title: Dose response and latency for radiation-induced fibrosis, edema, and neuropathy in breast cancer patients.
abstract: OBJECTIVE
  To study the incidence of various forms of late normal tissue injuries to determine the latency and dose-response relationships.
  
  
  METHODS
  We retrospectively analyzed the clinical records of 150 breast cancer patients treated with radiotherapy after mastectomy in the mid to late 1960s. None of the patients had received chemotherapy as a part of their primary treatment. Radiotherapy was delivered to the parasternal, axillary, and supraclavicular lymph node regions. Almost all the patients continued to be checked at regular 3-month to 1-year intervals at our Oncology Department. Detailed records were available for the entire 34 years of the follow-up period. The patients were divided into 3 groups. The prescribed dose was either 11 x 4 Gy (treated with 60Co photons) or 11 x 4 Gy or 14-15 x 3 Gy (treated with both 60Co photons and electrons). The dose recalculation at the brachial plexus where the axillary and supraclavicular beams overlapped was performed in the early 1970s and expressed in cumulative radiation effect (CRE) units. It varied widely among the individual patients. The received dose has now been converted to biologic effective dose(3) units, and from that into the equivalent dose in 2-Gy fractions to plot the dose-response relationships.
  
  
  RESULTS
  We present a comparison of the latency and frequency of fibrosis, edema, brachial plexus neuropathy, and paralysis in the three different subgroups and the total group. Dose-response relationships are shown at 5, 10, and 30 years after irradiation.
  
  
  CONCLUSIONS
  The use of large daily fractions, combined with hotspots from overlapping fields, was the cause of the complications. Clear dose-response curves were seen for late radiation injuries. The incidence seen at 5 years did not represent the full spectrum of injuries. Doses that seem safe at 5 years can lead to serious complications later.
authors.affiliation: Department of Radiation Sciences, Translational Research Group, Umeå University Hospital, Sweden. silvia.johansson@onkologi.umu.se
authors.forename: Silvia
authors.initials: S
authors.lastname: Johansson
authors.forename: Hans
authors.initials: H
authors.lastname: Svensson
authors.forename: Juliana
authors.initials: J
authors.lastname: Denekamp
mesh_terms: D020516:Brachial Plexus Neuropathies / Q000453:epidemiology / Q000209:etiology*; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D004487:Edema / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D015182:Lymphatic Irradiation; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology*; D010243:Paralysis / Q000453:epidemiology / Q000209:etiology*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies