Factors Associated with Late Local Radiation Toxicity after Post-Operative Breast Irradiation
Table 4
Significant association between various risk factors and late radiation breast toxicity ≥12 months after whole breast irradiation.
Author (year)
Associated risk factors
Measure of association
Estimation of association
Ciamella (2014)
Skin toxicity
OR
Boost
3.06 (1.28–7.30)
Subcutaneous toxicity
Chemotherapy
2.59 (1.17–5.72)
Breast volumes receiving >104% vs. <100%
0.08 (0.1–0.52)
Breast volumes receiving >107% vs.<100%
6.27 (1.34–29.37)
de rose (2016)
PTV
NR
de rose (2020)
Boost volume > 70 cm3
OR
2.14 (1.26–3.62)
Treated skin areaa > 400 cm2
2.16 (1.12–4.19)
Breast size >1500 cm3
2.10 (1.03–4.30)
Digesu (2018)
Skin
OR
Tobacco smoking
2.15 (1.38–3.34)b
PTV volume
1.12 (1.07–1.18)b
1.27 (1.15–1.41)c
Subcutaneous
3DCRT vs. Mara-1d technique
2.18 (1.50–3.18)b
Diabetes
3.01 (1.08–8.42)c
PTV volume
1.65 (1.01–2.71)b
1.14 (1.08–1.20)b
1.14 (1.01–1.28)c
Hannan (2012)
Prone vs. supine position
R
NR
Large breast vs small breast
NR
BMI
0.38
PTV
0.027
Hosni (2017)
Age >50 y vs. <50 y
OR
NR (1.01–1.20)
DMd
NR (0.00–0.20)
Keller (2012)
RT boost dose (>16 vs. <16 Gy)
OR
2.4 (1.5–3.7)
RT vs. RT combined with chemotherapy and endocrine therapy
1.9 (1.2–2.9)
CTV 500–900 vs. <500
1.9 (NR)
CTV ≥900 vs. <500
3.0 (2.0–4.5)
Boost energy ≥12 MeV vs. ≤10
1.8 (1.3–2.7)
Lazzari (2017)
PTV <1300 vs. >1300 cc
R
0.955
Breast volumes receiving >110%f
0.402
Surgery good vs. poor result
0.455
Palumbo (2018)
None
HR
NA
Yu (2017)g
Re-excision
NR
Postoperative complication
All shown variables were significantly associated with late radiation toxicity. See Supplementary material for nonsignificant variables. aSkin surface surrounding irradiated area receiving at least 20 Gy. bEstimation for Grade 1 toxicity. cEstimation for Grade 2 toxicity. dModulated accelerated hypofractionated radiotherapy. eNo vs. yesf<10% vs. >10%. gResults of univariable analysis, no multivariable analysis performed. Abbreviations: 3DCRT 3D conformal radiotherapy; BMI body mass index; CTV clinical target volume; DM diabetes mellitus; MeV megaelectrovolt; NA not applicable; NR not reported; OR odds ratio; PTV planned target volume; R Pearson’s correlation; RT radiotherapy.
