Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS).
Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS).
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DOI：
10.1186/1748-717x-7-217
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发表时间：
2012-12-18
期刊：
影响因子：
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通讯作者：
Wenz F
中科院分区：
文献类型：
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作者：
Kraus-Tiefenbacher U;Sfintizky A;Welzel G;Simeonova A;Sperk E;Siebenlist K;Mai S;Wenz F
BCS后的标准3D-CRT可能会导致强度范围广泛的皮肤毒性，包括急性效应，如红斑或晚期效应。为了减少这些副作用，它是强制性的，以确定潜在的影响因素，在乳腺癌患者进行标准的三维适形放射治疗（3D-CRT）的乳房和现代全身治疗。在2006年至2010年期间，共211例乳腺癌患者（中位年龄52.4岁，范围24-77岁）在我们的机构接受BCS连续治疗后接受了3D-CRT（50戈伊全乳房光子放疗，随后16戈伊电子加速到肿瘤床），并特别关注50 Gy疗程结束时记录的皮肤毒性。对每名躺在直线加速器床上的患者进行标准化的乳房摄影记录，手臂抬高。根据常见毒性标准（CTC）评分记录皮肤毒性。潜在的影响因素分为三组：患者特异性（吸烟，年龄，乳房大小，体重指数= BMI，过敏），肿瘤特异性（肿瘤大小）和治疗特异性因素（他莫昔芬或芳香酶抑制剂的抗激素治疗，化疗）。使用IBM SPSS 19版进行单变量和多变量统计分析。在对整个乳房进行50戈伊3D-CRT后，所有211名患者中有28.9%没有红斑，62.2%出现1级红斑（G1），8.5%出现2级红斑。无患者出现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）、放射治疗期间吸烟（p = 0.064）和无过敏（p= 0.014）以及肿瘤大小较大（p = 0.009）和抗激素治疗（p = 0.005）对急性皮肤毒性（红斑G 0 vs G1 vs G2）的发展有显著影响或趋势。患者年龄、BMI和化疗选择均未显示对较高级别毒性的任何显著影响。在多变量分析中，与较高级别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）。与类似患者队列相比，本研究中接受治疗的患者在50戈伊3D-CRT后客观记录的皮肤毒性较少。与更高级别皮肤毒性相关的因素是3D-CRT期间吸烟、无过敏和乳房体积较大。
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. 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.