Advertisement

Acute and Late Skin Toxicity from Breast Radiation

  • Lindsey Sloan
  • Sara AlcornEmail author
Chapter

Abstract

Acute and late skin toxicities are an unfortunate but expected side effect of breast cancer treatment with radiation therapy. Thoughtful consideration of the normal structure and function of the skin and the anatomy of the breast may facilitate understanding and anticipation of radiation-related skin reactions. Specific acute and late toxicities have been described and are largely evaluated using provider-reported ratings of clinical exam findings. Risks for development of skin toxicity are likely related to both patient- and treatment-specific factors. Most techniques for the management of skin toxicity are experience-based or supported by small, non-randomized studies. Adoption of more detailed assessments of dermal injury following radiotherapy may improve understanding of discrete entities and identify new avenues toward the development of tailored management strategies for specific radiation-related skin toxicities.

Keywords

Breast cancer treatment Acute and late radiation skin toxicity Risk assessment Management 

References

  1. 1.
    Alhathlool A, Hein R, Andres C, Ring J, Eberlein B. Post-irradiation morphea: case report and review of the literature. J Dermatol Case Rep. 2012;6(3):73–7.  https://doi.org/10.3315/jdcr.2012.1106.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Andreassen CN, Overgaard J, Alsner J, Overgaard M, Herskind C, Cesaretti JA, et al. ATM sequence variants and risk of radiation-induced subcutaneous fibrosis after postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys. 2006;64(3):776–83.  https://doi.org/10.1016/j.ijrobp.2005.09.014.CrossRefPubMedGoogle Scholar
  3. 3.
    Arsenault J, Parpia S, Reiter H, Doherty M, Lukka H, Rakovitch E, et al. Acute toxicity and quality of life of hypofractionated radiation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 2015;93(3 Suppl):S59.  https://doi.org/10.1016/j.ijrobp.2015.07.141.CrossRefGoogle Scholar
  4. 4.
    Back M, Guerrieri M, Wratten C, Steigler A. Impact of radiation therapy on acute toxicity in breast conservation therapy for early breast cancer. Clin Oncol (R Coll Radiol). 2004;16(1):12–6.  https://doi.org/10.1016/j.clon.2003.08.005.CrossRefGoogle Scholar
  5. 5.
    Barkham AM. Radiotherapy skin reactions and treatments. Prof Nurse. 1993;8:732–6.PubMedGoogle Scholar
  6. 6.
    Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47–56.  https://doi.org/10.1016/S1470-2045(14)71156-8.CrossRefPubMedGoogle Scholar
  7. 7.
    Bennett C. An investigation into the use of a non-metallic deodorant during radiotherapy treatment: a randomised controlled trial. J Radiother Pract. 2009;8(1):3–9.  https://doi.org/10.1017/S146039690800647X.CrossRefGoogle Scholar
  8. 8.
    Bleasel NR, Stapleton KM, Commens C, Ahern VA. Radiation-induced localized scleroderma in breast cancer patients. Aust J Dermatol. 1999;40(2):99–102.  https://doi.org/10.1046/j.1440-0960.1999.00330.x.CrossRefGoogle Scholar
  9. 9.
    Boesmans S, Decoster L, Schallier D. Pemetrexed-induced radiation recall dermatitis of the breast. Anticancer Res. 2014;34(3):1179–82.PubMedGoogle Scholar
  10. 10.
    Bolderston A, Lloyd NS, Wong RK, Holden L, Robb-Blenderman L, Supportive Care Guidelines Group of Cancer Care Ontario Program in Evidence-Based Care. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer. 2006;14(8):802–17.  https://doi.org/10.1007/s00520-006-0063-4.CrossRefPubMedGoogle Scholar
  11. 11.
    Boström A, Lindman H, Swartling C, Berne B, Bergh J. Potent corticosteroid cream (mometasone furoate) significantly reduces acute radiation dermatitis: results from a double-blind, randomized study. Radiother Oncol. 2001;59(3):257–65.  https://doi.org/10.1016/S0167-8140(01)00327-9.CrossRefPubMedGoogle Scholar
  12. 12.
    Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, et al. Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol. 1997;15(3):974–86.  https://doi.org/10.1200/JCO.1997.15.3.974.CrossRefPubMedGoogle Scholar
  13. 13.
