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01-03-2014 | Original Article

Appropriate evaluation of and risk factors for radiation dermatitis in breast cancer patients receiving hypofractionated whole-breast irradiation after breast-conserving surgery

Authors: Nobuhiko Yoshikawa, Taisuke Inomata, Taiju Shimbo, Masatsugu Takahashi, Yasuo Uesugi, Hiroshi Juri, Yoshifumi Narumi

Published in: Breast Cancer | Issue 2/2014

Abstract

Background

In grading radiation-induced dermatitis (RID), there are not only inter-evaluator differences but also intra-evaluator variations. We retrospectively analyzed the advantages of establishing a more precise evaluation method using photographs to minimize intra-evaluator variations and RID risk factors.

Methods

We analyzed 301 breasts, including those of 3 patients with bilateral breast cancer who underwent hypofractionated whole-breast irradiation (WBI) after breast-conserving surgery. Four radiation oncologists (A, B, C and D) evaluated photographs taken before, during and after radiation therapy and graded RID using two methods.

Results

The percentages of maximum grades between the two methods varied widely. Kappa statistics revealed that the inter- and intra-evaluator agreements were mostly fair. In multivariate analysis, age (≤60 years old), boost irradiation, concurrent hormonal therapy and chemotherapy prior to WBI are statistically significant risk factors for ≥ grade 2 RID according to two evaluators (B and D), two evaluators (A and B), one evaluator (B) and one evaluator (D), respectively.

Conclusions

The assessment of serial skin change in photographs is useful for judging RID. No risk factor was statistically significant for all evaluators because of wide intra-evaluator variations and large inter-evaluator differences. More objective criteria are needed for appropriate evaluation of RID.

Sonoo H, Noguchi S. Results of questionnaire survey on breast cancer surgery in Japan 2004–2006. Breast Cancer. 2008;15:3–4.PubMedCrossRef

Frieben H. Demonstration eines Cancroid des rechten Handruckens, das sich nach langdauernder Einwirkung von Rontgenstrahlen entwickelt hatte. Fortschr Rontgenstr. 1902;6:106–11.

Schnur JB, Love B, Scheckner BL, Green S, Gabriella A, Montgomery GH. A systematic review of patient-rated measures of radiodermatitis in breast cancer radiotherapy. J Clin Oncol. 2011;34:529–36.

Yoshida K, Yamazaki H, Takenaka T, Tanaka E, Kotsuma T, Fujita Y, et al. Objective assessment of dermatitis following post-operative radiotherapy in patients with breast cancer treated with breast-conserving treatment. Strahlenther Onkol. 2010;186:621–9.PubMedCrossRef

Berthelet E, Truong PT, Musso K, Grant V, Kwan W, Moravan V, et al. Preliminary reliability and validity testing of a new Skin Toxicity Assessment Tool (STAT) in breast cancer patients undergoing radiotherapy. Am J Clin Oncol. 2004;27:626–31.PubMedCrossRef

Neben-Wittich MA, Atherton PJ, Schwartz DJ, Sloan JA, Griffin PC, Deming RL, et al. Comparison of provider-assessed and patient-reported outcome measures of acute skin toxicity during a phase III trial of mometasone cream versus placebo during breast radiotherapy: the North Central Cancer Treatment Group (N06C4). Int J Radiat Oncol Biol Phys. 2011;81:397–402.PubMedCentralPubMedCrossRef

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRef

Falkowski S, Trouillas P, Duroux JL, Bonnetblanc JM, Clavere P. Radiodermatitis prevention with sucralfate in breast cancer: fundamental and clinical studies. Support Care Cancer. 2011;19:57–65.PubMedCrossRef

Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment. J Am Acad Dermatol. 2006;54:28–46.PubMedCrossRef

10.

Sitton E. Early and late radiation-induced skin alterations Part I: mechanisms of skin changes. Oncol Nurs Forum. 1992;19:801–7.PubMed

11.

Inomata T, Narabayashi I, Inada Y, Shimbo T, Takahashi M, Tatsumi T, et al. Patients’ subjective evaluation of early and late sequelae in patients with breast cancer irradiated with short fractionation for breast conservation therapy: comparison with conventional fractionation. Breast Cancer. 2008;15:93–100.PubMedCrossRef

12.

Budischewski K, Fischbeck S, Mose S. Quality of life of breast cancer patients in the course of adjuvant radiotherapy. Support Care Cancer. 2008;16:299–304.PubMedCrossRef

13.

Yamazaki H, Yoshida K, Kotsuma T, Kuriyama K, Masuda N, Nishimura T, et al. Longitudinal practical measurement of skin color and moisture during and after breast-conserving therapy: influence of neoadjuvant systemic therapy. Jpn J Radiol. 2009;27:309–15.PubMedCrossRef

14.

Momm F, Bartelt S, Haigis K, Grosse-sender A, Witucki G. Spectrophotometric skin measurements correlate with EORTC/RTOG-common toxicity criteria. Strahlenther Onkol. 2005;181:392–5.PubMedCrossRef

15.

Tucker S, Turesson I, Thames H. Evidence of individual differences in the radiosensitivity of human skin. Eur J Cancer. 1992;28:1782–91.CrossRef

16.

Porock D, Krisjanson L, Nikoletti S, Cameron F, Pedler P. Predicting the severity of radiation skin reactions in women with breast cancer. Oncol Nurs Forum. 1998;25:1019–29.PubMed

17.

Bentzen SM, Skoczylas JZ, Overgaard M, Overgaard J. Radiotherapy-related lung fibrosis enhanced by tamoxifen. J Natl Cancer Inst. 1996;88:918–22.PubMedCrossRef

18.

Wazer DE, DiPetrillo T, Schmidt-Ullrich R, Weld L, Smith TJ, Marchamt DJ, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992;10:356–63.PubMed

19.

Harris EE, Christensen VJ, Hwang WT, Fox K, Solin LJ. Impact of concurrent versus sequential tamoxifen with radiation therapy in early-stage breast cancer patients undergoing breast conservation treatment. J Clin Oncol. 2005;23:11–6.PubMedCrossRef

20.

Valakh V, Trombetta MG, Wets ED, Labban G, Khalid MK, Kaminsky A, et al. Influence of concurrent anastrozole on acute and late side effects of whole breast radiotherapy. Am J Clin Oncol. 2011;33:245–8.CrossRef

21.

Azria D, Belkacemi Y, Romieu G, Gourgou S, Gutowaski M, Zaman K, et al. Concurrent or sequential adjuvant letrozole and radiotherapy after conservative surgery for early stage breast cancer (CO-HO-RT): a phase 2 randomized trial. Lancet Oncol. 2010;11:258–65.PubMedCrossRef

22.

Iwakawa M, Noda S, Yamada S, Yamamoto N, Miyazawa Y, Yamazaki H, et al. Analysis of non-genetic risk factors for adverse skin reactions to radiotherapy among 284 breast cancer patients. Breast Cancer. 2006;13:300–7.PubMedCrossRef

23.

Hijal T, Al Hamad AA, Niazi T, Sultanem K, Bahoric B, Vuong T, et al. Hypofractionated radiotherapy and adjuvant chemotherapy do not increase radiation-induced dermatitis in breast cancer patients. Curr Oncol. 2010;17:22–7.PubMedCentralPubMed

Title: Appropriate evaluation of and risk factors for radiation dermatitis in breast cancer patients receiving hypofractionated whole-breast irradiation after breast-conserving surgery
Authors: Nobuhiko Yoshikawa
Taisuke Inomata
Taiju Shimbo
Masatsugu Takahashi
Yasuo Uesugi
Hiroshi Juri
Yoshifumi Narumi
Publication date: 01-03-2014
Publisher: Springer Japan
Published in: Breast Cancer / Issue 2/2014
Print ISSN: 1340-6868
Electronic ISSN: 1880-4233
DOI: https://doi.org/10.1007/s12282-012-0366-x

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