Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany.
Radiat Oncol. 2012 Dec 18;7:217. doi: 10.1186/1748-717X-7-217.
PURPOSE/OBJECTIVES: Standard 3D-CRT after BCS may cause skin toxicity with a wide range of intensity including acute effects like erythema or late effects. In order to reduce these side effects it is mandatory to identify potential factors of influence in breast cancer patients undergoing standard three-dimensional conformal radiation therapy (3D-CRT) of the breast and modern systemic therapy.
MATERIALS/METHODS: Between 2006 and 2010 a total of 211 breast cancer patients (median age 52,4 years, range 24-77) after BCS consecutively treated in our institution with 3D-CRT (50 Gy whole breast photon radiotherapy followed by 16 Gy electron boost to the tumorbed) were evaluated with special focus on documented skin toxicity at the end of the 50 Gy-course. Standardized photodocumentation of the treated breast was done in each patient lying on the linac table with arms elevated. Skin toxicity was documented according to the common toxicity criteria (CTC)-score. Potential influencing factors were classified in three groups: patient-specific (smoking, age, breast size, body mass index = BMI, allergies), tumor-specific (tumorsize) and treatment-specific factors (antihormonal therapy with tamoxifen or aromatase inhibitors, chemotherapy). Uni- and multivariate statistical analyses were done using IBM SPSS version 19.
After 50 Gy 3D-CRT to the whole breast 28.9% of all 211 patients had no erythema, 62.2% showed erythema grade 1 (G1) and 8.5% erythema grade 2. None of the patients had grade 3/4 (G3/4) erythema.In univariate analyses a significant influence or trend on the development of acute skin toxicities (erythema G0 versus G1 versus G2) was observed for larger breast volumes (p=0,004), smoking during radiation therapy (p=0,064) and absence of allergies (p=0,014) as well as larger tumorsize (p=0,009) and antihormonal therapy (p=0.005).Neither patient age, BMI nor choice of chemotherapy showed any significant effect on higher grade toxicity. In the multivariate analysis, factors associated with higher grade skin toxicity were larger breast target volume (p=0,003), smoking (p=0,034) and absence of allergies (p=0,002).
Patients treated in this study showed less objectively documented skin toxicity after 50 Gy 3D-CRT compared to similar patient cohorts. Factors associated with higher grade skin toxicity were smoking during 3D-CRT, absence of allergies and larger breast volumes.
目的/目标：保乳手术后的标准 3D-CRT 可能会导致皮肤毒性，其强度范围广泛，包括急性效应如红斑或晚期效应。为了减少这些副作用，有必要识别接受保乳手术后标准三维适形放射治疗（3D-CRT）和现代全身治疗的乳腺癌患者的潜在影响因素。
材料/方法：2006 年至 2010 年，我们机构连续治疗了 211 例保乳术后乳腺癌患者（中位年龄 52.4 岁，范围 24-77 岁），采用 3D-CRT（全乳腺 50Gy 光子放疗，随后在肿瘤床给予 16Gy 电子增敏）。特别关注 50Gy 疗程结束时记录的皮肤毒性。在每个患者躺在直线加速器治疗台上并抬高手臂的情况下，对治疗的乳房进行标准化的光记录。根据常见毒性标准（CTC）评分记录皮肤毒性。潜在影响因素分为三组：患者特定因素（吸烟、年龄、乳房大小、体重指数[BMI]、过敏）、肿瘤特定因素（肿瘤大小）和治疗特定因素（他莫昔芬或芳香化酶抑制剂的抗激素治疗、化疗）。使用 IBM SPSS 版本 19 进行单变量和多变量统计分析。
211 例患者中有 28.9%在接受全乳腺 50Gy 3D-CRT 后无红斑，62.2%出现红斑 1 级（G1），8.5%出现红斑 2 级。没有患者出现 3/4 级（G3/4）红斑。在单变量分析中，观察到乳房体积较大（p=0.004）、放疗期间吸烟（p=0.064）、无过敏（p=0.014）、肿瘤较大（p=0.009）和抗激素治疗（p=0.005）对急性皮肤毒性（红斑 G0 与 G1 与 G2）的发展有显著影响或趋势。患者年龄、BMI 或化疗选择均无显著影响。多变量分析中，与较高等级皮肤毒性相关的因素是较大的乳房靶体积（p=0.003）、吸烟（p=0.034）和无过敏（p=0.002）。
与类似的患者队列相比，接受本研究治疗的患者在接受 50Gy 3D-CRT 后皮肤毒性的客观记录较少。与较高等级皮肤毒性相关的因素是 3D-CRT 期间吸烟、无过敏和较大的乳房体积。