    Campbell IR, Illingworth MH. Can patients wash during radiotherapy to the breast or chest wall? A randomized controlled trial. Clin Oncol (R Coll Radiol). 1992;4(2):78–82.  https://doi.org/10.1016/S0936-6555(05)80971-9.CrossRefGoogle Scholar
  14. 14.
    Chan RJ, Webster J, Chung B, Marquart L, Ahmed M, Garantziotis S. Prevention and treatment of acute radiation-induced skin reactions: a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2014;  https://doi.org/10.1186/1471-2407-14-53.
  15. 15.
    Chen M, Chen W, Lai C, Hung C, Liu K, Cheng Y. Predictive factors of radiation-induced skin toxicity in breast cancer patients. BMC Cancer. 2010;  https://doi.org/10.1186/1471-2407-10-508.
  16. 16.
    Choi M, Kipps T, Kurzrock R. ATM mutations in cancer: therapeutic implications. Mol Cancer Ther. 2016;15(8):1781–91.  https://doi.org/10.1158/1535-7163.MCT-15-0945.CrossRefPubMedGoogle Scholar
  17. 17.
    Colver GB, Rodger A, Mortimer PS, Savin JA, Neill SM, Hunter JA. Post-irradiation morphoea. Br J Dermatol. 1989;120:831–5.  https://doi.org/10.1111/j.1365-2133.1989.tb01382.x.CrossRefPubMedGoogle Scholar
  18. 18.
    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. 1995;31(5):1341–6.  https://doi.org/10.1016/0360-3016(95)00060-C.CrossRefPubMedGoogle Scholar
  19. 19.
    De Langhe S, Mulliez T, Veldeman L, Remouchamps V, van Greveling A, Gilsoul M, et al. Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy. BMC Cancer. 2014;  https://doi.org/10.1186/1471-2407-14-711.
  20. 20.
    Delanian S, Porcher R, Balla-Mekias S, Lefaix JL. Randomized, placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis. J Clin Oncol. 2003;21(13):2545–50.  https://doi.org/10.1200/JCO.2003.06.064.CrossRefPubMedGoogle Scholar
  21. 21.
    Denham JW, Hauer-Jensen M. The radiotherapeutic injury – a complex ‘wound’. Radiother Oncol. 2002;63(2):129–45.  https://doi.org/10.1016/S0167-8140(02)00060-9.CrossRefPubMedGoogle Scholar
  22. 22.
    Dubner S, Bovi J, White J, Susnik B. Postirradiation morphea in a breast cancer patient. Breast J. 2006;12(2):173–6.  https://doi.org/10.1111/j.1075-122X.2006.00229.x.CrossRefPubMedGoogle Scholar
  23. 23.
    Ellis H, Mahadevan V. Anatomy and physiology of the breast. Surgery. 2013;31(1):11–4.  https://doi.org/10.1016/j.mpsur.2012.10.018.CrossRefGoogle Scholar
  24. 24.
    Fernando IN, Ford HT, Powles TJ, Ashley S, Glees JP, Torr M, et al. Factors affecting acute skin toxicity in patients having breast irradiation after conservative surgery: a prospective study of treatment practice at the Royal Marsden Hospital. Clin Oncol (R Coll Radiol). 1996;8(4):226–33.  https://doi.org/10.1016/S0936-6555(05)80657-0.CrossRefGoogle Scholar
  25. 25.
    Fowble B, Yom SS, Yuen F, Arron S, editors. Skin care in radiation oncology, a practical guide. New York: Springer; 2016.Google Scholar
  26. 26.
    Gee A, Churn M, Errington RD. A randomised controlled trial to test a non-metallic deodorant used during a course of radiotherapy. J Radiother Pract. 2000;1:205–12.  https://doi.org/10.1017/S1460396999000321.CrossRefGoogle Scholar
  27. 27.
    Giess CS, Raza S, Birdwell RL. Distinguishing breast skin lesions from superficial breast parenchymal lesions: diagnostic criteria, imaging characteristics, and pitfalls. Radiographics. 2011;31:1959–72.  https://doi.org/10.1148/rg.317115116.CrossRefPubMedGoogle Scholar
  28. 28.
    Gonzalez-Ericsson PI, Estrada MV, Al-Rohil R, Sanders ME. Post-irradiation morphoea of the breast: a case report and review of the literature. Histopathology. 2018;72(3):342–50.  https://doi.org/10.1111/his.13343.CrossRefPubMedGoogle Scholar
  29. 29.
