De Langhe S, Mulliez T, Veldeman L, Remouchamps V, van Greveling A, Gilsoul M, De Schepper E, De Ruyck K, De Neve W, Thierens H, et al.
BMC cancer. Date of publication 2014 Sep 25;volume 14():711.
1. BMC Cancer. 2014 Sep 25;14:711. doi: 10.1186/1471-2407-14-711.
Factors modifying the risk for developing acute skin toxicity after whole-breast
intensity modulated radiotherapy.
De Langhe S, Mulliez T, Veldeman L, Remouchamps V, van Greveling A, Gilsoul M, De
Schepper E, De Ruyck K, De Neve W, Thierens H(1).
Author information:
(1)Department of Basic Medical Sciences, Ghent University, Proeftuinstraat 86,
9000 Ghent, Belgium. Hubert.Thierens@UGent.be.
BACKGROUND: After breast-conserving radiation therapy most patients experience
acute skin toxicity to some degree. This may impair patients' quality of life,
cause pain and discomfort. In this study, we investigated treatment and
patient-related factors, including genetic polymorphisms, that can modify the
risk for severe radiation-induced skin toxicity in breast cancer patients.
METHODS: We studied 377 patients treated at Ghent University Hospital and at
ST.-Elisabeth Clinic and Maternity in Namur, with adjuvant intensity modulated
radiotherapy (IMRT) after breast-conserving surgery for breast cancer. Women were
treated in a prone or supine position with normofractionated (25 × 2 Gy) or
hypofractionated (15 × 2.67 Gy) IMRT alone or in combination with other adjuvant
therapies. Patient- and treatment-related factors and genetic markers in
regulatory regions of radioresponsive genes and in LIG3, MLH1 and XRCC3 genes
were considered as variables. Acute dermatitis was scored using the CTCAEv3.0
scoring system. Desquamation was scored separately on a 3-point scale (0-none,
1-dry, 2-moist).
RESULTS: Two-hundred and twenty patients (58%) developed G2+ dermatitis whereas
moist desquamation occurred in 56 patients (15%). Normofractionation (both p <
0.001), high body mass index (BMI) (p = 0.003 and p < 0.001), bra cup size ≥ D (p
= 0.001 and p = 0.043) and concurrent hormone therapy (p = 0.001 and p = 0.037)
were significantly associated with occurrence of acute dermatitis and moist
desquamation, respectively. Additional factors associated with an increased risk
of acute dermatitis were the genetic variation in MLH1 rs1800734 (p=0.008),
smoking during RT (p = 0.010) and supine IMRT (p = 0.004). Patients receiving
trastuzumab showed decreased risk of acute dermatitis (p < 0.001).
CONCLUSIONS: The normofractionation schedule, supine IMRT, concomitant hormone
treatment and patient related factors (high BMI, large breast, smoking during
treatment and the genetic variation in MLH1 rs1800734) were associated with
increased acute skin toxicity in patients receiving radiation therapy after
breast-conserving surgery. Trastuzumab seemed to be protective.
DOI: 10.1186/1471-2407-14-711
PMCID: PMC4192342
PMID: 25252713 [Indexed for MEDLINE]
