CANTO-RT: Skin toxicities evaluation of a multicentre large prospective cohort of irradiated patients for early-stage breast cancer.
breast cancer
erythema
fibrosis
radiotherapy
skin toxicity
Journal
International journal of cancer
ISSN: 1097-0215
Titre abrégé: Int J Cancer
Pays: United States
ID NLM: 0042124
Informations de publication
Date de publication:
01 10 2022
01 10 2022
Historique:
revised:
02
04
2022
received:
01
03
2022
accepted:
15
04
2022
pubmed:
1
5
2022
medline:
13
8
2022
entrez:
30
4
2022
Statut:
ppublish
Résumé
Skin damage is the most common and most important toxicity during and after radiation therapy (RT). Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients irradiated for an early breast cancer. CANTO is a prospective clinical cohort study of 10 150 patients with stage I-III BC treated from 2012 to 2017 in 26 cancer centres. In our study, we used CANTO-RT, a subcohort of CANTO, including 3480 patients who received RT. We are focus on specific skin toxicities: erythema, fibrosis, telangiectasia and cutaneous pigmentation. The prevalence of toxicities of interest varied over time, so at baseline for early toxicity Month (M) 0-3-6, 41.1% of patients had erythema while 24.8% of patients had fibrosis. At M12 and M36, the prevalence of erythema decreased, respectively, while fibrosis remains stable. The prevalence of telangiectasia increases from 1% to 7.1% from M0-3-6 to M36. After adjustments, we showed an association between the occurrence of skin erythema and obesity; the type of surgery; the presence of axillary dissection; the use of taxane-based CT and the 3D vs IMRT irradiation technique. Regarding fibrosis, an association is found, at M0-3-6, with age at diagnosis, obesity, tobacco and the use of boost. Only obesity and the type of surgery received by the patient remained statistically significant at M12 and M36. In our study we identified several risk factors for acute and late skin reactions. The use of a boost was mainly related to the occurrence of fibrosis while the use of IMRT-type technique decreased the occurrence of skin erythema.
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1098-1108Informations de copyright
© 2022 UICC.
Références
Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol. 2006;54:28-46.
Savarese DM. Common Terminology Criteria for Adverse Events. Waltham, MA: UpToDate; 2013.
Singh M, Alavi A, Wong R, Akita S. Radiodermatitis: a review of our current understanding. Am J Clin Dermatol. 2016;17:277-292.
Hammer C, Maduro JH, Bantema-Joppe EJ, et al. Radiation-induced fibrosis in the boost area after three-dimensional conformal radiotherapy with a simultaneous integrated boost technique for early-stage breast cancer: a multivariable prediction model. Radiother Oncol. 2017;122:45-49.
Straub JM, New J, Hamilton CD, Lominska C, Shnayder Y, Thomas SM. Radiation-induced fibrosis: mechanisms and implications for therapy. J Cancer Res Clin Oncol. 2015;141:1985-1994.
Dueck AC, Mendoza TR, Mitchell SA, et al. Validity and reliability of the US National Cancer Institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). JAMA Oncol. 2015;1:1051-1059.
Arsenault J, Parpia S, Goldberg M, et al. Acute toxicity and quality of life of hypofractionated radiation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 2020;107:943-948.
Ciammella P, Podgornii A, Galeandro M, et al. Toxicity and cosmetic outcome of hypofractionated whole-breast radiotherapy: predictive clinical and dosimetric factors. Radiat Oncol. 2014;9:97.
Yoshida EJ, Chen H, Torres MA, Curran WJ, Liu T. Spectrophotometer and ultrasound evaluation of late toxicity following breast-cancer radiotherapy. Med Phys. 2011;38:5747-5755.
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341-1346.
Bazire L, Fromantin I, Diallo A, et al. Hydrosorb® versus control (water based spray) in the management of radio-induced skin toxicity: results of multicentre controlled randomized trial. Radiother Oncol. 2015;117:229-233.
Kirova YM, Fromantin I, De Rycke Y, et al. Can we decrease the skin reaction in breast cancer patients using hyaluronic acid during radiation therapy? Results of phase III randomised trial. Radiother Oncol. 2011;100:205-209.
Brouwers PJAM, van Werkhoven E, Bartelink H, et al. Predictors for poor cosmetic outcome in patients with early stage breast cancer treated with breast conserving therapy: results of the young boost trial. Radiother Oncol. 2018;128:434-441.
De Santis MC, Bonfantini F, Di Salvo F, et al. Factors influencing acute and late toxicity in the era of adjuvant hypofractionated breast radiotherapy. Breast. 2016;29:90-95.
Kuptsova N, Chang-Claude J, Kropp S, et al. Genetic predictors of long-term toxicities after radiation therapy for breast cancer. Int J Cancer. 2008;122:1333-1339.
Vaz-Luis I, Cottu P, Mesleard C, et al. UNICANCER: French prospective cohort study of treatment-related chronic toxicity in women with localised breast cancer (CANTO). ESMO Open. 2019;4:e000562.
R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Core Team; 2013.
Allali S, Kirova Y. Radiodermatitis and fibrosis in the context of breast radiation therapy: a critical review. Cancer. 2021;13:5928.
Kraus-Tiefenbacher U, Sfintizky A, Welzel G, et al. 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). Radiat Oncol. 2012;7:217.
Bronsart E, Dureau S, Xu HP, et al. Whole breast radiotherapy in the lateral isocentric lateral decubitus position: long-term efficacy and toxicity results. Radiother Oncol. 2017;124:214-219.
Pignol J-P, Olivotto I, Rakovitch E, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008;26:2085-2092.
Krug D, Köder C, Häfner MF, et al. Acute toxicity of normofractionated intensity modulated radiotherapy with simultaneous integrated boost compared to three-dimensional conformal radiotherapy with sequential boost in the adjuvant treatment of breast cancer. Radiat Oncol. 2020;15:235.
Hörner-Rieber J, Forster T, Hommertgen A, et al. Intensity modulated radiation therapy (IMRT) with simultaneously integrated boost shortens treatment time and is noninferior to conventional radiation therapy followed by sequential boost in adjuvant breast cancer treatment: results of a large randomized phase III trial (IMRT-MC2 trial). Int J Radiat Oncol Biol Phys. 2021;109:1311-1324.
Donovan EM, Yarnold JR, Adams EJ, Morgan A, Warrington APJ, Evans PM. An investigation into methods of IMRT planning applied to breast radiotherapy. Br J Radiol. 2008;81:311-322.
Bartelink H, Horiot J-C, Poortmans PM, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25:3259-3265.
Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16:47-56.
Hamilton DG, Bale R, Jones C, et al. Impact of tumour bed boost integration on acute and late toxicity in patients with breast cancer: a systematic review. Breast. 2016;27:126-135.
Palumbo I, Mariucci C, Falcinelli L, et al. Hypofractionated whole breast radiotherapy with or without hypofractionated boost in early stage breast cancer patients: a mono-institutional analysis of skin and subcutaneous toxicity. Breast Cancer. 2019;26:290-304.
Paelinck L, Gulyban A, Lakosi F, et al. Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial. Radiother Oncol. 2017;122:30-36.
Murray Brunt A, Haviland JS, Wheatley DA, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020;395:1613-1626.
Brunt AM, Wheatley D, Yarnold J, et al. Acute skin toxicity associated with a 1-week schedule of whole breast radiotherapy compared with a standard 3-week regimen delivered in the UK FAST-forward trial. Radiother Oncol. 2016;120:114-118.