title: Standard or hypofractionated radiotherapy in the postoperative treatment of breast cancer: a retrospective analysis of acute skin toxicity and dose inhomogeneities.
abstract: BACKGROUND
  To identify predictive factors of radiation-induced skin toxicity in breast cancer patients by the analysis of dosimetric and clinical factors.
  
  
  METHODS
  339 patients treated between January 2007 and December 2010 are included in the present analysis. Whole breast irradiation was delivered with Conventional Fractionation (CF) (50 Gy, 2.0/day, 25 fractions) and moderate Hypofractionated Schedule (HS) (44 Gy, 2.75 Gy/day, 16 fractions) followed by tumour bed boost. The impact of patient clinical features, systemic treatments and, in particular, dose inhomogeneities on the occurrence of different levels of skin reaction has been retrospectively evaluated.
  
  
  RESULTS
  G2 and G3 acute skin toxicity were 42% and 13% in CF patients and 30% and 7.5% in HS patients respectively. The retrieval and revaluation of 200 treatment plans showed a strong correlation between areas close to the skin surface, with inhomogeneities >107% of the prescribed dose, and the desquamation areas as described in the clinical records.
  
  
  CONCLUSIONS
  In our experience dose inhomogeneity underneath G2 - G3 skin reactions seems to be the most important predictor for acute skin damage and in these patients more complex treatment techniques should be considered to avoid skin damage. Genetic polymorphisms too have to be investigated as possible promising candidates for predicting acute skin reactions.
authors: Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Viale Oxford 81, Rome 00133, Italy.
authors: Grazia
authors: G
authors: Tortorelli
authors: Luana
authors: L
authors: Di Murro
authors: Rosaria
authors: R
authors: Barbarino
authors: Sara
authors: S
authors: Cicchetti
authors: Daniela
authors: D
authors: di Cristino
authors: Maria Daniela
authors: MD
authors: Falco
authors: Dahlia
authors: D
authors: Fedele
authors: Gianluca
authors: G
authors: Ingrosso
authors: Dania
authors: D
authors: Janniello
authors: Pasquale
authors: P
authors: Morelli
authors: Alessandra
authors: A
authors: Murgia
authors: Elisabetta
authors: E
authors: Ponti
authors: Sara
authors: S
authors: Terenzi
authors: Barbara
authors: B
authors: Tolu
authors: Riccardo
authors: R
authors: Santoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D004890:Erythema / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011855:Radiodermatitis / Q000209:etiology*; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
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