Skin dose-volume predictors of moderate-severe late side effects after whole breast radiotherapy

•A dosimetric model for late reactions has been developed on a large cohort of breast cancer patients.•We considered for the first time the dose distribution of a 3D skin structure in association with late effects in breast cancer RT.•Quantitative associations between skin DVH and late effects were...

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Veröffentlicht in:Radiotherapy and oncology 2024-05, Vol.194, p.110183, Article 110183
Hauptverfasser: Cicchetti, Alessandro, Mangili, Paola, Fodor, Andrei, Gabellini, Maria Giulia Ubeira, Chiara, Anna, Deantoni, Chiara, Mori, Martina, Pasetti, Marcella, Palazzo, Gabriele, Rancati, Tiziana, del Vecchio, Antonella, Gisella Di Muzio, Nadia, Fiorino, Claudio
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container_title Radiotherapy and oncology
container_volume 194
creator Cicchetti, Alessandro
Mangili, Paola
Fodor, Andrei
Gabellini, Maria Giulia Ubeira
Chiara, Anna
Deantoni, Chiara
Mori, Martina
Pasetti, Marcella
Palazzo, Gabriele
Rancati, Tiziana
del Vecchio, Antonella
Gisella Di Muzio, Nadia
Fiorino, Claudio
description •A dosimetric model for late reactions has been developed on a large cohort of breast cancer patients.•We considered for the first time the dose distribution of a 3D skin structure in association with late effects in breast cancer RT.•Quantitative associations between skin DVH and late effects were assessed.•Few clinical parameters (poor cosmesis, aromatase inhibitors (protective)) significantly modulate the risk. Toxicity after whole breast Radiotherapy is a relevant issue, impacting the quality-of-life of a not negligible number of patients. We aimed to develop a Normal Tissue Complication Probability (NTCP) model predicting late toxicities by combining dosimetric parameters of the breast dermis and clinical factors. The skin structure was defined as the outer CT body contour's 5 mm inner isotropic expansion. It was retrospectively segmented on a large mono-institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions to the whole breast. Toxicity was reported during Follow-Up (FU) using SOMA/LENT scoring. The study endpoint was moderate-severe late side effects consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G ≥ 2) developed within 42 months after RT completion. A machine learning pipeline was designed with a logistic model combining clinical factors and absolute skin DVH (cc) parameters as output. The FATP G2 + rate was 3.8 %, with 40/1066 patients experiencing side effects. After the preprocessing of variables, a cross-validation was applied to define the best-performing model. We selected a 4-variable model with Post-Surgery Cosmetic alterations (Odds Ratio, OR = 7.3), Aromatase Inhibitors (as a protective factor with OR = 0.45), V20 Gy (50 % of the prescribed dose, OR = 1.02), and V42 Gy (105 %, OR = 1.09). Factors were also converted into an adjusted V20Gy. The association between late reactions and skin DVH when delivering 40 Gy/15 fr was quantified, suggesting an independent role of V20 and V42. Few clinical factors heavily modulate the risk.
doi_str_mv 10.1016/j.radonc.2024.110183
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Toxicity after whole breast Radiotherapy is a relevant issue, impacting the quality-of-life of a not negligible number of patients. We aimed to develop a Normal Tissue Complication Probability (NTCP) model predicting late toxicities by combining dosimetric parameters of the breast dermis and clinical factors. The skin structure was defined as the outer CT body contour's 5 mm inner isotropic expansion. It was retrospectively segmented on a large mono-institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions to the whole breast. Toxicity was reported during Follow-Up (FU) using SOMA/LENT scoring. The study endpoint was moderate-severe late side effects consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G ≥ 2) developed within 42 months after RT completion. A machine learning pipeline was designed with a logistic model combining clinical factors and absolute skin DVH (cc) parameters as output. The FATP G2 + rate was 3.8 %, with 40/1066 patients experiencing side effects. After the preprocessing of variables, a cross-validation was applied to define the best-performing model. We selected a 4-variable model with Post-Surgery Cosmetic alterations (Odds Ratio, OR = 7.3), Aromatase Inhibitors (as a protective factor with OR = 0.45), V20 Gy (50 % of the prescribed dose, OR = 1.02), and V42 Gy (105 %, OR = 1.09). Factors were also converted into an adjusted V20Gy. The association between late reactions and skin DVH when delivering 40 Gy/15 fr was quantified, suggesting an independent role of V20 and V42. 