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acute radiation dermatitis, breast cancer, hypofractionation, BMI
Objective: Adjuvant breast radiation increases the risk of acute dermatitis and we aimed to identify patient and treatment characteristics that may increase this risk to help individualize the prevention and management of radiation-induced skin toxicities.
Methods/Materials: We analyzed 320 women with breast cancer who received adjuvant radiation for increased risk of acute dermatitis based upon age, BMI, histology, stage, chemotherapy, radiation fractionation, whole breast dose, tumor bed boost dose, total dose, diuretics use, smoking, diabetes, autoimmune disease, and chronic immunosuppression. Univariate logistic regression was used to compare each factor across the dermatitis groups. Significant factors were analyzed in a multivariate analysis.
Results: On univariate analysis, grade 3 dermatitis was more likely with a 1 unit BMI increase (OR 1.084, p=0.005). Grade 2 dermatitis risk increased with each 100 cGy increase in breast dose (OR 1.14, p=<0.001). Every 100 cGy total dose increase resulted in higher grade 2 and 3 dermatitis risks (OR 1.13 and 1.45, p=<0.001). There was decreased risk of grade 2 and 3 dermatitis with hypofractionated radiation (grade 2: OR 0.16, p=<0.0001; grade 3: OR 0.08, p=0.017).
On multivariate analysis, higher risk of grade 2 (OR 1.06, p=0.014) and 3 dermatitis (OR 1.12, p=<0.001) remained with increasing BMI. Higher total dose increased grade 3 dermatitis (OR 1.35, p=0.019). Hypofractionated radiation continued to decrease the risk of grade 2 dermatitis (OR 0.08, p=<0.001).
Conclusion: Lower BMI, lower total dose, and hypofractionated radiation were beneficial to decrease dermatitis risk. The other risk factors were not significant within our patient population.
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