title: Impact of hypofractionation and tangential beam IMRT on the acute skin reaction in adjuvant breast cancer radiotherapy.
abstract: BACKGROUND
  The purpose of the study was to evaluate the impact of multiple prognostic factors on the acute skin reaction in adjuvant breast cancer radiotherapy, in particular the impact of hypofractionation (HF) compared to conventional fractionation (CF) and tangential beam (TB) IMRT compared to three-dimensional conformal radiotherapy (3DCRT).
  
  
  METHODS
  Two-hundred and sixty-six breast cancer patients with postoperative radiotherapy after breast conserving surgery or mastectomy were retrospectively evaluated. Patients were treated with HF (15 fractions of 2.67 Gy; n = 121) or CF (28 fractions of 1.8 Gy or 25 fractions of 2.0 Gy; n = 145) and TB-IMRT (n = 151) or 3DCRT (n = 115). The acute skin reactions were prospectively assessed using the CTCAE v4 grading scale. Ordinal regression analysis was used to assess the impact of possible prognostic factors on the maximal acute skin reaction.
  
  
  RESULTS
  Grade 2 skin reactions were observed in 19 % of the patients treated with CF compared to 2 % treated with HF. On univariate analysis, the fractionation regimen, the PTV (breast versus chest wall), the volume of the PTV and the body mass index were significant prognostic factors for the maximum acute skin reaction. On multivariate analysis, the fractionation regimen (p < 0.00001) and the volume of the PTV (p = 0.0002) remained as independent significant factors.
  
  
  CONCLUSIONS
  Our data suggest that HF is associated with a significantly reduced maximal acute skin reaction compared to CF.
authors.affiliation: Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, 31952, Saudi Arabia. vrudat@saadmedical.com.
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
authors.affiliation: Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, 31952, Saudi Arabia.
authors.forename: Alaa
authors.initials: A
authors.lastname: Nour
authors.affiliation: Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, 31952, Saudi Arabia.
authors.forename: Salam Abou
authors.initials: SA
authors.lastname: Ghaida
authors.affiliation: Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, 31952, Saudi Arabia.
authors.forename: Aziz
authors.initials: A
authors.lastname: Alaradi
mesh_terms: D000208:Acute Disease; D000328:Adult; D001943:Breast Neoplasms / Q000150:complications / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000532:radiotherapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000150:complications / Q000532:radiotherapy; D018275:Carcinoma, Lobular / Q000150:complications / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D011446:Prospective Studies; D000069473:Radiation Dose Hypofractionation; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012871:Skin Diseases / Q000209:etiology* / Q000473:pathology
keywords: Breast neoplasms; Dose hypofractionation; IMRT; Radiation injuries; Radiotherapy; Risk factors