    Gzell CE, Carroll SL, Suchowerska N, Beith J, Tan K, Scolyer RA. Radiation recall dermatitis after pre-sensitization with pegylated liposomal doxorubicin. Cancer Investig. 2009;27(4):397–401.  https://doi.org/10.1080/07357900802392667.CrossRefGoogle Scholar
  30. 30.
    Haffty BG, Vicini FA, Beitsch P, Quiet C, Keleher A, Garcia D, et al. Timing of chemotherapy after MammoSite radiation therapy system breast brachytherapy: analysis of the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Int J Radiat Oncol Biol Phys. 2008;72(5):1441–8.  https://doi.org/10.1016/j.ijrobp.2008.02.070.CrossRefPubMedGoogle Scholar
  31. 31.
    Harper JL, Franklin LE, Jenrette JM, Aguero EG. Skin toxicity during breast irradiation: pathophysiology and management. South Med J. 2004;97(10):989–93.  https://doi.org/10.1097/01.SMJ.0000140866.97278.87.CrossRefPubMedGoogle Scholar
  32. 32.
    Hindley A, Zain Z, Wood L, Whitehead A, Sanneh A, Barber D, et al. Mometasone furoate cream reduces acute radiation dermatitis in patients receiving breast radiation therapy: results of a randomized trial. Int J Radiat Oncol Biol Phys. 2014;90(4):748–55.  https://doi.org/10.1016/j.ijrobp.2014.06.033.CrossRefPubMedGoogle Scholar
  33. 33.
    Ho AY, Fan G, Atencio DP, Green S, Formenti SC, Haffty BG, et al. Possession of ATM sequence variants as predictor for late normal tissue responses in breast cancer patients treated with radiotherapy. Int J Radiat Oncol Biol Phys. 2007;69(3):677–84.  https://doi.org/10.1016/j.ijrobp.2007.04.012.CrossRefPubMedGoogle Scholar
  34. 34.
    Ho AY, Olm-Shipman M, Zhang Z, Siu CT, Wilguck M, Phung A, et al. A randomized trial of mometasone furoate 0.1% to reduce high-grade acute radiation dermatitis in breast cancer patients receiving postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2018;101(2):325–33.  https://doi.org/10.1016/j.ijrobp.2018.02.006.CrossRefPubMedGoogle Scholar
  35. 35.
    Hoopfer D, Holloway C, Gabos Z, Alidrisi M, Chafe S, Krause B, et al. Three-arm randomized phase III trial: quality aloe and placebo cream versus powder as skin treatment during breast cancer radiation therapy. Clin Breast Cancer. 2015;15(3):181–90.  https://doi.org/10.1016/j.clbc.2014.12.006.CrossRefPubMedGoogle Scholar
  36. 36.
    Hu JJ, Urbanic JJ, Case LD, Takita C, Wright JL, Brown DR, et al. Association between inflammatory biomarker C-reactive protein and radiotherapy-induced early adverse skin reactions in a multiracial/ethnic breast cancer population. J Clin Oncol. 2018;36(24):2473–82.  https://doi.org/10.1200/JCO.2017.77.1790.CrossRefPubMedGoogle Scholar
  37. 37.
    Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment. J Am Acad Dermatol. 2006;54:28–46.  https://doi.org/10.1016/j.jaad.2005.08.054.CrossRefPubMedGoogle Scholar
  38. 38.
    Iannuzzi CM, Atencio DM, Green S, Stock RG, Rosenstein BS. ATM mutations in female breast cancer patients predict for an increase in radiation-induced late effects. Int J Radiat Oncol Biol Phys. 2002;52(3):606–13.  https://doi.org/10.1016/S0360-3016(01)02684-0.CrossRefPubMedGoogle Scholar
  39. 39.
    International Commission on Radiation Units and Measurements. Determination of dose equivalents resulting from external radiation sources. Washington, DC: ICRU; 1985.  https://doi.org/10.1093/jicru/os20.2.Report39.CrossRefGoogle Scholar
  40. 40.
    Jackson W. Surface effects of high-energy X rays at oblique incidence. Br J Radiol. 1971;44(518):109–15.  https://doi.org/10.1259/0007-1285-44-518-109.CrossRefPubMedGoogle Scholar
  41. 41.
