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Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy

(2014) BMC CANCER. 14.
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  • Cancer Plan, Action 29 project 015
Abstract
Background: After breast-conserving radiation therapy most patients experience acute skin toxicity to some degree. This may impair patients' quality of life, cause pain and discomfort. In this study, we investigated treatment and patient-related factors, including genetic polymorphisms, that can modify the risk for severe radiation-induced skin toxicity in breast cancer patients. Methods: We studied 377 patients treated at Ghent University Hospital and at ST.-Elisabeth Clinic and Maternity in Namur, with adjuvant intensity modulated radiotherapy (IMRT) after breast-conserving surgery for breast cancer. Women were treated in a prone or supine position with normofractionated (25 x 2 Gy) or hypofractionated (15 x 2.67 Gy) IMRT alone or in combination with other adjuvant therapies. Patient-and treatment-related factors and genetic markers in regulatory regions of radioresponsive genes and in LIG3, MLH1 and XRCC3 genes were considered as variables. Acute dermatitis was scored using the CTCAEv3.0 scoring system. Desquamation was scored separately on a 3-point scale (0-none, 1-dry, 2-moist). Results: Two-hundred and twenty patients (58%) developed G2+ dermatitis whereas moist desquamation occurred in 56 patients (15%). Normofractionation (both p < 0.001), high body mass index (BMI) (p = 0.003 and p < 0.001), bra cup size >= D (p = 0.001 and p = 0.043) and concurrent hormone therapy (p = 0.001 and p = 0.037) were significantly associated with occurrence of acute dermatitis and moist desquamation, respectively. Additional factors associated with an increased risk of acute dermatitis were the genetic variation in MLH1 rs1800734 (p=0.008), smoking during RT (p = 0.010) and supine IMRT (p = 0.004). Patients receiving trastuzumab showed decreased risk of acute dermatitis (p < 0.001). Conclusions: The normofractionation schedule, supine IMRT, concomitant hormone treatment and patient related factors (high BMI, large breast, smoking during treatment and the genetic variation in MLH1 rs1800734) were associated with increased acute skin toxicity in patients receiving radiation therapy after breast-conserving surgery. Trastuzumab seemed to be protective.
Keywords
ADVERSE-REACTIONS, RANDOMIZED-TRIAL, RADIATION-THERAPY, Radiotherapy, Genetic polymorphisms, Breast cancer, Acute skin toxicity, Large breast size, DERMATITIS, IRRADIATION, CANCER-PATIENTS, ASSOCIATION, POLYMORPHISMS, INJURY, IMRT

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MLA
De Langhe, Sofie et al. “Factors Modifying the Risk for Developing Acute Skin Toxicity After Whole-breast Intensity Modulated Radiotherapy.” BMC CANCER 14 (2014): n. pag. Print.
APA
De Langhe, S., MULLIEZ, T., Veldeman, L., Remouchamps, V., van Greveling, A., Gilsoul, M., DE SCHEPPER, E., et al. (2014). Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy. BMC CANCER, 14.
Chicago author-date
De Langhe, Sofie, THOMAS MULLIEZ, Liv Veldeman, Vincent Remouchamps, Annick van Greveling, Monique Gilsoul, ELINE DE SCHEPPER, Kim De Ruyck, Wilfried De Neve, and Hubert Thierens. 2014. “Factors Modifying the Risk for Developing Acute Skin Toxicity After Whole-breast Intensity Modulated Radiotherapy.” Bmc Cancer 14.
Chicago author-date (all authors)
De Langhe, Sofie, THOMAS MULLIEZ, Liv Veldeman, Vincent Remouchamps, Annick van Greveling, Monique Gilsoul, ELINE DE SCHEPPER, Kim De Ruyck, Wilfried De Neve, and Hubert Thierens. 2014. “Factors Modifying the Risk for Developing Acute Skin Toxicity After Whole-breast Intensity Modulated Radiotherapy.” Bmc Cancer 14.
Vancouver
1.
De Langhe S, MULLIEZ T, Veldeman L, Remouchamps V, van Greveling A, Gilsoul M, et al. Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy. BMC CANCER. 2014;14.
IEEE
[1]
S. De Langhe et al., “Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy,” BMC CANCER, vol. 14, 2014.
@article{5848950,
  abstract     = {{Background: After breast-conserving radiation therapy most patients experience acute skin toxicity to some degree. This may impair patients' quality of life, cause pain and discomfort. In this study, we investigated treatment and patient-related factors, including genetic polymorphisms, that can modify the risk for severe radiation-induced skin toxicity in breast cancer patients. 
Methods: We studied 377 patients treated at Ghent University Hospital and at ST.-Elisabeth Clinic and Maternity in Namur, with adjuvant intensity modulated radiotherapy (IMRT) after breast-conserving surgery for breast cancer. Women were treated in a prone or supine position with normofractionated (25 x 2 Gy) or hypofractionated (15 x 2.67 Gy) IMRT alone or in combination with other adjuvant therapies. Patient-and treatment-related factors and genetic markers in regulatory regions of radioresponsive genes and in LIG3, MLH1 and XRCC3 genes were considered as variables. Acute dermatitis was scored using the CTCAEv3.0 scoring system. Desquamation was scored separately on a 3-point scale (0-none, 1-dry, 2-moist). 
Results: Two-hundred and twenty patients (58%) developed G2+ dermatitis whereas moist desquamation occurred in 56 patients (15%). Normofractionation (both p < 0.001), high body mass index (BMI) (p = 0.003 and p < 0.001), bra cup size >= D (p = 0.001 and p = 0.043) and concurrent hormone therapy (p = 0.001 and p = 0.037) were significantly associated with occurrence of acute dermatitis and moist desquamation, respectively. Additional factors associated with an increased risk of acute dermatitis were the genetic variation in MLH1 rs1800734 (p=0.008), smoking during RT (p = 0.010) and supine IMRT (p = 0.004). Patients receiving trastuzumab showed decreased risk of acute dermatitis (p < 0.001). 
Conclusions: The normofractionation schedule, supine IMRT, concomitant hormone treatment and patient related factors (high BMI, large breast, smoking during treatment and the genetic variation in MLH1 rs1800734) were associated with increased acute skin toxicity in patients receiving radiation therapy after breast-conserving surgery. Trastuzumab seemed to be protective.}},
  articleno    = {{711}},
  author       = {{De Langhe, Sofie and MULLIEZ, THOMAS and Veldeman, Liv and Remouchamps, Vincent and van Greveling, Annick and Gilsoul, Monique and DE SCHEPPER, ELINE and De Ruyck, Kim and De Neve, Wilfried and Thierens, Hubert}},
  issn         = {{1471-2407}},
  journal      = {{BMC CANCER}},
  keywords     = {{ADVERSE-REACTIONS,RANDOMIZED-TRIAL,RADIATION-THERAPY,Radiotherapy,Genetic polymorphisms,Breast cancer,Acute skin toxicity,Large breast size,DERMATITIS,IRRADIATION,CANCER-PATIENTS,ASSOCIATION,POLYMORPHISMS,INJURY,IMRT}},
  language     = {{eng}},
  pages        = {{9}},
  title        = {{Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy}},
  url          = {{http://dx.doi.org/10.1186/1471-2407-14-711}},
  volume       = {{14}},
  year         = {{2014}},
}

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