title: Prospective evaluation of severe skin toxicity and pain during postmastectomy radiation therapy.
abstract: OBJECTIVE
  To prospectively capture acute toxicities and pain associated with postmastectomy radiation therapy (PMRT), to analyze patient and treatment risk factors for severe side effects.
  
  
  METHODS
  Women referred for PMRT were prospectively enrolled and assessed weekly during and after radiation therapy. The endpoint included severe National Cancer Institute Common Terminology Criteria for Adverse Effects grade 3 moist desquamation, other skin symptoms, and pain.
  
  
  RESULTS
  Of 257 patients, 73 (28.4%) experienced extensive moist desquamation, 84 (32.7%) Common Terminology Criteria for Adverse Effects skin toxicity grade 3, and 57 (22.2%) a pain impacting on daily life activities. Among symptoms only grade 3 moist desquamation was significantly associated with severe pain (P<.001). On multivariate analysis, smoking, high-energy photons, and skin bolus were significantly associated with severe moist desquamation. Skin toxicity doubled for smokers, with 40% severe pain, 48% grade 3 moist desquamation, and 64% grade 3 skin toxicity. Without skin bolus 4.2% had severe pain, none moist desquamation, and 2.1% grade 3 skin toxicity. When skin bolus was used on alternate days, the frequency increased to 15% for pain, 22% for moist desquamation, and 26% for grade 3 skin toxicity. When bolus was used daily, 32% had pain, 41% moist desquamation, and 47% grade 3 skin toxicity. Symptoms peaked 1 to 2 weeks after the end of PMRT.
  
  
  CONCLUSIONS
  The present cohort study suggests excessive radiation toxicity after PMRT. Among factors associated with an increase of toxicity are smoking habits and the use of skin bolus.
authors.affiliation: Department of Radiation Oncology, University of Toronto at Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: j.p.pignol@erasmusmc.nl.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Pignol
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada.
authors.forename: Thi Trinh Thuc
authors.initials: TT
authors.lastname: Vu
authors.affiliation: Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gunita
authors.initials: G
authors.lastname: Mitera
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sandy
authors.initials: S
authors.lastname: Bosnic
authors.affiliation: Imaging Division, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Helena M
authors.initials: HM
authors.lastname: Verkooijen
authors.affiliation: Department of Radiation Oncology, BC Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, Canada.
authors.forename: Pauline
authors.initials: P
authors.lastname: Truong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D010147:Pain Measurement; D011446:Prospective Studies; D011832:Radiation Injuries / Q000150:complications / Q000473:pathology; D011855:Radiodermatitis / Q000150:complications* / Q000473:pathology; D012307:Risk Factors; D012867:Skin / Q000528:radiation effects; D012907:Smoking / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents