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 |
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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. Few clinical factors heavily modulate the risk.</description><identifier>ISSN: 0167-8140</identifier><identifier>ISSN: 1879-0887</identifier><identifier>EISSN: 1879-0887</identifier><identifier>DOI: 10.1016/j.radonc.2024.110183</identifier><identifier>PMID: 38423138</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>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</subject><ispartof>Radiotherapy and oncology, 2024-05, Vol.194, p.110183, Article 110183</ispartof><rights>2024 Elsevier B.V.</rights><rights>Copyright © 2024 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c311t-496be6979bf06460e6645a4de9c5a331af770d2fc0c500aa49a0387f3d92a10e3</cites><orcidid>0009-0004-3394-9025 ; 0000-0002-0013-8494 ; 0000-0003-1062-2930 ; 0000-0002-7849-603X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.radonc.2024.110183$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38423138$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cicchetti, Alessandro</creatorcontrib><creatorcontrib>Mangili, Paola</creatorcontrib><creatorcontrib>Fodor, Andrei</creatorcontrib><creatorcontrib>Gabellini, Maria Giulia Ubeira</creatorcontrib><creatorcontrib>Chiara, Anna</creatorcontrib><creatorcontrib>Deantoni, Chiara</creatorcontrib><creatorcontrib>Mori, Martina</creatorcontrib><creatorcontrib>Pasetti, Marcella</creatorcontrib><creatorcontrib>Palazzo, Gabriele</creatorcontrib><creatorcontrib>Rancati, Tiziana</creatorcontrib><creatorcontrib>del Vecchio, Antonella</creatorcontrib><creatorcontrib>Gisella Di Muzio, Nadia</creatorcontrib><creatorcontrib>Fiorino, Claudio</creatorcontrib><title>Skin dose-volume predictors of moderate-severe late side effects after whole breast radiotherapy</title><title>Radiotherapy and oncology</title><addtitle>Radiother Oncol</addtitle><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.</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 ; 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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c311t-496be6979bf06460e6645a4de9c5a331af770d2fc0c500aa49a0387f3d92a10e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Breast</topic><topic>Breast Neoplasms - radiotherapy</topic><topic>Dose tolerance</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Organs at Risk - radiation effects</topic><topic>Radiation Injuries - etiology</topic><topic>Radiotherapy Dosage</topic><topic>Retrospective Studies</topic><topic>Skin - radiation effects</topic><topic>Skin reactions</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cicchetti, Alessandro</creatorcontrib><creatorcontrib>Mangili, Paola</creatorcontrib><creatorcontrib>Fodor, Andrei</creatorcontrib><creatorcontrib>Gabellini, Maria Giulia Ubeira</creatorcontrib><creatorcontrib>Chiara, Anna</creatorcontrib><creatorcontrib>Deantoni, Chiara</creatorcontrib><creatorcontrib>Mori, Martina</creatorcontrib><creatorcontrib>Pasetti, Marcella</creatorcontrib><creatorcontrib>Palazzo, Gabriele</creatorcontrib><creatorcontrib>Rancati, Tiziana</creatorcontrib><creatorcontrib>del Vecchio, Antonella</creatorcontrib><creatorcontrib>Gisella Di Muzio, Nadia</creatorcontrib><creatorcontrib>Fiorino, Claudio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Radiotherapy and oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cicchetti, Alessandro</au><au>Mangili, Paola</au><au>Fodor, Andrei</au><au>Gabellini, Maria Giulia Ubeira</au><au>Chiara, Anna</au><au>Deantoni, Chiara</au><au>Mori, Martina</au><au>Pasetti, Marcella</au><au>Palazzo, Gabriele</au><au>Rancati, Tiziana</au><au>del Vecchio, Antonella</au><au>Gisella Di Muzio, Nadia</au><au>Fiorino, Claudio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Skin dose-volume predictors of moderate-severe late side effects after whole breast radiotherapy</atitle><jtitle>Radiotherapy and oncology</jtitle><addtitle>Radiother Oncol</addtitle><date>2024-05</date><risdate>2024</risdate><volume>194</volume><spage>110183</spage><pages>110183-</pages><artnum>110183</artnum><issn>0167-8140</issn><issn>1879-0887</issn><eissn>1879-0887</eissn><abstract>•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.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>38423138</pmid><doi>10.1016/j.radonc.2024.110183</doi><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></addata></record> |
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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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