Relationship between early and late normal-tissue injury after postmastectomy radiotherapy

doi:10.1016/0167-8140(91)90092-U

Radiotherapy and Oncology

Volume 20, Issue 3, March 1991, Pages 159-165

https://doi.org/10.1016/0167-8140(91)90092-U Get rights and content

Abstract

Factors of importance in the development of telangiectasia were investigated in a series of 229 patients who, between 1978 and 1982, received postmastectomy radiotherapy with two different fractionation schedules. Patients who developed moist desquamation had a statistically significantly increased risk of developing telangiectasia after a specific course of radiotherapy. As an example the estimated incidence of severe telangiectasia after 44 Gy in 22 fractions increases from 27% to 49% in patients who developed grade ⩾ 2 moist desquamation as an early radiation reaction. A reanalysis of the Aarhus data with telangiectasia as the endpoint gave an $α β$ ratio at 2.8 Gy (95% c.l. (− 0.1, 8.1) Gy) and a relative biological effectiveness (RBE) of high energy electrons relative to 8 MV photons at 0.89 (95% c.l. (0.85, 0.93)). Patients age or the occurrence of severe erythema did not predispose to telangiectasia. A similar predisposition after moist desquamation was not seen for subcutaneous fibrosis. The RBE of high energy electrons relative to 8 MV photons for this endpoint was estimated at 0.88 (95% c.l. (0.86, 0.91)).

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Citation Excerpt :
The theoretical rationale behind the use of bolus in PMRT is to increase radiotherapy dose to the skin and dermal lymphatics, thereby reducing the risk of chest wall recurrences (CWR). However, bolus can lead to an increase in acute and late skin toxicities [4], and in some cases, significant moist desquamation, resulting in the early cessation of treatment and potentially inferior local control [5,6]. The routine use of bolus during PMRT remains a controversial issue, with limited clinical data to guide its optimal use.
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There were 314 patients suitable for analysis: 52 received bolus, 262 did not. The mean age was 53.2 years. The median follow-up was 4.2 years. The most common T stage was T2 (37%), followed by T3/T4 (33%). There were 229 patients (73%) who had N+ disease; 213 (68%) patients had grade 3 cancer. Oestrogen receptor was positive in 176 (56%) cases, progesterone receptor was positive in 134 (43%) and HER2 receptor was positive in 24 (8%). Lymphovascular space invasion was present in 146 patients (46%), dermal invasion in 30 patients (10%) and positive margin in 14 patients (4%). The 4 year chest wall recurrence rate was 14% (95% confidence interval 5.4–26.8%) in the bolus group and only 3.5% (95% confidence interval 1.6–6.4%) in the non-bolus group. On univariate analysis, use of bolus was associated with a significant difference in chest wall recurrence (hazard ratio 3.09; 1.15–8.33; P = 0.025). However, when taking into account margin status, this significance was lost (hazard ratio = 2.45; 95% confidence interval 0.80–7.50, P = 0.12). There was a higher rate of acute grade 2 skin toxicity in patients receiving bolus compared with those without, 40% versus 21% (P = 0.01).
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A Randomized Trial of Mometasone Furoate 0.1% to Reduce High-Grade Acute Radiation Dermatitis in Breast Cancer Patients Receiving Postmastectomy Radiation
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A 2-arm, double-blinded randomized trial was conducted to evaluate the efficacy of 0.1% mometasone furoate (MF) versus Eucerin Original (E) cream in preventing the development of moderate to severe acute radiation dermatitis (ARD) in breast cancer patients receiving postmastectomy radiation (PMRT).
Breast cancer patients undergoing chest wall with or without nodal radiation therapy (RT) (50 Gy) were eligible. Randomization (1:1) was to MF or E, applied twice daily from day 1 of PMRT to 14 days after PMRT. Patients were stratified by RT technique, body mass index, and reconstruction status. Daily bolus of 3 to 10 mm was applied in all patients. The primary endpoint was the development of provider-assessed grade ≥2 (Common Terminology Criteria for Adverse Events version 4.03) ARD with moist desquamation or any grade ≥3 dermatitis. Secondary endpoints were time to occurrence of maximum-grade dermatitis and patient-reported skin symptoms using a skin-related quality of life questionnaire, Skindex-16. Assessments were performed at baseline, weekly during PMRT, and 2 weeks after PMRT.
124 patients were enrolled between May 2013 and February 2016. Of those, 35% had pathologic stage III disease, 6% had cT4d disease, and 68% underwent reconstruction. Sixty percent received 3-dimensional conformal RT with photons only to the chest wall, 18% received electrons and photons, and 23% received inverse-planned intensity modulated RT. Groups were well balanced for age, skin type, and stage. The rate of moist desquamation was 54.8% in the entire cohort, with a significantly reduced incidence in the MF arm than in the E arm (43.8% vs 66.7%; P = .012). The MF arm had a lower incidence of maximum skin toxicities (P = .036) and longer time to development of grade 3 dermatitis (46 days vs 35.5 days, respectively; P ≤ .001). There was no difference in patient-reported skin outcomes between arms.
Breast cancer patients receiving MF during PMRT experienced significantly reduced rates of moist desquamation in comparison with a control cream.
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Regular paperRelationship between early and late normal-tissue injury after postmastectomy radiotherapy

Abstract

Radiother. Oncol.

Int. J. Radiat. Oncol. Biol. Phys.

Radiother. Oncol.

Radiother. Oncol.

Int. J. Radiat. Oncol. Biol. Phys.

Int. J. Radiat. Oncol. Biol. Phys.

Radiother. Oncol.

Int. J. Radiat. Oncol. Biol. Phys.

Radiother. Oncol.

Some methodological problems in estimating radiobiological parameters from clinical data. Alpha/beta ratios and electron RBE for cutaneous reactions in patients treated with postmastectomy radiotherapy

Acta Oncol.

Direct estimation of latent time for radiation injury in late-responding normal tissues: gut, lung and spinal cord

Int. J. Radiat. Biol.

New options in direct analysis of dose-response data

Int. J. Radiat. Biol.

Regular paper
Relationship between early and late normal-tissue injury after postmastectomy radiotherapy