title: Photobiomodulation therapy for the management of radiation-induced dermatitis : A single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery.
abstract: BACKGROUND
  Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT.
  
  
  METHODS
  Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a "matched" group (n = 25) was generated from the control group based on propensity for potentially confounding variables.
  
  
  RESULTS
  In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5.
  
  
  CONCLUSIONS
  PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery.
authors.affiliation: Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany. iosif.strouthos@uniklinik-freiburg.de.|Department of Radiotherapy and Oncology, Medical Center - Albert Ludwigs University of Freiburg, Robert Koch 3, 79106, Freiburg, Germany. iosif.strouthos@uniklinik-freiburg.de.
authors.forename: Iosif
authors.identifier: http://orcid.org/0000-0001-6229-5471
authors.initials: I
authors.lastname: Strouthos
authors.affiliation: Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.|Department of Radiotherapy and Oncology, J. W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Chatzikonstantinou
authors.affiliation: Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.|Department of Radiotherapy and Oncology, J. W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tselis
authors.affiliation: Institute of Biostatistics and Mathematical Modelling, J. W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Bon
authors.affiliation: Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.|Department of Radiation Oncology, Otto von Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Karagiannis
authors.affiliation: Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
authors.forename: Eleni
authors.initials: E
authors.lastname: Zoga
authors.affiliation: Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Ferentinos
authors.affiliation: Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Maximenko
authors.affiliation: Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Nikolettou-Fischer
authors.affiliation: Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Zamboglou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011855:Radiodermatitis / Q000532:radiotherapy*; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal; D016896:Treatment Outcome
keywords: Breast cancer; Light-emitting diode (LED); Photobiomodulation; Radiation therapy; Radiodermatitis