Analysis of risk factors related to acute radiation dermatitis in breast cancer patients during radiotherapy

Prediction of acute skin toxicity in tomotherapy of breast cancer using skin DVH data

Investigation and quantification of the relationship between the skin dose-volume histogram (DVH) and the risk of acute skin toxicity in breast cancer patients undergoing Tomotherapy by regression modeling. This prospective study included 52 breast cancer patients treated with Tomotherapy in the dose range of 42.5-60 Gy to the planned target volume. Grading of acute skin toxicity in patients was assessed by the maximum score recorded in weekly follow-ups during and up to three months' post-radiation therapy using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0 guidelines. A superficial layer with a thickness of 2 mm was designated as the Skin Representative Layer (SRL-2) on the Tomotherapy planning, and DVH was extracted for that. Then, multivariable and univariable logistic analyses were performed to identify the most predictive variables of acute skin toxicity from SRL-2 DVH values and patients' clinical parameters. The regression analysis identified V51Gy, representing the absolute SRL-2 volume receiving 51 Gy or more in physical dose, as the most predictive dosimetric parameter for grade 2-3 acute skin toxicity. The optimal cut-off value was 4.74 cc for the physical dose, with an Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) value of 0.749, even when adjusted for clinical and treatment-related variables. The logistic model based on V51Gy demonstrated superior calibration, with a slope and R² value approaching 1, indicating better agreement between predicted and observed outcomes. The risk of acute skin toxicity during breast cancer Tomotherapy is correlated with the V51Gy parameter of skin DVH. Limiting V51Gy < 4.74 cc, or 23.7 cm2 of skin area, should keep the risk of grade 2-3 acute skin toxicity below 26%.

Predictive factors associated with acute radiation dermatitis in patients with breast cancer: a retrospective cohort study

Background

Radiation therapy (RT) is a primary postsurgical treatment for breast cancer; however, it can cause acute radiation dermatitis (ARD), which can severely impair quality of life. The aim of this study was to identify predictive factors associated with moderate to severe ARD.

Materials and Methods

In this retrospective analysis, we utilized data from Chulabhorn Hospital's Health Information System that was collected between January 2017 and December 2022. A radiation oncology specialist assessed ARD in a cohort of 635 patients using the Radiation Therapy Oncology Group (RTOG) ARD grading scale. The patients were classified into two groups based on the maximum grade recorded: mild (grade < 2) and moderate to severe (grade ≥ 2). Various factors were examined, including demographic characteristics (age, body mass index (BMI), comorbidities) and treatment-related variables (surgical history, adjuvant chemotherapy, hormone therapy, targeted therapy, fractionation, boost treatments, and bolus application). Logistic regression was used to perform the statistical analysis.

Results

Among the 635 patients, the average age was 54.2 ± 10.9 years, and 32% were classified as having moderate to severe ARD. Multiple logistic regression analysis identified BMI ≥ 30 kg/m2 (adjusted odds ratio (AOR) = 2.33; 95% confidence interval (CI) [1.36-3.98]; p-value = 0.002), localized boost treatments (AOR = 2.09; 95% CI [1.08-4.06]; p-value = 0.029), and bolus application (AOR = 2.08; 95% CI [1.02-4.24]; p-value = 0.044) as significant risk factors for moderate to severe ARD. Conversely, hypofractionated RT (AOR = 0.31; 95% CI [0.16-0.57]; p < 0.001) and hormonal therapy (AOR = 0.60; 95% CI [0.42-0.86]; p-value = 0.005) were associated with a decreased risk. However, radiation to both the primary site and regional lymph nodes (AOR = 0.81; 95% CI [0.41-1.59]; p-value = 0.538) and targeted therapy (AOR = 0.72; 95% CI [0.43-1.20]; p-value = 0.210) did not significantly affect the risk of moderate to severe ARD.

Conclusions

We have identified key risk factors for moderate to severe ARD, including obesity and treatment modalities such as localized boost treatments and bolus application. Hormone therapy and hypofractionated RT appear to reduce ARD severity. These findings have implications for the development of treatment plans and the mitigation of the risk of ARD in patients undergoing RT.

