Skin Reaction in Radiation Therapy for Breast Cancer

The first medical intervention for many breast cancer patients is breast conserving surgery (BCS) and/or modified radical mastectomy (MRM). Most of these patients undergo radiation therapy, following surgery. The most common side-effect of breast radiotherapy is skin damage. In the present study, the severity of acute skin changes and the underlying causes were investigated in patients undergoing BCS and radiotherapy. This prospective, cohort study was performed on 31 female patients, undergoing breast surgery therapy at Shahid Rajaie Babolsar Radiotherapy Center from September 2011 to July 2012. A questionnaire was designed, including the patient’s characteristics, details of radiotherapy technique, and skin damage; the questionnaire was completed for each patient. The obtained results were analysed by performing ANOVA and Fisher''s exact tests. Complications were graded using the radiation therapy oncology group (RTOG) scale. Grade 0 or 4 of skin damage was observed in none of the patients. Among the evaluated patients, 58%, 35.5%, and 6.5% of the patients had grade 1, grade 2, and grade 3 of skin damage, respectively. There was no statistically significant relationship between regional skin burns and factors such as average tangential field size, internal mammary field, chemotherapy, prior history of diseases, tamoxifen use, previous radiotherapy in breast area, or skin type (p>0.05). However, there was a significant relationship between skin burns and presence of supraclavicular field (p=0.05). Considering the significant relationship between skin burn and supraclavicular field, special attention needs to be paid to factors affecting the treatment planning of supraclavicular field such as field size and photon energy.