학술논문
Skin dose-volume predictors of moderate-severe late side effects after whole breast radiotherapy.
Document Type
Academic Journal
Author
Cicchetti A; Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Data Science Unit, Milan, Italy. Electronic address: alessandro.cicchetti@istitutotumori.mi.it.; Mangili P; IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy.; Fodor A; IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy.; Gabellini MGU; IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy.; Chiara A; IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy.; Deantoni C; IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy.; Mori M; IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy.; Pasetti M; IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy.; Palazzo G; IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy.; Rancati T; Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Data Science Unit, Milan, Italy.; Del Vecchio A; IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy.; Gisella Di Muzio N; IRCCS San Raffaele Scientific Institute, Radiotherapy, Milan, Italy.; Fiorino C; IRCCS San Raffaele Scientific Institute, Medical Physics Milan, Italy.
Source
Publisher: Elsevier Scientific Publishers Country of Publication: Ireland NLM ID: 8407192 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0887 (Electronic) Linking ISSN: 01678140 NLM ISO Abbreviation: Radiother Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Toxicity after whole breast Radiotherapy is a relevant issue, impacting the quality-of-life of a not negligible number of patients. We aimed to develop a Normal Tissue Complication Probability (NTCP) model predicting late toxicities by combining dosimetric parameters of the breast dermis and clinical factors.
Methods: The skin structure was defined as the outer CT body contour's 5 mm inner isotropic expansion. It was retrospectively segmented on a large mono-institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions to the whole breast. Toxicity was reported during Follow-Up (FU) using SOMA/LENT scoring. The study endpoint was moderate-severe late side effects consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G ≥ 2) developed within 42 months after RT completion. A machine learning pipeline was designed with a logistic model combining clinical factors and absolute skin DVH (cc) parameters as output.
Results: The FATP G2 + rate was 3.8 %, with 40/1066 patients experiencing side effects. After the preprocessing of variables, a cross-validation was applied to define the best-performing model. We selected a 4-variable model with Post-Surgery Cosmetic alterations (Odds Ratio, OR = 7.3), Aromatase Inhibitors (as a protective factor with OR = 0.45), V20 Gy (50 % of the prescribed dose, OR = 1.02), and V42 Gy (105 %, OR = 1.09). Factors were also converted into an adjusted V20Gy.
Conclusions: The association between late reactions and skin DVH when delivering 40 Gy/15 fr was quantified, suggesting an independent role of V20 and V42. Few clinical factors heavily modulate the risk.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Methods: The skin structure was defined as the outer CT body contour's 5 mm inner isotropic expansion. It was retrospectively segmented on a large mono-institutional cohort of early-stage breast cancer patients enrolled between 2009 and 2017 (n = 1066). Patients were treated with tangential-field RT, delivering 40 Gy in 15 fractions to the whole breast. Toxicity was reported during Follow-Up (FU) using SOMA/LENT scoring. The study endpoint was moderate-severe late side effects consisting of Fibrosis-Atrophy-Telangiectasia-Pain (FATP G ≥ 2) developed within 42 months after RT completion. A machine learning pipeline was designed with a logistic model combining clinical factors and absolute skin DVH (cc) parameters as output.
Results: The FATP G2 + rate was 3.8 %, with 40/1066 patients experiencing side effects. After the preprocessing of variables, a cross-validation was applied to define the best-performing model. We selected a 4-variable model with Post-Surgery Cosmetic alterations (Odds Ratio, OR = 7.3), Aromatase Inhibitors (as a protective factor with OR = 0.45), V20 Gy (50 % of the prescribed dose, OR = 1.02), and V42 Gy (105 %, OR = 1.09). Factors were also converted into an adjusted V20Gy.
Conclusions: The association between late reactions and skin DVH when delivering 40 Gy/15 fr was quantified, suggesting an independent role of V20 and V42. Few clinical factors heavily modulate the risk.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)