Associations between breast radiation dermatitis and post-mastectomy pain syndrome in patients with breast cancer: A multicenter retrospective study

Objective

This study explores the relationship between breast radiation dermatitis (BRD) and post-mastectomy pain syndrome (PMPS) among patients with breast cancer. Both BRD and PMPS significantly impact quality of life, yet their correlation and risk factors require further investigation.

Methods

We conducted a multicenter retrospective analysis of 784 patients with breast cancer who underwent postoperative radiotherapy between 2017 and 2023. Clinical data on BRD and PMPS were collected through patient questionnaires and hospital records, examining risk factors and evaluating the prevalence of PMPS among those with BRD.

Results

BRD affected 81.25% of patients, with higher incidence among older and obese individuals. PMPS was observed in 23.4% of the BRD group versus 13.6% in non-BRD patients (P=0.009). Early BRD onset during radiotherapy (P=0.004) and larger dermatitis areas (P=0.000) were strongly associated with increased PMPS risk.

Conclusions

This study highlights the significant relationship between BRD and PMPS, underscoring the need for early interventions to manage BRD and reduce chronic pain risk. Tailored care strategies could improve outcomes for high-risk patients.

Utilizing radiomics and dosiomics with AI for precision prediction of radiation dermatitis in breast cancer patients

PURPOSE

This study explores integrating clinical features with radiomic and dosiomic characteristics into AI models to enhance the prediction accuracy of radiation dermatitis (RD) in breast cancer patients undergoing volumetric modulated arc therapy (VMAT).

MATERIALS AND METHODS

This study involved a retrospective analysis of 120 breast cancer patients treated with VMAT at Kaohsiung Veterans General Hospital from 2018 to 2023. Patient data included CT images, radiation doses, Dose-Volume Histogram (DVH) data, and clinical information. Using a Treatment Planning System (TPS), we segmented CT images into Regions of Interest (ROIs) to extract radiomic and dosiomic features, focusing on intensity, shape, texture, and dose distribution characteristics. Features significantly associated with the development of RD were identified using ANOVA and LASSO regression (p-value < 0.05). These features were then employed to train and evaluate Logistic Regression (LR) and Random Forest (RF) models, using tenfold cross-validation to ensure robust assessment of model efficacy.

RESULTS

In this study, 102 out of 120 VMAT-treated breast cancer patients were included in the detailed analysis. Thirty-two percent of these patients developed Grade 2+ RD. Age and BMI were identified as significant clinical predictors. Through feature selection, we narrowed down the vast pool of radiomic and dosiomic data to 689 features, distributed across 10 feature subsets for model construction. In the LR model, the J subset, comprising DVH, Radiomics, and Dosiomics features, demonstrated the highest predictive performance with an AUC of 0.82. The RF model showed that subset I, which includes clinical, radiomic, and dosiomic features, achieved the best predictive accuracy with an AUC of 0.83. These results emphasize that integrating radiomic and dosiomic features significantly enhances the prediction of Grade 2+ RD.

CONCLUSION

Integrating clinical, radiomic, and dosiomic characteristics into AI models significantly improves the prediction of Grade 2+ RD risk in breast cancer patients post-VMAT. The RF model analysis demonstrates that a comprehensive feature set maximizes predictive efficacy, marking a promising step towards utilizing AI in radiation therapy risk assessment and enhancing patient care outcomes.

Mepitel film for the prevention of radiation dermatitis: A comprehensive review of its efficacy, side effects, physics measurements, patient- and clinician-reported outcomes

Objective

This review aimed to summarize the benefits, side effects, physics measurements, and patient- and clinician-reported outcomes of Mepitel film (MF) in preventing radiation dermatitis (RD) for cancer patients.

Methods

The online database PubMed was searched from inception to April 15, 2024 with the search terms "Mepitel film" or "Mepitel." Articles of any study design evaluating MF for the prevention of RD were included. Non-human studies were excluded.

