Objective Evaluation of Risk Factors for Radiation Dermatitis in Whole-Breast Irradiation Using the Spectrophotometric L*a*b Color-Space
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Participants
2.2. Visual Examinations and Spectrophotometry Correlate Positively with Maximum a* Values and Inversely for Maximum L* Values
2.3. Patient-Related Risk Factors: Breast Volume and Darker Skin Are Risk Factors for Severe RID
2.4. Impact of a Sequential Boost and Treatment Technique on Maximum RID Severity
2.5. Correlations between Physician Assessed RID Severity, Objective Skin Color, and Subjective Symptoms
3. Discussion
4. Material and Methods
4.1. Radiation Technique
4.2. Visual Evaluation of Radiation-Induced Dermatitis (RID) and Spectrophotometry (SP)
4.3. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
RID | Radiation-Induced Dermatitis |
RT | Radiotherapy |
Gy | Gray (Unit) |
SP | Spectrophotometry |
CTCAE | Common Terminology Criteria for Adverse Effects |
RTOG | Radiation Therapy Oncology Group |
EORTG | European Organization for Research and Treatment of Cancer |
L* max | maximum L value (spectrophotometry) |
a* max | maximum a value (spectrophotometry) |
b* max | maximum b value (spectrophotometry) |
RISRAS | Radiation-Induced Skin Reaction Assessment Scale |
fx | Fraction(s) |
CF | Conventional Fractionation |
HF | Hypofractionation |
SD | Standard Deviation |
WBI | Whole Breast Irradiation |
BMI | Body Mass Index |
TNM | TNM Classification of Malignant Tumors |
DCIS | Ductal Carcinoma In Situ |
HI(D2%–D98%)/D50% | Homogeneity Index(D2%–D98%)/D50% |
HI-RTOG | Homogeneity Index (Radiation Therapy Oncology Group) |
SW | Sliding Window |
VMAT | Volumetric (partial-) arc therapy |
IMRT | Intensity-modulated Radiotherapy (sliding-window) |
Dmean | Mean dose within the target volume |
rel. D2% | Dose received by 2% of the target volume relative to the prescribed dose |
rel. D50% | Dose received by 50% of the target volume relative to the prescribed dose |
rel. D98% | Dose received by 98% of the target volume relative to the prescribed dose |
V≥107% | Volume receiving ≥ 107% of prescribed dose |
ANOVA | Analysis Of Variance |
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Characteristic | Parameter | Value |
---|---|---|
Gender | ||
Female | 142 | |
Age [a] | ||
Mean ± SD | 59.7 ± 11.0 | |
Range | 19–84 | |
BMI | ||
Mean ± SD | 26.8 ± 4.5 | |
Range | 18–45.7 | |
BMI < 20 | 7 | |
BMI 20–25 | 30 | |
BMI 25–30 | 80 | |
BMI 30–35 | 21 | |
BMI > 35 | 4 | |
Breast volume | ||
[mL] | Mean ± SD | 623.6 ± 347.6 |
Range | 124–1771 | |
Vol. > 400 mL | 30.65% | |
Vol. 400–800 mL | 42.74% | |
Vol. > 800 mL | 26.61% | |
Ethnicity | ||
Caucasian | 142 | |
Initial L* values | ||
Mean ± SD | 67.2 ± 4.81 | |
Range | 46.8–76.5 | |
Initial L* < 65 | 22.40% | |
Initial L* 65–70 | 52.20% | |
Initial L* > 70 | 25.40% | |
T Classification (TNM) | ||
DCIS | 18 | |
T1 | 92 | |
T2 | 32 | |
Radiation therapy | ||
50 Gy in 25 fx | 71 | |
40.05 Gy in 15 fx | 71 | |
Seq. boost of 16 | ||
Gy in 8 fx | 67 | |
Boost vol. [mL] | ||
Mean ± SD | 200.4 ± 107 | |
Range | 40–505 | |
HI(D2%–D98%)/D50% | 0.144 ± 0.04 | |
HIRTOG (max. isodose in | ||
target/reference isodose) | 1.07 ± 0.03 | |
