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Breast Cancer Research and Treatment

, Volume 73, Issue 2, pp 127–134 | Cite as

Breast Cancer Acute Radiotherapy Morbidity Evaluated by Different Scoring Systems

  • Escarlata López
  • Ma Isabel Núñez
  • Ma Rosario Guerrero
  • Rosario del Moral
  • Juan de Dios Luna
  • Ma del Mar Rodríguez
  • Ma Teresa Valenzuela
  • Mercedes Villalobos
  • José Mariano Ruiz de Almodóvar
Article

Abstract

Reporting of the outcome of radiotherapy is not satisfactory without a description of the treatment-related side effects. The purposes of this paper were: (1) to evaluate the frequency and the severity of collateral skin reactions in a group of breast cancer patients; (2) to report the acute reactions using some current scoring systems and to compare the application of them, and (3) to investigate the variation between intra- and interobservers using these different scales. We studied 108 breast cancer patients who, after surgical treatment, received adjuvant radiotherapy. Clinical skin evaluation was always performed by the same radiotherapist the last day of treatment, and the collateral radiation effects were photographed at that moment to facilitate later evaluations by another two expert doctors. Normal tissue damage was scored according to the Radiation Therapy Oncology Group/The European Organisation for Research, and Treatment of Cancer/ (RTOG/EORTC), the Danish, the European, and the Biomed2 side-effect scales. The most frequent acute complications found were erythema (91.7%), dry desquamation (29.6%) and moist desquamation (35.2%). The reactions were classified as severe in 13.9, 23, 18.5 and 13% of the patients with each of the different systems used, respectively. The concordance between the scoring of radiation-induced side effects on the skin assessed by direct observation of the patients or by examination of the photographic document was sufficient. This is a warrant of accuracy in the evaluation of acute normal tissue lesions. Our results allow us to state the advantage of the RTOG system over the others in terms of evaluating the acute effects produced by radiotherapy of women with breast cancer.

