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BioMed Research International
Volume 2014, Article ID 523568, 7 pages
Clinical Study

Cytokines, Fatigue, and Cutaneous Erythema in Early Stage Breast Cancer Patients Receiving Adjuvant Radiation Therapy

1Department of Translational Medicine, Institute of Radiation Oncology, “Sapienza” University, Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
2Department of Clinical and Molecular Medicine, Cellular Diagnostic Unit, “Sapienza” University, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
3Statistics, Probability and Applied Statistics, “Sapienza” University, Piazzale Aldo Moro 5, 00185 Rome, Italy
4Department of Translational Medicine, Breast Surgery, “Sapienza” University, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
5Department of Clinical and Molecular Medicine, Medical Oncology, “Sapienza” University and IDI-IRCCS, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
6UOD Psyco-oncology, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy

Received 6 November 2013; Revised 19 February 2014; Accepted 3 March 2014; Published 31 March 2014

Academic Editor: Pasquale F. Innominato

Copyright © 2014 Vitaliana De Sanctis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We investigated the hypothesis that patients developing high-grade erythema of the breast skin during radiation treatment could be more likely to present increased levels of proinflammatory cytokines which may lead, in turn, to associated fatigue. Forty women with early stage breast cancer who received adjuvant radiotherapy were enrolled from 2007 to 2010. Fatigue symptoms, erythema, and cytokine levels (IL-1β, IL-2, IL6, IL-8, TNF-α, and MCP-1) were registered at baseline, during treatment, and after radiotherapy completion. Seven (17.5%) patients presented fatigue without associated depression/anxiety. Grade ≥2 erythema was observed in 5 of these 7 patients. IL-1β, IL-2, IL-6, and TNF-α were statistically increased 4 weeks after radiotherapy (). After the Heckman two-step analysis, a statistically significant influence of skin erythema on proinflammatory markers increase (P = 0.00001) was recorded; in the second step, these blood markers showed a significant impact on fatigue (P = 0.026). A seeming increase of fatigue, erythema, and proinflammatory markers was observed between the fourth and the fifth week of treatment followed by a decrease after RT. There were no significant effects of hormone therapy, breast volume, and anemia on fatigue. Our study seems to suggest that fatigue is related to high-grade breast skin erythema during radiotherapy through the increase of cytokines levels.