{"title":"局部晚期乳腺癌患者早发性放射性皮炎的危险因素：体积调制电弧治疗与调强放疗的比较分析","authors":"Chih-Chieh Chang, Po-Wei Huang, Jang-Chun Lin, Jo-Ting Tsai, Shih-Ming Hsu","doi":"10.1007/s12282-025-01762-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Radiodermatitis is the predominant acute toxicity in locally advanced breast cancer (BC) radiotherapy. Early-onset radiodermatitis substantially increases the risk of high-grade injury and potential treatment interruption. This study aimed to identify risk factors for early-onset radiodermatitis by analyzing patient characteristics and dose-distribution profiles from step-and-shoot intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT).</p><p><strong>Methods: </strong>This retrospective analysis included 128 women with locally advanced unilateral BC who received postoperative IMRT or VMAT. Patient demographics, treatment parameters, and three-dimensional dose-volume metrics were extracted. Early-onset radiodermatitis was defined as CTCAE v5.0 grade ≥ 1 developing before the 20th treatment fraction. Univariable and multivariable logistic regression identified independent risk factors, and dosimetric variables were compared between IMRT and VMAT.</p><p><strong>Results: </strong>Early-onset radiodermatitis was observed in 35 of 128 patients (27.3%). Four independent predictors were identified: treatment technique (IMRT versus VMAT: odds ratio [OR] 4.25; 95% confidence interval [CI] 1.30-13.94; p = 0.017), left-sided irradiation (OR 20.98; 95% CI 2.39-184.27; p = 0.006), heart V<sub>5</sub> (OR 0.85 per 1% increase; 95% CI 0.74-0.97; p = 0.012), and PTV<sub>Breast</sub> volume (OR 1.002 per cc; 95% CI 1.000-1.004; p = 0.023). VMAT provided superior target coverage and reduced high-dose exposure to the heart and ipsilateral lung (V<sub>40</sub>), whereas IMRT better limited low-dose spill to the contralateral breast and lung and to the ipsilateral lung (V<sub>5</sub>).</p><p><strong>Conclusions: </strong>IMRT, left-sided irradiation, low heart V<sub>5</sub>, and large PTV<sub>Breast</sub> volume were independent risk factors for early-onset radiodermatitis. Awareness of these factors can guide prophylactic skin care and adaptive planning. While VMAT provides advantages in target coverage and cardiac/high-dose lung sparing against IMRT's superior control of low-dose exposure to normal tissues.</p>","PeriodicalId":520574,"journal":{"name":"Breast cancer (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk factors for early-onset radiodermatitis in patients with locally advanced breast cancer: a comparative analysis of volumetric modulated arc therapy and intensity-modulated radiotherapy.\",\"authors\":\"Chih-Chieh Chang, Po-Wei Huang, Jang-Chun Lin, Jo-Ting Tsai, Shih-Ming Hsu\",\"doi\":\"10.1007/s12282-025-01762-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Radiodermatitis is the predominant acute toxicity in locally advanced breast cancer (BC) radiotherapy. Early-onset radiodermatitis substantially increases the risk of high-grade injury and potential treatment interruption. This study aimed to identify risk factors for early-onset radiodermatitis by analyzing patient characteristics and dose-distribution profiles from step-and-shoot intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT).</p><p><strong>Methods: </strong>This retrospective analysis included 128 women with locally advanced unilateral BC who received postoperative IMRT or VMAT. Patient demographics, treatment parameters, and three-dimensional dose-volume metrics were extracted. Early-onset radiodermatitis was defined as CTCAE v5.0 grade ≥ 1 developing before the 20th treatment fraction. Univariable and multivariable logistic regression identified independent risk factors, and dosimetric variables were compared between IMRT and VMAT.</p><p><strong>Results: </strong>Early-onset radiodermatitis was observed in 35 of 128 patients (27.3%). Four independent predictors were identified: treatment technique (IMRT versus VMAT: odds ratio [OR] 4.25; 95% confidence interval [CI] 1.30-13.94; p = 0.017), left-sided irradiation (OR 20.98; 95% CI 2.39-184.27; p = 0.006), heart V<sub>5</sub> (OR 0.85 per 1% increase; 95% CI 0.74-0.97; p = 0.012), and PTV<sub>Breast</sub> volume (OR 1.002 per cc; 95% CI 1.000-1.004; p = 0.023). VMAT provided superior target coverage and reduced high-dose exposure to the heart and ipsilateral lung (V<sub>40</sub>), whereas IMRT better limited low-dose spill to the contralateral breast and lung and to the ipsilateral lung (V<sub>5</sub>).