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Background <p>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> Methods <p>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> Results <p>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; <i>p</i> = 0.017), left-sided irradiation (OR 20.98; 95% CI 2.39–184.27; <i>p</i> = 0.006), heart <i>V</i><sub>5</sub> (OR 0.85 per 1% increase; 95% CI 0.74–0.97; <i>p</i> = 0.012), and PTV<sub>Breast</sub> volume (OR 1.002 per cc; 95% CI 1.000–1.004; <i>p</i> = 0.023). VMAT provided superior target coverage and reduced high-dose exposure to the heart and ipsilateral lung (<i>V</i><sub>40</sub>), whereas IMRT better limited low-dose spill to the contralateral breast and lung and to the ipsilateral lung (<i>V</i><sub>5</sub>).</p> Conclusions <p>IMRT, left-sided irradiation, low heart <i>V</i><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>

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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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月27日

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  • Chih-Chieh Chang,
  • Po-Wei Huang,
  • Jang-Chun Lin,
  • Jo-Ting Tsai,
  • Shih-Ming Hsu

摘要

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.