    Jaspars JJP, Posma AN, van Immerseel AAH, Gittenberger-de Groo AC. The cutaneous innervation of the female breast and nipple-areola complex: implications for surgery. Br J Plast Surg. 1997;50(4):249–59.  https://doi.org/10.1016/S0007-1226(97)91155-3.CrossRefPubMedGoogle Scholar
  42. 42.
    Jolles B, Harrison RG. Enzymatic processes and vascular changes in the skin radiation reaction. Br J Radiol. 1966;39(457):12–8.  https://doi.org/10.1259/0007-1285-39-457-12.CrossRefPubMedGoogle Scholar
  43. 43.
    Jung K, Sabri S, Hanson J, Xu Y, Wang YW, Lai R, et al. Elevated ARG1 expression in primary monocytes-derived macrophages as a predictor of radiation-induced acute skin toxicities in early breast cancer patients. Cancer Biol Ther. 2015;16(9):1281–8.  https://doi.org/10.1080/15384047.2015.1056945.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Kole AJ, Kole L, Moran MS. Acute radiation dermatitis in breast cancer patients: challenges and solutions. Breast Cancer (Dove Med Press). 2017;9:313–23.  https://doi.org/10.2147/BCTT.S109763.CrossRefGoogle Scholar
  45. 45.
    Kong M, Hwang DS, Lee JY, Yoon SW. The efficacy and safety of Jaungo, a traditional medicinal ointment, in preventing radiation dermatitis in patients with breast cancer: a prospective, single-blinded, randomized pilot study. Evid Based Complement Alternat Med. 2016;  https://doi.org/10.1155/2016/9481413.
  46. 46.
    Korinko A, Yurick A. Maintaining skin integrity during radiotherapy. Am J Nurs. 1997;97:40–4.  https://doi.org/10.2307/3465498.CrossRefPubMedGoogle Scholar
  47. 47.
    Kraus-Tiefenbacher U, Sfintizky A, Welzel G, Simeonova A, Sperk E, Siebenlist K, et al. Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS). Radiat Oncol. 2012;  https://doi.org/10.1186/1748-717X-7-217.
  48. 48.
    Kupper TS. The activated keratinocyte: a model for inducible cytokine production by non-bone-marrow-derived cells in cutaneous inflammatory and immune responses. J Investig Dermatol. 1990;94(Suppl 6):146–50.  https://doi.org/10.1111/1523-1747.ep12876130.CrossRefGoogle Scholar
  49. 49.
    Laffin N, Smyth W, Heyer E, Fasugba O, Abernethy G, Gardner A. Effectiveness and acceptability of a moisturizing cream and a barrier cream during radiation therapy for breast cancer in the tropics: a randomized controlled trial. Cancer Nurs. 2015;38(3):205–14.  https://doi.org/10.1097/NCC.0000000000000161.CrossRefPubMedGoogle Scholar
  50. 50.
    Lanigan SW, Joannides T. Pulsed dye laser treatment of telangiectasia after radiotherapy for carcinoma of the breast. Br J Dermatol. 2003;148(1):77–9.  https://doi.org/10.1046/j.1365-2133.2003.04861.x.CrossRefPubMedGoogle Scholar
  51. 51.
    Leventhal J, Young MR. Radiation dermatitis: recognition, prevention, and management. Oncology (Williston Park). 2017;31(12):885–7.Google Scholar
  52. 52.
    Lilla C, Ambrosone CB, Kropp S, Helmbold I, Schmezer P, von Fournier D, et al. Predictive factors for late normal tissue complications following radiotherapy for breast cancer. Breast Cancer Res Treat. 2007;106(1):143–50.  https://doi.org/10.1007/s10549-006-9480-9.CrossRefPubMedGoogle Scholar
  53. 53.
    Liu K, Kasper M, Trott KR. Changes in keratinocyte differentiation during accelerated repopulation of the irradiated mouse epidermis. Int J Radiat Biol. 1996;69(6):763–9.  https://doi.org/10.1080/095530096145508.CrossRefPubMedGoogle Scholar
  54. 54.
    Moon D, Koo JS, Suh CO, Yoon CY, Bae J, Lee S. Radiation recall dermatitis induced by trastuzumab. Breast Cancer. 2016;23(1):159–63.  https://doi.org/10.1007/s12282-013-0462-6.CrossRefPubMedGoogle Scholar
  55. 55.
