Parekh Arti, Dholakia Avani D, Zabranksy Daniel J, Asrari Fariba, Camp Melissa, Habibi Mehran, Zellars Richard, Wright Jean L
Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, Maryland.
Department of Surgical Oncology, Johns Hopkins Hospital, Baltimore, Maryland.
Adv Radiat Oncol. 2017 Nov 6;3(1):8-15. doi: 10.1016/j.adro.2017.10.007. eCollection 2018 Jan-Mar.
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.
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.
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%; = .05). Among lumpectomy patients, chemotherapy use (odds ratio, 3.74; = .04) and regional nodal irradiation (odds ratio, 3.29; = .03) were also significant predictors of MD. Despite an elevated average BMI among lumpectomy patients, hypofractionated therapy resulted in lower rates of skin toxicity.
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.
乳腺癌辅助放疗中，放疗分割、体重指数（BMI）与急性皮肤毒性之间的关联日益受到关注。本研究评估了高BMI患者在接受乳房或胸壁放疗时发生≥2级皮炎和湿性脱屑（MD）的发生率，以了解放疗靶区、分割方案和BMI的作用。
我们回顾性评估了280例 upfront手术后接受乳腺癌辅助放疗的患者。我们收集了患者人口统计学、疾病和治疗特征以及急性皮肤毒性方面的信息。使用多个逻辑回归模型评估≥2级皮炎和MD的预测因素。
接受乳房切除术后放疗（PMRT）的患者MD发生率最高（24%）。保乳手术患者的发生率较低（8.7%），但与大分割放疗（1.8%；P = 0.05）相比，接受常规分割的患者MD发生率较高（10.9%）。在保乳手术患者中，化疗的使用（优势比，3.74；P = 0.04）和区域淋巴结照射（优势比，3.29；P = 0.03）也是MD的重要预测因素。尽管保乳手术患者的平均BMI升高，但大分割放疗导致皮肤毒性发生率较低。
我们确定了急性皮肤毒性的多个危险因素，包括PMRT和常规分割方案的使用。BMI升高、区域淋巴结照射和化疗的使用与MD风险增加相关。我们的研究结果强调，有必要探索在急性皮肤毒性风险最高的患者中使用毒性较小的大分割方案，包括BMI较高的患者和接受PMRT的患者。
