title: Late effects of dose fractionation on the mechanical properties of breast skin following post-lumpectomy radiotherapy.
abstract: OBJECTIVE
  Late radiation-induced skin effects were studied in a multicenter project using our new sensitive noninvasive viscoelasticity skin analyzer (VESA).
  
  
  METHODS
  Skin viscoelasticity and anisotropy were examined quantitatively in symmetric areas of both breasts in healthy women and in 110 breast cancer patients who underwent lumpectomy and radiotherapy. These parameters were evaluated by the VESA measurement of the speed of elastic wave propagation in the skin; higher VESA readings correspond to higher skin stiffness. Effect of radiation was estimated by comparison of the data recorded in the irradiated versus nonirradiated breast of the same patient.
  
  
  RESULTS
  Skin viscoelasticity and anisotropy were similar in contralateral areas of the breasts in healthy controls as well as in the nonirradiated breasts of the patients. With age, skin viscoelasticity decreased and anisotropy increased similarly in both breasts. Radiotherapy, by a total radiation dose in the range of 45-50 Gy given with 1.8 Gy/fraction (fx) resulted in a similar minor, but still statistically significant, increase of skin stiffness relative to control. The effect was more pronounced when a dose of 50 Gy was given in a higher dose/fraction of 2.5 Gy.
  
  
  CONCLUSIONS
  We found that the increase in dose of radiation per fraction had much more impact on the development of late skin effects than elevation in the total dose given.
authors.affiliation: Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel. Rafi@Hadassah.org.il
authors.forename: R
authors.initials: R
authors.lastname: Gorodetsky
authors.forename: C
authors.initials: C
authors.lastname: Lotan
authors.forename: K
authors.initials: K
authors.lastname: Piggot
authors.forename: L J
authors.initials: LJ
authors.lastname: Pierce
authors.forename: I
authors.initials: I
authors.lastname: Polyansky
authors.forename: S
authors.initials: S
authors.lastname: Dische
authors.forename: M I
authors.initials: MI
authors.lastname: Saunders
authors.forename: A S
authors.initials: AS
authors.lastname: Lichter
authors.forename: A
authors.initials: A
authors.lastname: Vexler
mesh_terms: D000328:Adult; D000368:Aged; D016880:Anisotropy; D001940:Breast / Q000503:physiopathology / Q000528:radiation effects*; D001943:Breast Neoplasms / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D004548:Elasticity / Q000528:radiation effects; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D012867:Skin / Q000503:physiopathology / Q000528:radiation effects*