Predictors of radiation-induced acute skin toxicity in breast cancer at a single institution: Role of fractionation and treatment volume

Arti Parekh, Avani D. Dholakia, Daniel J. Zabranksy, Fariba Asrari, Melissa Camp, Mehran Habibi, Richard Zellars, Jean Wright

Research output: Contribution to journalArticle

Abstract

Purpose: The associations among radiation fractionation, body mass index (BMI), and acute skin toxicity with adjuvant radiation for breast cancer is of increasing interest. This study evaluated the rate of grade ≥2 dermatitis and moist desquamation (MD) in patients with a high BMI who were treated to the breast or chest wall to understand the role of radiation target, fractionation regimen, and BMI. Methods and materials: We retrospectively evaluated 280 patients treated with adjuvant radiation for breast cancer after up-front surgery. We collected information on patient demographics, disease and treatment characteristics, and acute skin toxicities. Multiple logistic regression models were used to evaluate for predictors of grade ≥2 dermatitis and MD. Results: Patients undergoing post-mastectomy radiation therapy (PMRT) had the highest rate of MD (24%). The rate was lower (8.7%) among lumpectomy patients, but those receiving conventional fractionation had a higher rate of MD (10.9%) compared with hypofractionated therapy (1.8%; P = .05). Among lumpectomy patients, chemotherapy use (odds ratio, 3.74; P = .04) and regional nodal irradiation (odds ratio, 3.29; P = .03) were also significant predictors of MD. Despite an elevated average BMI among lumpectomy patients, hypofractionated therapy resulted in lower rates of skin toxicity. Conclusions: We identified multiple risk factors for acute skin toxicity, including the use of PMRT and conventionally fractionated regimens. Elevated BMI, regional nodal irradiation, and chemotherapy use were associated with an increased risk of MD. Our findings highlight the need to explore the use of less toxic hypofractionated regimens in patients who are at the highest risk of acute skin toxicity, including those with a higher BMI and those receiving PMRT.

Original languageEnglish (US)
JournalAdvances in Radiation Oncology
DOIs
StateAccepted/In press - Jan 1 2018

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Radiation
Breast Neoplasms
Skin
Body Mass Index
Segmental Mastectomy
Mastectomy
Radiotherapy
Dermatitis
Therapeutics
Logistic Models
Odds Ratio
Drug Therapy
Poisons
Thoracic Wall
Breast
Demography

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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Predictors of radiation-induced acute skin toxicity in breast cancer at a single institution : Role of fractionation and treatment volume. / Parekh, Arti; Dholakia, Avani D.; Zabranksy, Daniel J.; Asrari, Fariba; Camp, Melissa; Habibi, Mehran; Zellars, Richard; Wright, Jean.

In: Advances in Radiation Oncology, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Purpose: The associations among radiation fractionation, body mass index (BMI), and acute skin toxicity with adjuvant radiation for breast cancer is of increasing interest. This study evaluated the rate of grade ≥2 dermatitis and moist desquamation (MD) in patients with a high BMI who were treated to the breast or chest wall to understand the role of radiation target, fractionation regimen, and BMI. Methods and materials: We retrospectively evaluated 280 patients treated with adjuvant radiation for breast cancer after up-front surgery. We collected information on patient demographics, disease and treatment characteristics, and acute skin toxicities. Multiple logistic regression models were used to evaluate for predictors of grade ≥2 dermatitis and MD. Results: Patients undergoing post-mastectomy radiation therapy (PMRT) had the highest rate of MD (24{\%}). The rate was lower (8.7{\%}) among lumpectomy patients, but those receiving conventional fractionation had a higher rate of MD (10.9{\%}) compared with hypofractionated therapy (1.8{\%}; P = .05). Among lumpectomy patients, chemotherapy use (odds ratio, 3.74; P = .04) and regional nodal irradiation (odds ratio, 3.29; P = .03) were also significant predictors of MD. Despite an elevated average BMI among lumpectomy patients, hypofractionated therapy resulted in lower rates of skin toxicity. Conclusions: We identified multiple risk factors for acute skin toxicity, including the use of PMRT and conventionally fractionated regimens. Elevated BMI, regional nodal irradiation, and chemotherapy use were associated with an increased risk of MD. Our findings highlight the need to explore the use of less toxic hypofractionated regimens in patients who are at the highest risk of acute skin toxicity, including those with a higher BMI and those receiving PMRT.",
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AU - Asrari, Fariba

AU - Camp, Melissa

AU - Habibi, Mehran

AU - Zellars, Richard

AU - Wright, Jean

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N2 - Purpose: The associations among radiation fractionation, body mass index (BMI), and acute skin toxicity with adjuvant radiation for breast cancer is of increasing interest. This study evaluated the rate of grade ≥2 dermatitis and moist desquamation (MD) in patients with a high BMI who were treated to the breast or chest wall to understand the role of radiation target, fractionation regimen, and BMI. Methods and materials: We retrospectively evaluated 280 patients treated with adjuvant radiation for breast cancer after up-front surgery. We collected information on patient demographics, disease and treatment characteristics, and acute skin toxicities. Multiple logistic regression models were used to evaluate for predictors of grade ≥2 dermatitis and MD. Results: Patients undergoing post-mastectomy radiation therapy (PMRT) had the highest rate of MD (24%). The rate was lower (8.7%) among lumpectomy patients, but those receiving conventional fractionation had a higher rate of MD (10.9%) compared with hypofractionated therapy (1.8%; P = .05). Among lumpectomy patients, chemotherapy use (odds ratio, 3.74; P = .04) and regional nodal irradiation (odds ratio, 3.29; P = .03) were also significant predictors of MD. Despite an elevated average BMI among lumpectomy patients, hypofractionated therapy resulted in lower rates of skin toxicity. Conclusions: We identified multiple risk factors for acute skin toxicity, including the use of PMRT and conventionally fractionated regimens. Elevated BMI, regional nodal irradiation, and chemotherapy use were associated with an increased risk of MD. Our findings highlight the need to explore the use of less toxic hypofractionated regimens in patients who are at the highest risk of acute skin toxicity, including those with a higher BMI and those receiving PMRT.

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