title: Changes in skin microcirculation during radiation therapy for breast cancer.
abstract: BACKGROUND
  The majority of breast cancer patients who receive radiation treatment are affected by acute radiation-induced skin changes. The assessment of these changes is usually done by subjective methods, which complicates the comparison between different treatments or patient groups. This study investigates the feasibility of new robust methods for monitoring skin microcirculation to objectively assess and quantify acute skin reactions during radiation treatment.
  
  
  METHODS
  Laser Doppler flowmetry, laser speckle contrast imaging, and polarized light spectroscopy imaging were used to measure radiation-induced changes in microvascular perfusion and red blood cell concentration (RBC) in the skin of 15 patients undergoing adjuvant radiation therapy for breast cancer. Measurements were made before treatment, once a week during treatment, and directly after the last fraction.
  
  
  RESULTS
  In the treated breast, perfusion and RBC concentration were increased after 1-5 fractions (2.66-13.3 Gy) compared to baseline. The largest effects were seen in the areola and the medial area. No changes in perfusion and RBC concentration were seen in the untreated breast. In contrast, Radiation Therapy Oncology Group (RTOG) scores were increased only after 2 weeks of treatment, which demonstrates the potential of the proposed methods for early assessment of skin changes. Also, there was a moderate to good correlation between the perfusion (r = 0.52) and RBC concentration (r = 0.59) and the RTOG score given a week later.
  
  
  CONCLUSIONS
  We conclude that radiation-induced microvascular changes in the skin can be objectively measured using novel camera-based techniques before visual changes in the skin are apparent. Objective measurement of microvascular changes in the skin may be valuable in the comparison of skin reactions between different radiation treatments and possibly in predicting acute skin effects at an earlier stage.
authors.affiliation: a Department of Radiation Physics and Department of Medical and Health Sciences , Linköping University , Linköping , Sweden.
authors.forename: Erik
authors.identifier: http://orcid.org/0000-0002-8387-0583
authors.initials: E
authors.lastname: Tesselaar
authors.affiliation: b Department of Oncology and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.
authors.forename: Anna M
authors.identifier: http://orcid.org/0000-0001-8425-8110
authors.initials: AM
authors.lastname: Flejmer
authors.affiliation: c Department of Hand and Plastic Surgery and Burns and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.
authors.forename: Simon
authors.identifier: http://orcid.org/0000-0002-4997-6835
authors.initials: S
authors.lastname: Farnebo
authors.affiliation: a Department of Radiation Physics and Department of Medical and Health Sciences , Linköping University , Linköping , Sweden.|d The Skandion Clinic , Uppsala , Sweden.
authors.forename: Alexandru
authors.identifier: http://orcid.org/0000-0001-8171-2541
authors.initials: A
authors.lastname: Dasu
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D008833:Microcirculation; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012867:Skin / Q000098:blood supply* / Q000528:radiation effects