An ultrasonographic evaluation of skin thickness in breast cancer patients after postmastectomy radiation therapy.
BACKGROUND
To determine the usefulness of ultrasonography in the assessment of post radiotherapy skin changes in postmastectomy breast cancer patients.


METHODS
Patients treated for postmastectomy radiotherapy in National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH), Singapore between January 2004- December 2005 was recruited retrospectively. Ultrasound scan was performed on these Asian patients who had been treated to a total dose of 46-50 Gy with 1 cm bolus placed on the skin. The ultrasound scans were performed blinded to the RTOG scores, and the skin thickness of the individually marked points on the irradiated chest wall was compared to the corresponding points on the non-irradiated breast.


RESULTS
The mean total skin thickness inclusive of the epidermis and the dermis of the right irradiated chest wall was 0.1712 mm (± 0.03392 mm) compared with the contra-lateral non-irradiated breast which was 0.1845 mm (± 0.04089 mm; p = 0.007). The left irradiated chest wall had a mean skin thickness of 0.1764 mm (± 0.03184 mm) compared with the right non-irradiated breast which was 0.1835 mm (± 0.02584 mm; p = 0.025). These independent t-tests produced a significant difference of reduced skin thickness on the right irradiated chest wall, p = 0.007 (p < 0.05) and left irradiated chest wall p = 0.025 (p < 0.025) in comparison to the non-irradiated skin thickness investigating chronic skin reactions. Patients with grade 2 acute skin toxicity presented with thinner skin as compared to patients with grade 1 (p = 0.006).


CONCLUSIONS
This study has shown that there is a statistically significant difference between the skin thicknesses of the irradiated chest wall and the contra-lateral non-irradiated breast and a predisposition to chronic reactions was found in patients with acute RTOG scoring of grade1 and grade 2.
National University of Singapore, Yong Loo Lin School of Medicine, 21 Lower Kent Ridge Road, Singapore.
Sharon
S
Wong
Amarjit
A
Kaur
Michael
M
Back
Khai Mun
KM
Lee
Shaun
S
Baggarley
Jiade Jay
JJ
Lu
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery*; D002921:Cicatrix / Q000000981:diagnostic imaging; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D008954:Models, Biological; D009929:Organ Size / Q000528:radiation effects; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000473:pathology / Q000528:radiation effects; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012867:Skin / Q000000981:diagnostic imaging* / Q000473:pathology*; D014463:Ultrasonography
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