The incidence of postoperative radiotherapy-induced acute dermatitis in breast cancer and its influencing factors for Chinese women

Abstract

Purpose: To investigate the incidence of skin acute reaction and its influencing factors in postoperative breast cancer radiotherapy patients.

Methods: One hundred and seventy three cases of breast cancer patients treated with postoperative radiotherapy were consecutively enrolled from June 1, 2016 to July 31, 2017 in our breast cancer center. Irradiation technology includes conformal intensity-modulated radiotherapy and a conventional two-dimensional one with conventional fraction. Any acute radiation dermatitis was recorded and the influencing factors were analyzed at the end of the radiation treatment.

Results: Radiotherapy-induced acute dermatitis in patients with breast-conserving surgery was relatively mild. Among the 173 patients, 33 cases had no obvious changes in the skin (grade 0); 121 cases had grade 1 skin reactions, manifested as local dark erythema and dry peeling; 29 cases had grade 2 skin reactions, characterized by edema, hyperemia, or erosion part; no grade 3 cases of skin reactions were observed. The incidence of grade 0, grade 1, and grade 2 reactions in all patients was 19.1%, 69.9%, and 11.0%, respectively. The severity of skin acute reaction is independent of the tumor sites, molecular subtypes, patients' age, and irradiation modalities, but it depends on the surgical types, fields treated, and planned total radiation. There is a trend favoring no chemotherapy over chemotherapy, though p-value is 0.074.

Conclusion: Skin acute reaction in postoperative radiotherapy breast cancer patients is generally common but mild, and there are quite a few patients who need interruption or cessation of the radiotherapy process. The patients need to be well informed and made aware that any skin reaction will likely be mild, especially for the breast-conserving patients.

Keywords: breast neoplasm; intensity modulated radiotherapy (IMRT); radiotherapy; skin acute reaction.

Figure 1

Image of radiation modalities. Notes: IMRT involved tangential sliding window continuous segmentation with inverse planning of an optimization structure derived from the target volume. Conventional 2D radiation usually had three fields, field A for supraclavicular lymph nodes, field B for medial side of chest wall, and field C for lateral side of chest wall. Abbreviations: 2D, two-dimensional; IMRT, intensity-modulated radiotherapy.

Figure 2

The representative images of grade 0, grade 1, and grade 2 dermatitis in postmastectomy radiotherapy (top panel) and postlumpectomy radiotherapy (bottom panel). Notes: Grade 0: no obvious skin change over baseline; grade 1: skin reactions manifested as local follicular, faint, or dull erythema/epilation/dry desquamation/decreased sweating; grade 2: skin reactions, characterized by tender or bright erythema, patchy moist desquamation/moderate edema. All pictures were taken on the day of the last fraction.