    National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. Common terminology criteria for adverse events (CTCAE) version 5.0. 2017. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf. Accessed 23 Sept 2018.
  56. 56.
    Noble-Adams R. Radiation-induced reactions. 1: an examination of the phenomenon. Br J Nurs. 1999;8(17):1134–40.  https://doi.org/10.12968/bjon.1999.8.17.6503.CrossRefPubMedGoogle Scholar
  57. 57.
    Noh JM, Choi DH, Park H, Huh SJ, Park W, Seol SW, et al. Comparison of acute skin reaction following morning versus late afternoon radiotherapy in patients with breast cancer who have undergone curative surgical resection. J Radiat Res. 2014;55(3):553–8.  https://doi.org/10.1093/jrr/rrt14.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Parekh A, Dholakia AD, Zabranksy DJ, Asrari F, Camp M, Habibi M, et al. Predictors of radiation-induced acute skin toxicity in breast cancer at a single institution: role of fractionation and treatment volume. Adv Radiat Oncol. 2017;3(1):8–15.  https://doi.org/10.1016/j.adro.2017.10.007.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixe K, Beckham W, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008;26(13):2085–92.  https://doi.org/10.1200/JCO.2007.15.2488.CrossRefPubMedGoogle Scholar
  60. 60.
    Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol. 2004;22(8):1447–53.  https://doi.org/10.1200/JCO.2004.07.063.CrossRefPubMedGoogle Scholar
  61. 61.
    Poortmans PM, Collette L, Bartelink H, Struikmans H, Van den Bogaert WF, Fourquet A, et al. The addition of a boost dose on the primary tumour bed after lumpectomy in breast conserving treatment for breast cancer. A summary of the results of EORTC 22881-10882 “boost versus no boost” trial. Cancer Radiother. 2008;12(6–7):565–70.  https://doi.org/10.1016/j.canrad.2008.07.014.CrossRefPubMedGoogle Scholar
  62. 62.
    Porock D, Kristjanson L, Nikoletti S, Cameron F, Pedler P. Predicting the severity of radiation skin reactions in women with breast cancer. Oncol Nurs Forum. 1998;25(6):1019–29.PubMedGoogle Scholar
  63. 63.
    Rhee J, Kim GE, Lee CH, Kwon JM, Han SH, Kim YS, et al. Radiation recall dermatitis induced by tamoxifen during adjuvant breast cancer treatment. Radiat Oncol J. 2014;32(4):262–5.  https://doi.org/10.3857/roj.2014.32.4.262.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Rodemann HP, Blaese MA. Responses of normal cells to ionizing radiation. Semin Radiat Oncol. 2007;17(2):81–8.  https://doi.org/10.1016/j.semradonc.2006.11.005.CrossRefPubMedGoogle Scholar
  65. 65.
    Rollmann DC, Novotny PJ, Petersen IA, Garces YI, Bauer HJ, Yan ES, et al. Double-blind, placebo-controlled pilot study of processed ultra emu oil versus placebo in the prevention of radiation dermatitis. Int J Radiat Oncol Biol Phys. 2015;92(3):650–8.  https://doi.org/10.1016/j.ijrobp.2015.02.028.CrossRefPubMedGoogle Scholar
  66. 66.
    Rossi AM, Nehal KS, Lee EH. Radiation-induced breast telangiectasias treated with the pulsed dye laser. J Clin Aesthet Dermatol. 2014;7(12):34–7.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Rossi AM, Blank NR, Nehal K, Dusza S, Lee EH. Effect of laser therapy on quality of life in patients with radiation-induced breast telangiectasias. Lasers Surg Med. 2018;50(4):284–90.  https://doi.org/10.1002/lsm.22780.CrossRefPubMedGoogle Scholar
  68. 68.
    Roy I, Fortin A, Larochelle M. The impact of skin washing with water and soap during breast irradiation: a randomized study. Radiother Oncol. 2001;58(3):333–9.  https://doi.org/10.1016/S0167-8140(00)00322-4.CrossRefPubMedGoogle Scholar
  69. 69.
    Rubin DB. The radiation biology of the vascular endothelium. 1st ed. Boca Raton: CRC Press; 1998.Google Scholar
  70. 70.
