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Meta-Analysis
. 2025 Jul;212(1):1-12.
doi: 10.1007/s10549-025-07700-y. Epub 2025 May 5.

Chronic skin toxicities in breast cancer survivors: a systematic review and meta-analysis of radiotherapy techniques

Shing Fung Lee  1   2 , Henry C Y Wong  3 , Jolien Robijns  4 , Stephen Lowell B Ciocon  5 , Paula Elaine Diniz Dos Reis  6   7 , Sarina Sadeghi  8 , Muna Al-Khaifi  8 , Mami Ogita  9 , Adrian W Chan  10 , Agata Rembielak  11   12 , Daniel Livesey  13 , Matthew Chong  14 , Zhihui Amy Liu  15   16 , Mark Trombetta  17 , Wee Yao Koh  18   19 , Yiat Horng Leong  18 , Gustavo N Marta  20   21   22 , Pierluigi Bonomo  23 , Viola Salvestrini  23 , Vassilios Vassiliou  24 , Pradnya Chopade  5 , Partha Patel  25 , Cindy Wong  26 , Julie Ryan Wolf  27   28 , Corina van den Hurk  29 , Raymond J Chan  30 , Michael Jefford  31 , Edward Chow  32   33 , Jennifer Yin Yee Kwan  5   32   34 ; on behalf of the Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology and, Survivorship Study Groups
Affiliations
Meta-Analysis

Chronic skin toxicities in breast cancer survivors: a systematic review and meta-analysis of radiotherapy techniques

Shing Fung Lee et al. Breast Cancer Res Treat. 2025 Jul.

Abstract

Purpose: This study assessed the impact of radiotherapy (RT) techniques on chronic skin reactions and health-related quality of life (HRQoL) in breast cancer patients, comparing conventional RT with modern techniques such as intensity-modulated RT (IMRT).

Methods: A comprehensive search was conducted in Embase, MEDLINE, and Cochrane CENTRAL from inception to April 26, 2024. Conventional RT, which uses 2D or 3D imaging to shape radiation beams without dynamic intensity modulation, was compared with alternate RT techniques for adjuvant breast cancer treatment. Primary outcomes included chronic grade ≥ 2 skin toxicities (hyperpigmentation, breast fibrosis, telangiectasia, edema, and atrophy/retraction) and HRQoL, assessed mainly with EORTC QLQ-C30 and QLQ-BR23 modules. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.

Results: From 1305 screened studies, nine articles representing seven studies (2418 patients), including three randomized controlled trials, met inclusion criteria. Most studies used conventional fractionation (45-50 Gray in 25 fractions). IMRT was associated with a lower incidence of chronic grade ≥ 2 hyperpigmentation (RR: 0.39, 95%CI: 0.17-0.89, I2 = 0%) compared to conventional RT. No significant differences were found for grade ≥ 2 breast fibrosis, telangiectasia, edema, and atrophy/retraction. Cosmetic outcomes from IMRT were favorable in the short term, with no long-term differences. Three studies reported no significant HRQoL differences between IMRT and conventional RT.

Conclusion: IMRT may reduce certain chronic skin toxicities compared to conventional RT. However, consistent long-term differences in cosmetic outcomes or HRQoL were not observed. These findings are limited by the small number of studies and variability in reporting standards.

Keywords: Breast neoplasms; Conformal; Intensity-modulated; Quality of life; Radiotherapy; Skin diseases.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent to publish: Not applicable.

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