Results

The database search identified 119 articles and 13 of them were included in this review. Across these studies, MF was found to be beneficial in reducing RD and improved patient- and clinician-reported outcomes in breast and head and neck cancers. Side effects of MF included itchiness, acne, allergic reaction, tightness, discomfort, and poor film adherence, but patient dropouts were uncommon. MF did not cause a bolus effect or increased skin dose in physics measurements.

Conclusions

MF is a safe and effective intervention for preventing acute RD. It should be recommended in breast cancer patients where the data is more robust. Further research is needed to evaluate MF's efficacy on patients with different skin tones, its cost-effectiveness, and identifying patients who most benefit from MF relative to other effective interventions.

Acute skin toxicity and self-management ability among Chinese breast cancer radiotherapy patients: a qualitative study

OBJECTIVES

Radiation dermatitis is the most common reaction to radiotherapy, almost all breast cancer patients receive radiotherapy on an outpatient basis. Currently, there are no studies on the experience of radiation dermatitis and the ability to self-manage it. Therefore, we aimed to use qualitative approaches to gain a deeper understanding of the actual experiences and self-management ability in order to provide a reference for further improving the effectiveness of self-management and to optimize symptom management strategies.

METHODS

A descriptive qualitative study was conducted using purposive sampling to select 17 breast cancer patients undergoing radiotherapy. Semi-structured interviews were conducted from September to November 2023. The Colaizzi seven-step analysis method was used to classify the data into summarized themes.

RESULTS

Four themes were identified from the interview responses: (1) multiple self-reported skin symptoms in breast cancer patients with radiation dermatitis; (2) the multidimensional impact on patient's quality of life, especially pruritus, ulceration; (3) the ability to self-manage radiation dermatitis: strong mental toughness, positive response, and self-doubt; (4) challenges faced: concerns about radiotherapy side effects and recurrence, targeted symptom management and continuity of care after the radiotherapy.

CONCLUSIONS

Healthcare professionals should consider patients' self-reported symptoms when assessing radiation dermatitis. For pruritus and pain, we can enhance precision symptom management to improve patients' quality of life. By utilizing information technology tools, we can increase breast cancer patients' ability and confidence in managing radiation dermatitis effectively while enhancing accurate symptom management during radiotherapy.

Tamoxifen induces ferroptosis in MCF-7 organoid

BACKGROUND

Breast cancer is the most common female malignant tumor type globally. The occurrence and development of breast cancer involve ferroptosis, which is closely related to its treatment. The development of breast cancer organoids facilitates the analysis of breast cancer molecular background and tumor biological behavior, including clinical pathological characteristics, drug response, or drug resistance relationship, and promotes the advancement of precision treatment for breast cancer. The three-dimensional (3D) cell culture of breast cancer MCF-7 organoid is more similar to the in vivo environment and thus obtains more realistic results than 2D cell culture. Our study examined the new mechanism of tamoxifen in treating breast cancer through breast cancer MCF-7 organoids.

METHODS

We used 3D cells to culture breast cancer MCF-7 organoid, as well as tamoxifen-treated MCF-7 and tamoxifen-resistant MCF-7 (MCF-7 TAMR) cells. We used transcriptome sequencing. We detected GPX4 and SLC7A11 protein levels using Western blotting and the content of ATP, glutathione, and ferrous ions using the Cell Counting Lite 3D Kit. We assessed cell viability using the Cell Counting Kit-8 (CCK-8) assay.

RESULTS

Tamoxifen significantly inhibited the growth of MCF-7 organoids and significantly induced ferroptosis in MCF-7 organoids. The ferroptosis inhibitor reversed the significant tamoxifen-induced MCF-7 organoid inhibition activity. Moreover, the ferroptosis activator enhanced the tamoxifen-induced MCF-7 TAMR cell activity inhibition.

CONCLUSION

Our study revealed that ferroptosis plays an important role in tamoxifen-induced MCF-7 organoid cell death and provides a new research idea for precise treatment of breast cancer through an organoid model.