomes reported significant differences between smokers and non-smokers. None of the articles reported non-smokers to have a higher risk than smokers. CONCLUSION Cigarette smoking can pose a higher risk of post-treatment complications that can influence an individual's quality of life, survival rate and/or recurrence risk. This review further assessed the impact of smoking on various patient outcomes and side-effects in the adjuvant breast RT setting. The information provided in this review suggest that smoking cessation programs would help educate patients to understand their risks of being a current or former smoker when undergoing RT.
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Affiliation(s)
- Gina Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Caitlin Yee
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leah Drost
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Tam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alyson McCarvell
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erin McKenzie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Gortman AM, Aherne NJ, Amalaseelan J, Last A, Westhuyzen J, Chamberlain L, Shakespeare TP. Long-term outcomes of patients with conserved breast cancer treated with adjuvant hypofractionated prone breast intensity-modulated radiation therapy. J Med Imaging Radiat Oncol 2020; 64:845-851. [PMID: 32543013 DOI: 10.1111/1754-9485.13072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/20/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION New techniques for adjuvant radiation therapy after breast conservation include prone positioning, hypofractionation and intensity-modulated radiation therapy (IMRT). Long-term evaluations of this combination are lacking, and we report our own experience. METHODS Patients with invasive breast cancer followed for a minimum 36 months post-IMRT were eligible. Dose used was 40 Gray in 15 fractions over 3 weeks to the whole breast via forward-planned prone, whole breast IMRT. A 10 Gy in 5 fraction supine boost was offered. RESULTS Between January 2012 and January 2020, 2199 patients had breast conservation and adjuvant radiation: 489 received hypofractionated prone breast IMRT, with 155 eligible for our evaluation. Median follow-up was 52 months. Median age was 62 (range 36-80), 78.7% were T1, 20.6% were T2, and 12.3% were node-positive. Grade was 1 in 26.5%, 2 in 43.9% and 3 in 29.7%; 87.1% were oestrogen receptor positive, 3.2% were HER2 positive, and 11.0% were triple negative. 58.6% received a boost, 74.8% endocrine therapy and 32.3% chemotherapy. No patient developed local recurrence. One regional recurrence was successfully salvaged. Six patients (3.9%) developed metastases, and 1.9% died. Five-year actuarial local recurrence-free, regional recurrence-free and breast cancer-specific survival rates were 100.0%, 98.2% and 94.8%. Late grade 1 and 2 breast pain occurred in 20.0% and 1.3% of patients. Only 11.0% had new pain compared to pre-radiation. No patient developed radiation-induced pneumonitis, pulmonary fibrosis, rib fracture or cardiac toxicity. All patients scored cosmesis as 'good' or better. CONCLUSION Adjuvant hypofractionated prone breast IMRT has excellent locoregional control and minimal toxicity.
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Affiliation(s)
- Aron M Gortman
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Noel J Aherne
- Department Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Julan Amalaseelan
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Andrew Last
- Department Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Justin Westhuyzen
- Department Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Lauren Chamberlain
- Department Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales, Australia.,Department Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia.,Department Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
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Manie TM, Youssef MMG, Taha SN, Rabea A, Farahat AM. Batwing mammoplasty: a safe oncoplastic technique for breast conservation in breast cancer patients with gigantomastia. Ann R Coll Surg Engl 2020; 102:115-119. [PMID: 31538808 PMCID: PMC6996419 DOI: 10.1308/rcsann.2019.0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Surgical management of breast cancer with gigantomastia can be challenging when planning breast conservation, as major breast reduction is required. Complex oncoplastic procedures can carry an additional surgical risk in this situation. We suggest batwing mammoplasty as a simple and safe oncoplastic procedure for those patients. MATERIALS AND METHODS Fourteen patients with gigantomastia diagnosed with breast cancer were included in this prospective cohort study. All underwent batwing mammoplasty and contralateral symmetrisation procedure between May 2016 and June 2018. Patient satisfaction assessed by the Breast-Q questionnaire. RESULTS All patients had a body mass index above 30kg/m2 with a mean of 36.7kg/m2 (range 31.6-44.9kg/m2). The mean distance from midclavicular point to nipple was 42cm (range 38-50cm). The mean operative time was 83 minutes for procedures done by a single surgeon. Mean specimen weight was 1.2kg (ranging from 1.035-1.63kg). Postoperative complications occurred in 14.2% of patients. Nipple-areola complex viability was not compromised nor sensation impaired. The mean Breast-Q score for patient satisfaction with breasts was 68.6 (range 61-74). The mean score for physiological wellbeing was 77.3 (range 64-84) and the mean score for physical wellbeing was 35 (range 31-40). CONCLUSION Batwing mammoplasty is a safe and simple oncoplastic procedure in patients who have breast cancer with gigantomastia. It has short operative time and low complications rate. In our cohort of patients, there was no delay in the delivery of adjuvant treatment. The cosmetic outcome was favourable with a high patient satisfaction.
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Affiliation(s)
- TM Manie
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - MMG Youssef
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
- Breast Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - SN Taha
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - A Rabea
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - AM Farahat
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Skin Care During and After Radiotherapy and Anticancer Treatment. Radiat Oncol 2020. [DOI: 10.1007/978-3-319-52619-5_115-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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