rel. D2% [%] | 94.29 ± 14.43 | |
rel. D50% [%] | 90.56 ± 13.75 | |
rel. D98% [%] | 81.24 ± 12.88 | |
Treatment technique | ||
Sliding-window | 115 | |
VMAT | 7 |
Characteristic | Parameter | L* Max | a* Max |
---|---|---|---|
CTCAE 0° | Mean ± SD | 67.35 ± 2.44 | 9.11 ± 1.68 |
Median | 67.0 | 9.1 | |
95% CI | 65.9–68.8 | 8.1–10.1 | |
Range | 64.8–73.6 | 4.8–11.2 | |
CTCAE I° | Mean ± SD | 62.55 ± 4.78 | 10.95 ± 2.18 |
Median | 64.0 | 11.0 | |
95% CI | 61.0–64.1 | 10.3–11.6 | |
Range | 48.1–70.1 | 8.18–16.8 | |
CTCAE II° | Mean ± SD | 59.47 ± 6.08 | 12.68 ± 2.01 |
Median | 59.6 | 12.84 | |
95% CI | 57.7–61.3 | 12.1–13.3 | |
Range | 32.9–67.7 | 10.1–19.4 | |
CTCAE III° | Mean ± SD | 53.4 ± 4.29 | 19.32 ± 1.97 |
Median | 54.0 | 18.56 | |
95% CI | 49.6–57.2 | 17.6–21.1 | |
Range | 46.3–57.7 | 17.6–22.5 |
Parameter | CTCAE | L* Max. | a* Max. |
---|---|---|---|
Age [a] | 0.1289 (−) | 0.0825 (+) | 0.5491 (−) |
BMI [kg/m2] | 0.2282 (+) | 0.9428 (−) | 0.1212 (+) |
Breast volume [mL] | 0.0047 (+) | 0.9379 (+) | 0.0509 (+) |
Boost (y/n) | 0.0635 (+) | 0.5084 (−) | 0.9629 (+) |
Boost vol. [mL] | 0.6119 (+) | 0.6456 (−) | 0.4453 (+) |
Mean Dose to PTV [%] | 0.4435 (−) | 0.9059 (−) | 0.9889 (+) |
rel. D2% | 0.5635 (−) | 0.1062 (−) | 0.1147 (+) |
rel. D50% | 0.5532 (−) | 0.1087 (−) | 0.1210 (+) |
rel. D98% | 0.5595 (−) | 0.1011 (−) | 0.1178 (+) |
V≥107% [mL] | 0.8424 (+) | 0.5715 (−) | 0.9127 (+) |
HIRTOG | 0.8209 (+) | 0.8924 (+) | 0.3468 (+) |
HI(D2%–D98%)/D50% | 0.7125 (+) | 0.7217 (+) | 0.7711 (+) |
L* baseline | 0.2848 (−) | <0.0001 (+) | 0.0155 (−) |
a* baseline | 0.2892 (+) | <0.0001 (−) | 0.0006 (+) |
b* baseline | 0.3702 (−) | 0.0002 (−) | 0.5846 (+) |
CTCAE | <0.0001 (−) | <0.0001 (+) | |
L* max. | <0.0001 (−) | <0.0001 (−) | |
a* max. | <0.0001 (+) | <0.0001 (−) | |
b* max. | 0.5229 (−) | 0.1258 (−) | 0.4628 (+) |
Pain (RISRAS) | <0.0001 (+) | 0.0115 (−) | 0.002 (+) |
Burning (RISRAS) | 0.0003 (+) | 0.025 (−) | 0.0856 (+) |
Itching (RISRAS) | 0.1517 (+) | 0.8369 (−) | 0.7335 (−) |
Activities (RISRAS) | <0.0001 (+) | 0.0011 (−) | 0.0409 (+) |
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Share and Cite
Böhner, A.M.C.; Koch, D.; Schmeel, F.C.; Röhner, F.; Schoroth, F.; Sarria, G.R.; Abramian, A.-V.; Baumert, B.G.; Giordano, F.A.; Schmeel, L.C. Objective Evaluation of Risk Factors for Radiation Dermatitis in Whole-Breast Irradiation Using the Spectrophotometric L*a*b Color-Space. Cancers 2020, 12, 2444. https://doi.org/10.3390/cancers12092444
Böhner AMC, Koch D, Schmeel FC, Röhner F, Schoroth F, Sarria GR, Abramian A-V, Baumert BG, Giordano FA, Schmeel LC. Objective Evaluation of Risk Factors for Radiation Dermatitis in Whole-Breast Irradiation Using the Spectrophotometric L*a*b Color-Space. Cancers. 2020; 12(9):2444. https://doi.org/10.3390/cancers12092444
Chicago/Turabian StyleBöhner, Alexander M. C., David Koch, Frederic Carsten Schmeel, Fred Röhner, Felix Schoroth, Gustavo R. Sarria, Alina-Valik Abramian, Brigitta Gertrud Baumert, Frank Anton Giordano, and Leonard Christopher Schmeel. 2020. "Objective Evaluation of Risk Factors for Radiation Dermatitis in Whole-Breast Irradiation Using the Spectrophotometric L*a*b Color-Space" Cancers 12, no. 9: 2444. https://doi.org/10.3390/cancers12092444