breast cancer normal tissue damage radiotherapy reliability side-effect scales 

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References

  1. 1.
    Tubiana M: The role of local treatment in the cure of cancer. Eur J Cancer 28 A: 2061–2069, 1992Google Scholar
  2. 2.
    Dische S, Warburton MF, Jones D, Lartigau E: The recording of morbidity related to radiotherapy. Radiother Oncol 16: 103–108, 1989Google Scholar
  3. 3.
    Dische S: The uniform reporting of treatment-related morbidity. Semin Radiat Oncol 4: 112–118, 1994Google Scholar
  4. 4.
    Riesenbeck D, Dorr W: Documentation of radiation-induced oral mucositis. Scoring systems. Strahlenther Onkol 174 (suppl 3): 44–46, 1998Google Scholar
  5. 5.
    Parulekar W, Mackenzie R, Bjarnason G, Jordan RC: Scoring oral mucositis. Oral Oncol 34 (1): 63–71, 1998Google Scholar
  6. 6.
    Baumann M: Is curative radiation therapy in elderly patients limited by increased normal tissue toxicity? Radiother Oncol 46: 225–227, 1998Google Scholar
  7. 7.
    Bentzen SM, Overgaard J: Patient-to-patient variability in the expression of radiation-induced normal tissue injury. Semin Radiat Oncol 4: 68–80, 1994Google Scholar
  8. 8.
    Bentzen SM, Overgaard J: Clinical manifestations of normal-tissue damage. In: Gordon Steel G (ed) Basic Clinical Radiobiology. 2nd edn, Oxford University Press, 1997, pp 87–97Google Scholar
  9. 9.
    Turesson I, Nyman J, Holmberg E, Oden A: Prognostic factors for acute and late skin reactions in radiotherapy patients. Int J Radiat Oncol Biol Phys 36: 1065–1075, 1996Google Scholar
  10. 10.
    Tucker S, Geara F, Peters L, Brock WA: How much could the radiotherapy dose be altered for individual patients based on a predictive assay of normal-tissue radiosensitivity? Radiother Oncol 38: 103–113, 1996Google Scholar
  11. 11.
    Geara FB, Peters LJ, Ang KK, Garden AS, Tucker SL, Levy LB, Brown BW: Comparison between normal tissue reactions and local tumour control in head and neck cancer patients treated by definitive radiotherapy. Int J Radiat Oncol Biol Phys 35: 455–462, 1996Google Scholar
  12. 12.
    NÚñez MI, Guerrero MR, Lopez E, Del Moral R, Valenzuela MT, Siles E, Villalobos M, Pedraza V, Peacock JH, Ruiz DE, Almodóvar JM: DNA damage and prediction of radiation response in lymphocytes and epidermal skin human cells. Int J Cancer 76: 354–361, 1998Google Scholar
  13. 13.
    Ramsay J, Birrell G: Normal tissue radiosensitivity in breast cancer patients. Int J Radiat Oncol Biol Phys 31: 339–344, 1995Google Scholar
  14. 14.
    Bentzen SM, Overgaard M: Relationship between early and late normal-tissue injury after postmastectomy radiotherapy. Radiother Oncol 20: 159–165, 1991Google Scholar
  15. 15.
    Bentzen SM: Towards evidence based radiation oncology: improving the design, analysis, and reporting of clinical outcome studies in radiotherapy. Radiother Oncol 46: 5–18, 1998Google Scholar
  16. 16.
    Bentzen SM, Vaeth M, Pedersen D, Overgaard J: Why actuarial estimates should be used in reporting late normal-tissue effects of cancer treatment? Int J Radiat Oncol Biol Phys 32: 1531–1534, 1995Google Scholar
  17. 17.
    Cox JD, Stetz J, Pajak TF: Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31: 1341–1346, 1995Google Scholar
  18. 18.
    Overgaard M, Bentzen SM, Christensen JJ, Madsen EH: The value of the NSD formula in equation of acute and late radiation complications in normal tissue following 2 and 5 fractions per week in breast cancer patients treated with postmastectomy radiotherapy. Radiother Oncol 9: 1–11, 1987Google Scholar
  19. 19.
    Burnet NG, Johansen J, Turesson I, Nyman J, Peacock JH: Describing patients' normal tissue reactions: concerning the possibility of individualising radiotherapy dose prescriptions based on potential predictive assays of normal tissue radiosensitivity. Int J Cancer 79: 606–613, 1998Google Scholar
  20. 20.
    Warszawski A, Röttinger R, Vogel R, Warszawski N: 20MHz ultrasonic imaging for quantitative assessment and documentation of early and late postradiation skin reactions in breast cancer patients. Radiother Oncol 47: 241–247, 1998Google Scholar
  21. 21.
    Kaanders J, Ang K: Early reactions as dose-limiting factors in radiotherapy. Semin Radiat Oncol 4: 55–67, 1994Google Scholar
  22. 22.
    Ciabattoni A, Scopa A, Spedicato MR, Turriziani A: Organ preservation and quality of life: the quality of life of patients undergoing radiation therapy. Rays 22 (3): 490–498, 1997Google Scholar
  23. 23.
    Van Der Kogel AJ: Radiation response and tolerance of normal tissues. In: Gordon Steel G (ed) Basic Clinical Radiobiology. 2nd edn, Oxford University Press, 1997, pp 30–39Google Scholar
  24. 24.
    Kuhnt T, Richter C, Enke H, Dunst J: Acute radiation reaction and local control in breast cancer patients treated with postmastectomy radiotherapy. Strahlenther Onkol 174(5): 257–261, 1998Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Escarlata López
    • 1
  • Ma Isabel Núñez
    • 2
  • Ma Rosario Guerrero
    • 2
  • Rosario del Moral
    • 1
  • Juan de Dios Luna
    • 3
  • Ma del Mar Rodríguez
    • 4
  • Ma Teresa Valenzuela
    • 2
  • Mercedes Villalobos
    • 2
  • José Mariano Ruiz de Almodóvar
    • 2
  1. 1.Servicio de Oncología RadioterápicaHospital Universitario 'Virgen de las Nieves'Spain
  2. 2.Unidad Mixta de Investigaciones Médicas, Hospital Universitario 'San Cecilio'Universidad de GranadaSpain
  3. 3.Departamento de Bioestadística, Facultad de MedicinaUniversidad de GranadaSpain
  4. 4.Departamento de EstadísticaHospital Universitario 'Virgen de las Nieves'GranadaSpain

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