</p><p><strong>Conclusions: </strong>IMRT, left-sided irradiation, low heart V<sub>5</sub>, and large PTV<sub>Breast</sub> volume were independent risk factors for early-onset radiodermatitis. Awareness of these factors can guide prophylactic skin care and adaptive planning. While VMAT provides advantages in target coverage and cardiac/high-dose lung sparing against IMRT's superior control of low-dose exposure to normal tissues.</p>\",\"PeriodicalId\":520574,\"journal\":{\"name\":\"Breast cancer (Tokyo, Japan)\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-08-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Breast cancer (Tokyo, Japan)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12282-025-01762-y\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast cancer (Tokyo, Japan)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12282-025-01762-y","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：放射性皮炎是局部晚期乳腺癌（BC）放疗的主要急性毒性。早发性放射性皮炎大大增加了高级别损伤和潜在治疗中断的风险。本研究旨在通过分析步进射调强放疗（IMRT）和体积调制弧线治疗（VMAT）的患者特征和剂量分布特征，确定早发性放射性皮炎的危险因素。方法：本回顾性分析包括128例局部晚期单侧BC患者接受术后IMRT或VMAT治疗。提取患者人口统计资料、治疗参数和三维剂量-体积指标。早发性放射性皮炎定义为在第20次治疗前发生CTCAE v5.0级≥1级。单变量和多变量logistic回归确定了独立危险因素，并比较了IMRT和VMAT之间的剂量学变量。结果：128例患者中有35例（27.3%）出现早发性放射性皮炎。确定了四个独立的预测因素：治疗技术（IMRT vs VMAT：优势比[OR] 4.25； 95%可信区间[CI] 1.30-13.94; p = 0.017），左侧照射（OR 20.98; 95% CI 2.39-184.27; p = 0.006），心脏V5 (OR 0.85; 95% CI 0.74-0.97; p = 0.012)， PTVBreast体积（OR 1.002 / cc; 95% CI 1.000-1.004; p = 0.023）。VMAT提供了更好的靶覆盖，减少了心脏和同侧肺的高剂量暴露（V40），而IMRT更好地限制了低剂量泄漏到对侧乳房和肺以及同侧肺（V5）。结论：IMRT、左侧照射、心脏V5低、PTVBreast体积大是早发性放射性皮炎的独立危险因素。了解这些因素可以指导预防性皮肤护理和适应性规划。虽然VMAT在靶覆盖和心脏/高剂量肺保护方面具有优势，但IMRT对正常组织低剂量暴露的优越控制。
Risk factors for early-onset radiodermatitis in patients with locally advanced breast cancer: a comparative analysis of volumetric modulated arc therapy and intensity-modulated radiotherapy.
Background: Radiodermatitis is the predominant acute toxicity in locally advanced breast cancer (BC) radiotherapy. Early-onset radiodermatitis substantially increases the risk of high-grade injury and potential treatment interruption. This study aimed to identify risk factors for early-onset radiodermatitis by analyzing patient characteristics and dose-distribution profiles from step-and-shoot intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT).
Methods: This retrospective analysis included 128 women with locally advanced unilateral BC who received postoperative IMRT or VMAT. Patient demographics, treatment parameters, and three-dimensional dose-volume metrics were extracted. Early-onset radiodermatitis was defined as CTCAE v5.0 grade ≥ 1 developing before the 20th treatment fraction. Univariable and multivariable logistic regression identified independent risk factors, and dosimetric variables were compared between IMRT and VMAT.
Results: Early-onset radiodermatitis was observed in 35 of 128 patients (27.3%). Four independent predictors were identified: treatment technique (IMRT versus VMAT: odds ratio [OR] 4.25; 95% confidence interval [CI] 1.30-13.94; p = 0.017), left-sided irradiation (OR 20.98; 95% CI 2.39-184.27; p = 0.006), heart V5 (OR 0.85 per 1% increase; 95% CI 0.74-0.97; p = 0.012), and PTVBreast volume (OR 1.002 per cc; 95% CI 1.000-1.004; p = 0.023). VMAT provided superior target coverage and reduced high-dose exposure to the heart and ipsilateral lung (V40), whereas IMRT better limited low-dose spill to the contralateral breast and lung and to the ipsilateral lung (V5).
Conclusions: IMRT, left-sided irradiation, low heart V5, and large PTVBreast volume were independent risk factors for early-onset radiodermatitis. Awareness of these factors can guide prophylactic skin care and adaptive planning. While VMAT provides advantages in target coverage and cardiac/high-dose lung sparing against IMRT's superior control of low-dose exposure to normal tissues.
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