Assessment of the Relationship between Absorbed Skin Dose and Chronic Dermal Side-Effects of Radiotherapy in Patients with Breast Cancer

Document Type : Original Article


1 Associate Professor, Department of Radiation Oncology, Solid Tumor Treatment Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Specialist in Radiation Oncology, Solid Tumor Treatment Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Specialist in Pediatric Allergy Allergy and Immunology, Allergy and Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Considering the increasing incidence of breast cancer and patients’ delayed referral to healthcare centers, a large number of these patients are potential candidates for mastectomy and radiotherapy and will eventually suffer from early- or late-onset complications. In this study, we aimed to investigate the prevalence of chronic radiation-induced skin complications and its relation with radiation dose at skin surface in breast radiation of female patients with breast cancer.
Methods: Overall, 194 female patients with non-metastatic breast cancer, who had undergone locoregional radiation therapy of breast and regional lymph nodes during 1999-2009, were enrolled in this cross-sectional study. Chronic skin complications induced by breast radiation were assessed, based on the classification of Radiation Therapy Oncology Group (RTOG). For data analysis, Chi-square and Fisher’s exact test were performed, using SPSS version 18. P-value less than 0.05 was considered statistically significant.
Results: Among 194 patients evaluated in this study, 55 subjects (28.4%) did not have any skin complications (grade 0). On the other hand, 50 (25.8%), 42 (21.6%), 16 (21.6%), and 31 (12.6%) patients had grade 1, grade 2, grade 3, and grade 4 complications, based on RTOG system, respectively. Our results showed that radiation dose at skin surface had a significant impact on the incidence of chronic skin complications. Moreover, increase in maximum skin dose was significantly correlated with chronic skin complications (P=0.009).
Conclusion: As the results indicated, radiation dose at skin surface during radiotherapy is significantly correlated with chronic skin complications, and this relation should be considered in treatment planning.


  1. American Cancer Society: Cancer facts and figures 2002. Atlanta: American Cancer Society; 2002.
  2. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin 2006; 56: 106–130.
  3. Kraus-Tiefenbacher U, Sfintizky A, Welzel G, Simeonova A, Sperk E, Siebenlist K, et al. Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS). Radiat Oncol 2012; 7:217.
  4. Twardella D, Popanda O, Helmbold I, Ebbeler R, Benner A, von Fournier D, et al. Personal characteristics, therapy modalities and individual DNA repair capacity as predictive factors of acute skin toxicity in an unselected cohort of breast cancer patients receiving radiotherapy. Radiother Oncol 2003; 69(2): 145-53.
  5. López E, Guerrero R, Núñez MI, del Moral R, Villalobos M, Martínez-Galán J, et al. Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation-induced DNA damage in lymphocytes. Breast Cancer Res. 2005; 7(5): R690-8.
  6. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5): 1341-6.
  7. Pires AM, Segreto RA, Segreto HR. RTOG criteria to evaluate acute skin reaction and its risk factors in patients with breast cancer submitted to radiotherapy. Rev Lat Am Enfermagem 2008; 16(5): 844-9.
  8. Perez CA, et al. Principles and practice of radiation oncology, 5th ed. Philadelphia, Lippincott Williams & Wilkins; 2008.
  9. Munshi A, Kakkar S, Bhutani R, Jalali R, Budrukkar A, Dinshaw KA. Factors influencing cosmetic outcome in breast conservation. Clin Oncol (R Coll Radiol) 2009; 21(4): 285-93.