• Effects of axillary dose restr...

*Result*: Effects of axillary dose restriction on plan quality and acute radiation dermatitis in breast cancer radiotherapy.

Title:
Effects of axillary dose restriction on plan quality and acute radiation dermatitis in breast cancer radiotherapy.
Authors:
Shen M; Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021, Nanning, Guangxi, China., Shen M; Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China., Mo Y; Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021, Nanning, Guangxi, China., Lin C; Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021, Nanning, Guangxi, China., Qin J; Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021, Nanning, Guangxi, China. Electronic address: 15077109925@163.com.
Source:
Medical dosimetry : official journal of the American Association of Medical Dosimetrists [Med Dosim] 2025 Summer; Vol. 50 (2), pp. 173-178. Date of Electronic Publication: 2025 Jan 15.
Publication Type:
Journal Article; Randomized Controlled Trial
Language:
English
Journal Info:
Publisher: Elsevier Science Country of Publication: United States NLM ID: 8908862 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4022 (Electronic) Linking ISSN: 18734022 NLM ISO Abbreviation: Med Dosim Subsets: MEDLINE
Imprint Name(s):
Publication: <2000->: New York, NY : Elsevier Science
Original Publication: [Southwest Harbor, Me. : Beech Hill Pub.,
MeSH Terms:
Breast Neoplasms*/radiotherapy , Radiodermatitis*/prevention & control , Radiodermatitis*/etiology , Axilla*/radiation effects , Radiotherapy Planning, Computer-Assisted*/methods, Humans ; Female ; Middle Aged ; Radiotherapy Dosage ; Adult ; Aged ; Prospective Studies ; Organs at Risk/radiation effects
Contributed Indexing:
Keywords: Acute radiation dermatitis; Axillary dose restriction; Breast neoplasm; Plan quality; Radiotherapy
Entry Date(s):
Date Created: 20250115 Date Completed: 20250503 Latest Revision: 20250508
Update Code:
20260130
DOI:
10.1016/j.meddos.2024.12.005
PMID:
39814639
Database:
MEDLINE

*Further Information*

*Axillary dose restriction (ADR) is rarely implemented in breast cancer radiotherapy by radiation oncologists to minimize exposure to organs at risk (OARs), particularly the axilla. This prospective randomized controlled study aims to evaluate the efficacy of ADR in improving plan quality (PQ) and its impact on acute radiation dermatitis (ARD) in breast cancer radiotherapy. The study recruited breast cancer patients who required postoperative radiotherapy but did not have an indication for axillary irradiation. Delineation and dosimetric assessment of the axilla (Axilla Levels I-III and Axillary Cavity) were performed in all cases, with ADR implemented randomly. ADR involved restricting the mean axilla dose to 40-45 Gy during radiotherapy. The outcomes assessed included the ARD grades (both overall and axillary) and dose-volume parameters of PQ including skin V35. The study enrolled 87 patients, who were randomly divided into two groups: Group I (50 patients) received ADR, while Group C (37 patients) did not. ADR was found to be significantly associated with reduced exposure doses to the axilla and ipsilateral lung, specifically in patients with modified radical mastectomy (MRM). Results of other PQ parameters, such as D95, V93, V95, V100, V107 for the planning target volume (PTV), V30, Dmean for the heart, Dmax for the spinal cord, and V5 for the ipsilateral lung, demonstrated potential benefits in alleviating doses to these OARs while maintaining optimized PQ, although these results were not statistically significant. However, no statistically significant correlation between ADR and severe ARD (≥ Grade 2) or skin V35 was established, either in the total patient population or in subgroups. Additionally, a multivariable logistic regression for severe ARD was conducted, with ADR and skin V35 included as predictive factors. Only older age was found to be significantly associated with severe ARD. Implementing ADR in breast cancer radiotherapy not only protects the axilla and ipsilateral lung but also maintains optimized PQ, specifically in MRM patients, though it shows no evidence of alleviating ARD. Adopting ADR may be considered a valuable option in breast cancer radiotherapy.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)*

*Declaration of competing interest The authors declare no conflicts of interest.*