    Russell NS, Knaken H, Bruinvis AD, Hart AAM, Begg AC, Lebesque JV. Quantification of patient to patient variation of skin erythema developing as a response to radiotherapy. Radiother Oncol. 1994;30(3):213–21.  https://doi.org/10.1016/0167-8140(94)90460-X.CrossRefPubMedGoogle Scholar
  71. 71.
    Schaffer JV, Carroll C, Dvoretsky I, Huether MJ, Girardi M. Postirradiation morphea of the breast presentation of two cases and review of the literature. Dermatology. 2000;200:67–71.  https://doi.org/10.1159/000018322.CrossRefPubMedGoogle Scholar
  72. 72.
    Schnur JB, Ouellette SC, Dilorenzo TA, Green S, Montgomery GH. A qualitative analysis of acute skin toxicity among breast cancer radiotherapy patients. Psychooncology. 2011;20(3):260–8.  https://doi.org/10.1002/pon.1734.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Shah DJ, Hirpara R, Poelman CL, Woods A, Hummers LK, Wigley FM, et al. Impact of radiation therapy on scleroderma and cancer outcomes in scleroderma patients with breast cancer. Arthritis Care Res. 2018;70(10):1517–24.  https://doi.org/10.1002/acr.23505.CrossRefGoogle Scholar
  74. 74.
    Shaitelman SF, Schlembach PJ, Arzu I, Ballo M, Bloom ES, Buchholz D, et al. Acute and short-term toxic effects of conventionally fractionated vs hypofractionated whole-breast irradiation: a randomized clinical trial. JAMA Oncol. 2015;1(7):931–41.  https://doi.org/10.1001/jamaoncol.2015.2666.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Sharp L, Finnila K, Johansson H, Abrahamsson M, Hatschek T, Bergenmar M. No differences between Calendula cream and aqueous cream in the prevention of acute radiation skin reactions – results from a randomised blinded trial. Eur J Oncol Nurs. 2013;17(4):429–35.  https://doi.org/10.1016/j.ejon.2012.11.003.CrossRefPubMedGoogle Scholar
  76. 76.
    Sharp L, Johansson H, Hatschek T, Bergenmar M. Smoking as an independent risk factor for severe skin reactions due to adjuvant radiotherapy for breast cancer. Breast. 2013;22(5):634–8.  https://doi.org/10.1016/j.breast.2013.07.047.CrossRefPubMedGoogle Scholar
  77. 77.
    Spalek M. Chronic radiation-induced dermatitis: challenges and solutions. Clin Cosmet Investig Dermatol. 2016;9:473–82.  https://doi.org/10.2147/CCID.S94320.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Sprangers MA, Groenvold M, Arraras JI, Franklin J, te Velde A, Muller M, et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol. 1996;14(10):2756–68.  https://doi.org/10.1200/JCO.1996.14.10.2756.CrossRefPubMedGoogle Scholar
  79. 79.
    Terrazzino S, La Mattina P, Gambaro G, Masini L, Franco P, Canonico PL, et al. Common variants of GSTP1, GSTA1, and TGFβ1 are associated with the risk of radiation-induced fibrosis in breast cancer patients. Int J Radiat Oncol Biol Phys. 2012;83(2):504–11.  https://doi.org/10.1016/j.ijrobp.2011.06.2012.CrossRefPubMedGoogle Scholar
  80. 80.
    Terrazzino S, La Mattina P, Masini L, Caltavuturo T, Gambaro G, Canonico PL, et al. Common variants of eNOS and XRCC1 genes may predict acute skin toxicity in breast cancer patients receiving radiotherapy after breast conserving surgery. Radiother Oncol. 2012;103(2):199–205.  https://doi.org/10.1016/j.radonc.2011.12.002.CrossRefPubMedGoogle Scholar
  81. 81.
    Théberge V, Harel F, Dagnault A. Use of axillary deodorant and effect on acute skin toxicity during radiotherapy for breast cancer: a prospective randomised noninferiority trial. Radiat Oncol Biol Phys. 2009;75(4):1048–52.  https://doi.org/10.1016/j.ijrobp.2008.12.046.CrossRefGoogle Scholar
  82. 82.
    Tieu MT, Graham P, Browne L, Chin YS. The effect of adjuvant postmastectomy radiotherapy bolus technique on local recurrence. Int J Radiat Oncol Biol Phys. 2011;  https://doi.org/10.1016/j.ijrobp.2011.01.002.
