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Title: Prospective Evaluation of Severe Skin Toxicity and Pain During Postmastectomy Radiation Therapy

Purpose: To prospectively capture acute toxicities and pain associated with postmastectomy radiation therapy (PMRT), to analyze patient and treatment risk factors for severe side effects. Methods and Materials: Women referred for PMRT were prospectively enrolled and assessed weekly during and after radiation therapy. The endpoint included severe National Cancer Institute Common Terminology Criteria for Adverse Effects grade 3 moist desquamation, other skin symptoms, and pain. Results: Of 257 patients, 73 (28.4%) experienced extensive moist desquamation, 84 (32.7%) Common Terminology Criteria for Adverse Effects skin toxicity grade 3, and 57 (22.2%) a pain impacting on daily life activities. Among symptoms only grade 3 moist desquamation was significantly associated with severe pain (P<.001). On multivariate analysis, smoking, high-energy photons, and skin bolus were significantly associated with severe moist desquamation. Skin toxicity doubled for smokers, with 40% severe pain, 48% grade 3 moist desquamation, and 64% grade 3 skin toxicity. Without skin bolus 4.2% had severe pain, none moist desquamation, and 2.1% grade 3 skin toxicity. When skin bolus was used on alternate days, the frequency increased to 15% for pain, 22% for moist desquamation, and 26% for grade 3 skin toxicity. When bolus was used daily, 32% had pain, 41% moist desquamation, andmore » 47% grade 3 skin toxicity. Symptoms peaked 1 to 2 weeks after the end of PMRT. Conclusions: The present cohort study suggests excessive radiation toxicity after PMRT. Among factors associated with an increase of toxicity are smoking habits and the use of skin bolus.« less
Authors:
 [1] ;  [2] ;  [3] ;  [4] ;  [5] ;  [6]
  1. Department of Radiation Oncology, Erasmus University, Rotterdam (Netherlands)
  2. Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec (Canada)
  3. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (Canada)
  4. Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)
  5. Imaging Division, University Medical Centre Utrecht, Utrecht (Netherlands)
  6. Department of Radiation Oncology, BC Cancer Agency, Vancouver Island Centre, Victoria, British Columbia (Canada)
Publication Date:
OSTI Identifier:
22423851
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 91; Journal Issue: 1; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; EVALUATION; HAZARDS; MULTIVARIATE ANALYSIS; NEOPLASMS; PAIN; PATIENTS; RADIOTHERAPY; SIDE EFFECTS; SKIN; TOBACCO SMOKES; TOXICITY; WOMEN