title: Cytokines, fatigue, and cutaneous erythema in early stage breast cancer patients receiving adjuvant radiation therapy.
abstract: We investigated the hypothesis that patients developing high-grade erythema of the breast skin during radiation treatment could be more likely to present increased levels of proinflammatory cytokines which may lead, in turn, to associated fatigue. Forty women with early stage breast cancer who received adjuvant radiotherapy were enrolled from 2007 to 2010. Fatigue symptoms, erythema, and cytokine levels (IL-1β, IL-2, IL6, IL-8, TNF-α, and MCP-1) were registered at baseline, during treatment, and after radiotherapy completion. Seven (17.5%) patients presented fatigue without associated depression/anxiety. Grade ≥2 erythema was observed in 5 of these 7 patients. IL-1β, IL-2, IL-6, and TNF-α were statistically increased 4 weeks after radiotherapy (P < 0.05). After the Heckman two-step analysis, a statistically significant influence of skin erythema on proinflammatory markers increase (P = 0.00001) was recorded; in the second step, these blood markers showed a significant impact on fatigue (P = 0.026). A seeming increase of fatigue, erythema, and proinflammatory markers was observed between the fourth and the fifth week of treatment followed by a decrease after RT. There were no significant effects of hormone therapy, breast volume, and anemia on fatigue. Our study seems to suggest that fatigue is related to high-grade breast skin erythema during radiotherapy through the increase of cytokines levels.
authors.affiliation: Department of Translational Medicine, Institute of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.affiliation: Department of Translational Medicine, Institute of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Linda
authors.identifier: 0000-0003-1534-4386
authors.initials: L
authors.lastname: Agolli
authors.affiliation: Department of Clinical and Molecular Medicine, Cellular Diagnostic Unit, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Visco
authors.affiliation: Department of Translational Medicine, Institute of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Flavia
authors.identifier: 0000-0002-2241-0460
authors.initials: F
authors.lastname: Monaco
authors.affiliation: Department of Translational Medicine, Institute of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Muni
authors.affiliation: Statistics, Probability and Applied Statistics, "Sapienza" University, Piazzale Aldo Moro 5, 00185 Rome, Italy.
authors.forename: Alessandra
authors.identifier: 0000-0002-7772-3130
authors.initials: A
authors.lastname: Spagnoli
authors.affiliation: Department of Translational Medicine, Institute of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Campanella
authors.affiliation: Department of Translational Medicine, Institute of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Valeriani
authors.affiliation: Department of Translational Medicine, Institute of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.affiliation: Department of Translational Medicine, Institute of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Mattia F
authors.initials: MF
authors.lastname: Osti
authors.affiliation: Department of Translational Medicine, Breast Surgery, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Amanti
authors.affiliation: Department of Clinical and Molecular Medicine, Medical Oncology, "Sapienza" University and IDI-IRCCS, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pellegrini
authors.affiliation: UOD Psyco-oncology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Brunetti
authors.affiliation: UOD Psyco-oncology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Costantini
authors.affiliation: Statistics, Probability and Applied Statistics, "Sapienza" University, Piazzale Aldo Moro 5, 00185 Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Alfò
authors.affiliation: Department of Clinical and Molecular Medicine, Cellular Diagnostic Unit, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Torrisi
authors.affiliation: Department of Clinical and Molecular Medicine, Medical Oncology, "Sapienza" University and IDI-IRCCS, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marchetti
authors.affiliation: Department of Translational Medicine, Institute of Radiation Oncology, "Sapienza" University, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy*; D016207:Cytokines / Q000097:blood*; D004890:Erythema / Q000453:epidemiology* / Q000209:etiology; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods
chemical_list: D016207:Cytokines