  83. 83.
    Tortorelli G, Di Murro L, Barbarino R, Cicchetti S, di Cristino D, Falco MD, et al. Standard or hypofractionated radiotherapy in the postoperative treatment of breast cancer: a retrospective analysis of acute skin toxicity and dose inhomogeneities. BMC Cancer. 2013;  https://doi.org/10.1186/1471-2407-13-230.
  84. 84.
    Vajrala G, Jain PK, Surana S, Fernandes DJ. Generalized vitiligo post radiotherapy in a breast cancer patient. J Cancer Res Ther. 2014;10(2):365–7.  https://doi.org/10.4103/0973-1482.136659.CrossRefPubMedGoogle Scholar
  85. 85.
    Walsh N, Rheaume D, Barnes P, Tremaine R, Reardon M. Postirradiation morphea: an underrecognized complication of treatment for breast cancer. Hum Pathol. 2008;39(11):1680–8.  https://doi.org/10.1016/j.humpath.2008.04.010.CrossRefPubMedGoogle Scholar
  86. 86.
    Watson LC, Gies D, Thompson E, Thomas B. Randomized control trial: evaluating aluminum-based antiperspirant use, axilla skin toxicity, and reported quality of life in women receiving external beam radiotherapy for treatment of stage 0, I, and II breast cancer. Int J Radiat Oncol Biol Phys. 2012;  https://doi.org/10.1016/j.ijrobp.2011.12.006.
  87. 87.
    Wazer DE, Kaufman S, Cuttino L, DiPetrillo T, Arthur DW. Accelerated partial breast irradiation: an analysis of variables associated with late toxicity and long-term cosmetic outcome after high-dose-rate interstitial brachytherapy. Int J Radiat Oncol Biol Phys. 2006;64(2):489–95.  https://doi.org/10.1016/j.ijrobp.2005.06.028.CrossRefPubMedGoogle Scholar
  88. 88.
    Wernicke AG, Swistel AJ, Parashar B, Myskowski PL. Levofloxacin-induced radiation recall dermatitis: a case report and a review of the literature. Clin Breast Cancer. 2010;10(5):404–6.  https://doi.org/10.3816/CBC.2010.n.054.CrossRefPubMedGoogle Scholar
  89. 89.
    Williams MS, Burk M, Loprinzi CL, Hill M, Schomberg PJ, Nearhood K, et al. Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys. 1996;32(2):345–9.  https://doi.org/10.1016/S0360-3016(96)00320-3.CrossRefGoogle Scholar
  90. 90.
    Wobb JL, Shah C, Jawad MS, Wallace M, Dilworth JT, Grills IS, et al. Comparison of chronic toxicities between brachytherapy-based accelerated partial breast irradiation and whole breast irradiation using intensity modulated radiotherapy. Breast. 2015;24(6):739–44.  https://doi.org/10.1016/j.breast.2015.09.004.CrossRefPubMedGoogle Scholar
  91. 91.
    Wright JL, Takita C, Reis IM, Zhao W, Lee E, Hu JJ. Racial variations in radiation-induced skin toxicity severity: data from a prospective cohort receiving postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2014;90(1):335–43.  https://doi.org/10.1016/j.ijrobp.2014.06.042.CrossRefPubMedGoogle Scholar
  92. 92.
    Wright JL, Takita C, Reis IM, Zhao W, Lee E, Nelson OL, et al. Prospective evaluation of radiation-induced skin toxicity in a race/ethnically diverse breast cancer population. Cancer Med. 2016;5(3):454–64.  https://doi.org/10.1002/cam4.608.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Yang DS, Lee JA, Yoon WS, Lee NK, Park YJ, Lee S, et al. Comprehensive evaluation of personal, clinical, and radiation dosimetric parameters for acute skin reaction during whole breast radiotherapy. Biomed Res Int. 2016;  https://doi.org/10.1155/2016/3656574.
  94. 94.
    Zucca-Matthes G, Urban C, Vallejo A. Anatomy of the nipple and breast ducts. Gland Surg. 2016;5(1):32–6.  https://doi.org/10.3978/j.issn.2227-684X.2015.05.10.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins UniversityBaltimoreUSA

Personalised recommendations