title: Appropriate evaluation of and risk factors for radiation dermatitis in breast cancer patients receiving hypofractionated whole-breast irradiation after breast-conserving surgery.
abstract: BACKGROUND
  In grading radiation-induced dermatitis (RID), there are not only inter-evaluator differences but also intra-evaluator variations. We retrospectively analyzed the advantages of establishing a more precise evaluation method using photographs to minimize intra-evaluator variations and RID risk factors.
  
  
  METHODS
  We analyzed 301 breasts, including those of 3 patients with bilateral breast cancer who underwent hypofractionated whole-breast irradiation (WBI) after breast-conserving surgery. Four radiation oncologists (A, B, C and D) evaluated photographs taken before, during and after radiation therapy and graded RID using two methods.
  
  
  RESULTS
  The percentages of maximum grades between the two methods varied widely. Kappa statistics revealed that the inter- and intra-evaluator agreements were mostly fair. In multivariate analysis, age (≤60 years old), boost irradiation, concurrent hormonal therapy and chemotherapy prior to WBI are statistically significant risk factors for ≥ grade 2 RID according to two evaluators (B and D), two evaluators (A and B), one evaluator (B) and one evaluator (D), respectively.
  
  
  CONCLUSIONS
  The assessment of serial skin change in photographs is useful for judging RID. No risk factor was statistically significant for all evaluators because of wide intra-evaluator variations and large inter-evaluator differences. More objective criteria are needed for appropriate evaluation of RID.
authors.affiliation: Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan, rad101@poh.osaka-med.ac.jp.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Yoshikawa
authors.forename: Taisuke
authors.initials: T
authors.lastname: Inomata
authors.forename: Taiju
authors.initials: T
authors.lastname: Shimbo
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Takahashi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Uesugi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Juri
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Narumi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D015412:Mastectomy, Segmental; D008875:Middle Aged; D015999:Multivariate Analysis; D010781:Photography / Q000379:methods*; D011855:Radiodermatitis / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult