TY - JOUR
T1 - Chronic skin toxicities in breast cancer survivors
T2 - a systematic review and meta-analysis of radiotherapy techniques
AU - Lee, Shing Fung
AU - Wong, Henry C.Y.
AU - Robijns, Jolien
AU - Ciocon, Stephen Lowell B.
AU - Dos Reis, Paula Elaine Diniz
AU - Sadeghi, Sarina
AU - Al-Khaifi, Muna
AU - Ogita, Mami
AU - Chan, Adrian W.
AU - Rembielak, Agata
AU - Livesey, Daniel
AU - Chong, Matthew
AU - Liu, Zhihui Amy
AU - Trombetta, Mark
AU - Koh, Wee Yao
AU - Leong, Yiat Horng
AU - Marta, Gustavo N.
AU - Bonomo, Pierluigi
AU - Salvestrini, Viola
AU - Vassiliou, Vassilios
AU - Chopade, Pradnya
AU - Patel, Partha
AU - Wong, Cindy
AU - Wolf, Julie Ryan
AU - van den Hurk, Corina
AU - Chan, Raymond J.
AU - Jefford, Michael
AU - Chow, Edward
AU - Kwan, Jennifer Yin Yee
AU - on behalf of the Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology and, Survivorship Study Groups
PY - 2025/7
Y1 - 2025/7
N2 - Purpose: This study assessed the impact of radiotherapy (RT) techniques on chronic skin reactions and health-related quality of life (HRQoL) in breast cancer patients, comparing conventional RT with modern techniques such as intensity-modulated RT (IMRT). Methods: A comprehensive search was conducted in Embase, MEDLINE, and Cochrane CENTRAL from inception to April 26, 2024. Conventional RT, which uses 2D or 3D imaging to shape radiation beams without dynamic intensity modulation, was compared with alternate RT techniques for adjuvant breast cancer treatment. Primary outcomes included chronic grade ≥ 2 skin toxicities (hyperpigmentation, breast fibrosis, telangiectasia, edema, and atrophy/retraction) and HRQoL, assessed mainly with EORTC QLQ-C30 and QLQ-BR23 modules. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: From 1305 screened studies, nine articles representing seven studies (2418 patients), including three randomized controlled trials, met inclusion criteria. Most studies used conventional fractionation (45-50 Gray in 25 fractions). IMRT was associated with a lower incidence of chronic grade ≥ 2 hyperpigmentation (RR: 0.39, 95%CI: 0.17-0.89, I2 = 0%) compared to conventional RT. No significant differences were found for grade ≥ 2 breast fibrosis, telangiectasia, edema, and atrophy/retraction. Cosmetic outcomes from IMRT were favorable in the short term, with no long-term differences. Three studies reported no significant HRQoL differences between IMRT and conventional RT. Conclusion: IMRT may reduce certain chronic skin toxicities compared to conventional RT. However, consistent long-term differences in cosmetic outcomes or HRQoL were not observed. These findings are limited by the small number of studies and variability in reporting standards.
AB - Purpose: This study assessed the impact of radiotherapy (RT) techniques on chronic skin reactions and health-related quality of life (HRQoL) in breast cancer patients, comparing conventional RT with modern techniques such as intensity-modulated RT (IMRT). Methods: A comprehensive search was conducted in Embase, MEDLINE, and Cochrane CENTRAL from inception to April 26, 2024. Conventional RT, which uses 2D or 3D imaging to shape radiation beams without dynamic intensity modulation, was compared with alternate RT techniques for adjuvant breast cancer treatment. Primary outcomes included chronic grade ≥ 2 skin toxicities (hyperpigmentation, breast fibrosis, telangiectasia, edema, and atrophy/retraction) and HRQoL, assessed mainly with EORTC QLQ-C30 and QLQ-BR23 modules. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: From 1305 screened studies, nine articles representing seven studies (2418 patients), including three randomized controlled trials, met inclusion criteria. Most studies used conventional fractionation (45-50 Gray in 25 fractions). IMRT was associated with a lower incidence of chronic grade ≥ 2 hyperpigmentation (RR: 0.39, 95%CI: 0.17-0.89, I2 = 0%) compared to conventional RT. No significant differences were found for grade ≥ 2 breast fibrosis, telangiectasia, edema, and atrophy/retraction. Cosmetic outcomes from IMRT were favorable in the short term, with no long-term differences. Three studies reported no significant HRQoL differences between IMRT and conventional RT. Conclusion: IMRT may reduce certain chronic skin toxicities compared to conventional RT. However, consistent long-term differences in cosmetic outcomes or HRQoL were not observed. These findings are limited by the small number of studies and variability in reporting standards.
KW - Breast neoplasms
KW - Conformal
KW - Intensity-modulated
KW - Quality of life
KW - Radiotherapy
KW - Skin diseases
UR - http://www.scopus.com/inward/record.url?scp=105005880518&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1194051
U2 - 10.1007/s10549-025-07700-y
DO - 10.1007/s10549-025-07700-y
M3 - Review article
C2 - 40323361
AN - SCOPUS:105005880518
SN - 0167-6806
VL - 212
SP - 1
EP - 12
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
IS - 1
ER -
