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Title: Racial Variations in Radiation-Induced Skin Toxicity Severity: Data From a Prospective Cohort Receiving Postmastectomy Radiation

Abstract

Purpose: Radiation-induced skin toxicity is one of the most symptomatic side effects of postmastectomy radiation therapy (PMRT). We sought to determine whether the severity of acute skin toxicity was greater in black patients in a prospective cohort receiving PMRT and to identify other predictors of more severe skin toxicity. Methods and Materials: We evaluated the first 110 patients in an ongoing prospective study assessing radiation-induced skin toxicity in patients receiving PMRT. We recorded patient demographics, body mass index (BMI), and disease and treatment characteristics. Logistic regression analyses were conducted to evaluate the effect of potential predictors on the risk of skin toxicity. Results: A total of 23.6% respondents self-identified as black, 5.5% as non-Hispanic white, 69.1% as Hispanic white, and 1.8% as other; 57% were postmenopausal, and 70.9% had BMI of >25. Median chest wall dose was 50 Gy, and mastectomy scar dose was 60 Gy. Most patients, 95.5%, were treated with a 0.5-cm bolus throughout treatment. There were no significant differences in patient characteristics in black versus non-black patients. At RT completion, moist desquamation was more common in black patients (73.1% vs 47.6%, respectively, P=.023), in postmenopausal patients (63.5% vs 40.4%, respectively, P=.016), and in those with BMI of ≥25 (60.3%more » vs 37.5%, respectively, P=.030). On multivariate analysis, the effects of black race (odds ratio [OR] = 7.46, P=.031), BMI ≥25 (OR = 2.95, P=.043) and postmenopausal status (OR = 8.26, P=.004) remained significant risk factors for moist desquamation. Conclusions: In this prospectively followed, racially diverse cohort of breast cancer patients receiving PMRT delivered in a uniform fashion, including the routine use of chest wall boost and bolus, black race, higher BMI, and postmenopausal status emerged as significant predictors of moist desquamation. There was a high frequency of moist desquamation, particularly in those patients with elevated risk. Continued study of patient selection for chest wall boost and bolus as well improved skin toxicity management strategies are needed.« less

Authors:
 [1];  [2];  [3];  [4]; ;  [5];  [3];  [4]
  1. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (United States)
  2. Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida (United States)
  3. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (United States)
  4. (United States)
  5. Department of Public Health Sciences, University of Miami, Miami, Florida (United States)
Publication Date:
OSTI Identifier:
22423818
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 90; Journal Issue: 2; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEST; HAZARDS; MAMMARY GLANDS; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; REGRESSION ANALYSIS; SIDE EFFECTS; SKIN; TOXICITY

Citation Formats

Wright, Jean L., E-mail: jwrigh71@jhmi.edu, Takita, Cristiane, Reis, Isildinha M., Department of Public Health Sciences, University of Miami, Miami, Florida, Zhao, Wei, Lee, Eunkyung, Hu, Jennifer J., and Department of Public Health Sciences, University of Miami, Miami, Florida. Racial Variations in Radiation-Induced Skin Toxicity Severity: Data From a Prospective Cohort Receiving Postmastectomy Radiation. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2014.06.042.
Wright, Jean L., E-mail: jwrigh71@jhmi.edu, Takita, Cristiane, Reis, Isildinha M., Department of Public Health Sciences, University of Miami, Miami, Florida, Zhao, Wei, Lee, Eunkyung, Hu, Jennifer J., & Department of Public Health Sciences, University of Miami, Miami, Florida. Racial Variations in Radiation-Induced Skin Toxicity Severity: Data From a Prospective Cohort Receiving Postmastectomy Radiation. United States. doi:10.1016/J.IJROBP.2014.06.042.
Wright, Jean L., E-mail: jwrigh71@jhmi.edu, Takita, Cristiane, Reis, Isildinha M., Department of Public Health Sciences, University of Miami, Miami, Florida, Zhao, Wei, Lee, Eunkyung, Hu, Jennifer J., and Department of Public Health Sciences, University of Miami, Miami, Florida. Wed . "Racial Variations in Radiation-Induced Skin Toxicity Severity: Data From a Prospective Cohort Receiving Postmastectomy Radiation". United States. doi:10.1016/J.IJROBP.2014.06.042.
@article{osti_22423818,
title = {Racial Variations in Radiation-Induced Skin Toxicity Severity: Data From a Prospective Cohort Receiving Postmastectomy Radiation},
author = {Wright, Jean L., E-mail: jwrigh71@jhmi.edu and Takita, Cristiane and Reis, Isildinha M. and Department of Public Health Sciences, University of Miami, Miami, Florida and Zhao, Wei and Lee, Eunkyung and Hu, Jennifer J. and Department of Public Health Sciences, University of Miami, Miami, Florida},
abstractNote = {Purpose: Radiation-induced skin toxicity is one of the most symptomatic side effects of postmastectomy radiation therapy (PMRT). We sought to determine whether the severity of acute skin toxicity was greater in black patients in a prospective cohort receiving PMRT and to identify other predictors of more severe skin toxicity. Methods and Materials: We evaluated the first 110 patients in an ongoing prospective study assessing radiation-induced skin toxicity in patients receiving PMRT. We recorded patient demographics, body mass index (BMI), and disease and treatment characteristics. Logistic regression analyses were conducted to evaluate the effect of potential predictors on the risk of skin toxicity. Results: A total of 23.6% respondents self-identified as black, 5.5% as non-Hispanic white, 69.1% as Hispanic white, and 1.8% as other; 57% were postmenopausal, and 70.9% had BMI of >25. Median chest wall dose was 50 Gy, and mastectomy scar dose was 60 Gy. Most patients, 95.5%, were treated with a 0.5-cm bolus throughout treatment. There were no significant differences in patient characteristics in black versus non-black patients. At RT completion, moist desquamation was more common in black patients (73.1% vs 47.6%, respectively, P=.023), in postmenopausal patients (63.5% vs 40.4%, respectively, P=.016), and in those with BMI of ≥25 (60.3% vs 37.5%, respectively, P=.030). On multivariate analysis, the effects of black race (odds ratio [OR] = 7.46, P=.031), BMI ≥25 (OR = 2.95, P=.043) and postmenopausal status (OR = 8.26, P=.004) remained significant risk factors for moist desquamation. Conclusions: In this prospectively followed, racially diverse cohort of breast cancer patients receiving PMRT delivered in a uniform fashion, including the routine use of chest wall boost and bolus, black race, higher BMI, and postmenopausal status emerged as significant predictors of moist desquamation. There was a high frequency of moist desquamation, particularly in those patients with elevated risk. Continued study of patient selection for chest wall boost and bolus as well improved skin toxicity management strategies are needed.},
doi = {10.1016/J.IJROBP.2014.06.042},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 90,
place = {United States},
year = {2014},
month = {10}
}