Department of Radiation Oncology, University of Florida, Gainesville, FL, USA.
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
Radiat Oncol. 2018 Apr 19;13(1):72. doi: 10.1186/s13014-018-1004-3.
To identify prognostic factors for grade 3 radiation dermatitis following passive-scattering proton therapy for breast cancer.
This retrospective study included data on 23 (11 post-mastectomy and 12 post-lumpectomy) breast cancer patients who underwent proton therapy with the passive scattering technique in our institute from 2012 to 2016. Each patient received 50-50.4 cobalt Gy equivalent (CGE) at 1.8 or 2 CGE per daily fraction. Logistic regression analysis was performed to identify prognostic factors for grade 3 skin toxicity. Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the performance of the models.
43% of the studied patients developed grade 3 radiation dermatitis. The dose-volume histogram (DVH) parameters of V52.5CGE and D10cm to skin5mm were correlated with grade 3 radiation dermatitis in both univariate and multivariate logistic regression analyses. Univariate logistic regression analysis suggested that D10cm to skin5mm (AUC = 0.69) and V52.5CGE to skin5mm (AUC = 0.70) were prognostic for grade 3 skin toxicity. The models using the combination of D10cm to skin5mm or V52.5CGE to skin5mm with breast volume marginally increased the AUC to 0.72 and 0.73, respectively. Models using the combination of D10cm to skin5mm or V52.5CGE to skin5mm with history of smoking increased the AUC to 0.75 and 0.83, respectively.
In the current study, we identified prognostic factors for grade 3 radiation dermatitis in patients treated with passive-scattering proton therapy for breast cancer. This study provides promising tool for identifying high risk patients for whom treatment plan adjustment could be done to reduce the risk of radiation-induced grade 3 skin toxicity.
为了确定乳腺癌被动散射质子治疗后 3 级放射性皮炎的预后因素。
本回顾性研究纳入了 2012 年至 2016 年在我院接受被动散射技术质子治疗的 23 例（11 例乳房切除术和 12 例保乳术）乳腺癌患者的数据。每位患者接受 50-50.4 钴 Gy 等效（CGE），每日 1.8 或 2 CGE 分次照射。采用逻辑回归分析确定 3 级皮肤毒性的预后因素。采用受试者工作特征（ROC）曲线分析和曲线下面积（AUC）来评估模型的性能。
43%的研究患者发生 3 级放射性皮炎。在单变量和多变量逻辑回归分析中，V52.5CGE 和 D10cm 至皮肤 5mm 的剂量-体积直方图（DVH）参数与 3 级放射性皮炎相关。单变量逻辑回归分析表明，D10cm 至皮肤 5mm（AUC=0.69）和 V52.5CGE 至皮肤 5mm（AUC=0.70）是 3 级皮肤毒性的预后因素。使用 D10cm 至皮肤 5mm 或 V52.5CGE 至皮肤 5mm 与乳房体积的组合，AUC 分别增加到 0.72 和 0.73。使用 D10cm 至皮肤 5mm 或 V52.5CGE 至皮肤 5mm 与吸烟史的组合，AUC 分别增加到 0.75 和 0.83。
在本研究中，我们确定了接受被动散射质子治疗的乳腺癌患者 3 级放射性皮炎的预后因素。该研究为识别高风险患者提供了有前景的工具，可对其治疗计划进行调整，以降低 3 级皮肤放射性毒性的风险。
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