Evaluation of skin dose and skin toxicity in patients undergoing intraoperative radiotherapy for early breast cancer

See, Mee-Hoong and Ung, Ngie Min and Wong, Jeannie Hsiu Ding and Zaili, Zainor and Abdul Malik, Rozita and Bustam, Anita Zarina and Saad, Marniza and Jamaris, Suniza and Mosiun, Joanne Aisha and Mohd Taib, Nur Aishah (2021) Evaluation of skin dose and skin toxicity in patients undergoing intraoperative radiotherapy for early breast cancer. Journal of Applied Clinical Medical Physics, 22 (8). pp. 139-147. ISSN 1526-9914, DOI https://doi.org/10.1002/acm2.13338.

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Purpose This study aims to evaluate in vivo skin dose delivered by intraoperative radiotherapy (IORT) and determine the factors associated with an increased risk of radiation-induced skin toxicity. Methodology A total of 21 breast cancer patients who underwent breast-conserving surgery and IORT, either as IORT alone or IORT boost plus external beam radiotherapy (EBRT), were recruited in this prospective study. EBT3 film was calibrated in water and used to measure skin dose during IORT at concentric circles of 5 mm and 40 mm away from the applicator. For patients who also had EBRT, the maximum skin dose was estimated using the radiotherapy treatment planning system. Mid-term skin toxicities were evaluated at 3 and 6 months post-IORT. Results The average skin dose at 5 mm and 40 mm away from the applicator was 3.07 +/- 0.82 Gy and 0.99 +/- 0.28 Gy, respectively. Patients treated with IORT boost plus EBRT received an additional skin dose of 41.07 +/- 1.57 Gy from the EBRT component. At 3 months post-IORT, 86% of patients showed no evidence of skin toxicity. However, the number of patients suffering from skin toxicity increased from 15% to 38% at 6 months post-IORT. We found no association between the IORT alone or with the IORT boost plus EBRT and skin toxicity. Older age was associated with increased risk of skin toxicities. A mathematical model was derived to predict skin dose. Conclusion EBT3 film is a suitable dosimeter for in vivo skin dosimetry in IORT, providing patient-specific skin doses. Both IORT alone and IORT boost techniques resulted in similar skin toxicity rates.

Item Type: Article
Funders: University of Malaya Research Grant (UMRG) from the University of Malaya [RP046C-15HTM], Post-Graduate Research (PPP) grant from the University of Malaya [PG011-2016A]
Uncontrolled Keywords: Dosimetry; Early breast cancer; INTRABEAM system; IORT; Local complications; Radiochromic film; Skin toxicity
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Divisions: Faculty of Medicine
Faculty of Medicine > Biomedical Imaging Department
Faculty of Medicine > Clinical Oncology Department
Faculty of Medicine > Medicine Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 09 Jun 2022 03:58
Last Modified: 09 Jun 2022 03:58
URI: http://eprints.um.edu.my/id/eprint/34385

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