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Toxicity after whole breast Radiotherapy is a relevant issue, impacting the quality-of-life of a not negligible number of patients. We aimed to develop a Normal Tissue Complication Probability (NTCP) model predicting late toxicities by combining dosimetric parameters of the breast dermis and clinical factors. The skin structure was defined as the outer CT body contour's 5 mm inner isotropic expansion. It was retrospectively segmented on a large mono-institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions to the whole breast. Toxicity was reported during Follow-Up (FU) using SOMA/LENT scoring. The study endpoint was moderate-severe late side effects consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G ≥ 2) developed within 42 months after RT completion. A machine learning pipeline was designed with a logistic model combining clinical factors and absolute skin DVH (cc) parameters as output. The FATP G2 + rate was 3.8 %, with 40/1066 patients experiencing side effects. After the preprocessing of variables, a cross-validation was applied to define the best-performing model. We selected a 4-variable model with Post-Surgery Cosmetic alterations (Odds Ratio, OR = 7.3), Aromatase Inhibitors (as a protective factor with OR = 0.45), V20 Gy (50 % of the prescribed dose, OR = 1.02), and V42 Gy (105 %, OR = 1.09). Factors were also converted into an adjusted V20Gy. The association between late reactions and skin DVH when delivering 40 Gy/15 fr was quantified, suggesting an independent role of V20 and V42. Few clinical factors heavily modulate the risk.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Breast</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Dose tolerance</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Organs at Risk - radiation effects</subject><subject>Radiation Injuries - etiology</subject><subject>Radiotherapy Dosage</subject><subject>Retrospective Studies</subject><subject>Skin - radiation effects</subject><subject>Skin reactions</subject><issn>0167-8140</issn><issn>1879-0887</issn><issn>1879-0887</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtPJCEURokZo-3jH5gJy9lUeymootiYGOMrMXGhrpGGS6Stanqguo3_XkypS1fckPPdxyHkhMGcAWtPl_NkXFzZeQ21mLPy1_EdMmOdVBV0nfxDZgWTVccE7JODnJcAUAOXe2Sfd6LmjHcz8vzwGlbUxYzVNvabAek6oQt2jCnT6OkQHSYzYpVxiwlpX2qag0OK3qMdMzV-xETfXmKPdJHQ5JGWxUIcX0pw_X5Edr3pMx5_vYfk6ery8eKmuru_vr04v6ssZ2yshGoX2CqpFh5a0QK2rWiMcKhsYzhnxksJrvYWbANgjFAGeCc9d6o2DJAfkn9T33WK_zeYRz2EbLHvzQrjJutacVFL0aimoGJCbYo5J_R6ncJg0rtmoD_d6qWe3OpPt3pyW2J_vyZsFgO6n9C3zAKcTQCWO7cBk8424MoWn6mo0i6G3yd8AKU8jRI</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Cicchetti, Alessandro</creator><creator>Mangili, Paola</creator><creator>Fodor, Andrei</creator><creator>Gabellini, Maria Giulia Ubeira</creator><creator>Chiara, Anna</creator><creator>Deantoni, Chiara</creator><creator>Mori, Martina</creator><creator>Pasetti, Marcella</creator><creator>Palazzo, Gabriele</creator><creator>Rancati, Tiziana</creator><creator>del Vecchio, Antonella</creator><creator>Gisella Di Muzio, Nadia</creator><creator>Fiorino, Claudio</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0009-0004-3394-9025</orcidid><orcidid>https://orcid.org/0000-0002-0013-8494</orcidid><orcidid>https://orcid.org/0000-0003-1062-2930</orcidid><orcidid>https://orcid.org/0000-0002-7849-603X</orcidid></search><sort><creationdate>202405</creationdate><title>Skin dose-volume predictors of moderate-severe late side effects after whole breast radiotherapy</title><author>Cicchetti, Alessandro ; 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Toxicity after whole breast Radiotherapy is a relevant issue, impacting the quality-of-life of a not negligible number of patients. We aimed to develop a Normal Tissue Complication Probability (NTCP) model predicting late toxicities by combining dosimetric parameters of the breast dermis and clinical factors. The skin structure was defined as the outer CT body contour's 5 mm inner isotropic expansion. It was retrospectively segmented on a large mono-institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions to the whole breast. Toxicity was reported during Follow-Up (FU) using SOMA/LENT scoring. The study endpoint was moderate-severe late side effects consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G ≥ 2) developed within 42 months after RT completion. A machine learning pipeline was designed with a logistic model combining clinical factors and absolute skin DVH (cc) parameters as output. The FATP G2 + rate was 3.8 %, with 40/1066 patients experiencing side effects. After the preprocessing of variables, a cross-validation was applied to define the best-performing model. We selected a 4-variable model with Post-Surgery Cosmetic alterations (Odds Ratio, OR = 7.3), Aromatase Inhibitors (as a protective factor with OR = 0.45), V20 Gy (50 % of the prescribed dose, OR = 1.02), and V42 Gy (105 %, OR = 1.09). Factors were also converted into an adjusted V20Gy. The association between late reactions and skin DVH when delivering 40 Gy/15 fr was quantified, suggesting an independent role of V20 and V42. 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identifier ISSN: 0167-8140
ispartof Radiotherapy and oncology, 2024-05, Vol.194, p.110183, Article 110183
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subjects Adult
Aged
Aged, 80 and over
Breast
Breast Neoplasms - radiotherapy
Dose tolerance
Female
Fibrosis
Humans
Middle Aged
Organs at Risk - radiation effects
Radiation Injuries - etiology
Radiotherapy Dosage
Retrospective Studies
Skin - radiation effects
Skin reactions
title Skin dose-volume predictors of moderate-severe late side effects after whole breast radiotherapy
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