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Jean L Wright - One of the best experts on this subject based on the ideXlab platform.

  • Prospective evaluation of radiation-induced skin toxicity in a race/ethnically diverse breast cancer population.
    Cancer medicine, 2016
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao, Eunkyung Lee, Omar L. Nelson
    Abstract:

    We evaluated predictors of radiation-induced skin toxicity in a prospective study of a tri-racial/ethnic breast cancer population. We evaluated patient demographics, tumor characteristics, and treatment variables in the first 392 patients in a prospective study assessing radiation-induced skin toxicity. Logistic regression analyses were conducted to evaluate potential predictors of skin toxicity. The study consists of 59 non-Hispanic whites (NHW; 15%), 241 Hispanic Whites (HW; 62%), 79 black or African Americans (AA; 20%), and 13 others (3%). Overall, 48% developed grade 0-1 skin toxicity, 49.8% grade 2, and 2.2% grade 3 by the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) scale. Twenty-one percent developed Moist Desquamation. In multivariate analysis, higher body mass index (BMI; OR = 2.09; 95%CI = 1.15, 3.82), higher disease stage (OR = 1.82; 95%CI = 1.06, 3.11), ER-positive/PR-negative status (OR = 2.74; 95%CI = 1.26, 5.98), and conventionally fractionated regimens (OR = 3.25; 95%CI = 1.76, 6.01) were significantly associated with higher skin toxicity grade after adjustment for age, race, ethnicity, ER status, and breast volume. B MI specifically predicted for Moist Desquamation, but not degree of erythema. In this racially and ethnically diverse cohort of breast cancer patients receiving radiation to the intact breast, risk factors including BMI, disease stage, and conventionally fractionated radiation predicted for higher skin toxicity grade, whereas age, race, ethnicity, and breast volume did not. BMI specifically predicted for Moist Desquamation, suggesting that preventive measures to address this particular outcome should be investigated.

  • Racial variations in radiation-induced skin toxicity severity: data from a prospective cohort receiving postmastectomy radiation
    International journal of radiation oncology biology physics, 2014
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao, Eunkyung Lee
    Abstract:

    Purpose Radiation-induced skin toxicity is one of the most symptomatic side effects of postmastectomy radiation therapy (PMRT). We sought to determine whether the severity of acute skin toxicity was greater in black patients in a prospective cohort receiving PMRT and to identify other predictors of more severe skin toxicity. Methods and Materials We evaluated the first 110 patients in an ongoing prospective study assessing radiation-induced skin toxicity in patients receiving PMRT. We recorded patient demographics, body mass index (BMI), and disease and treatment characteristics. Logistic regression analyses were conducted to evaluate the effect of potential predictors on the risk of skin toxicity. Results A total of 23.6% respondents self-identified as black, 5.5% as non-Hispanic white, 69.1% as Hispanic white, and 1.8% as other; 57% were postmenopausal, and 70.9% had BMI of >25. Median chest wall dose was 50 Gy, and mastectomy scar dose was 60 Gy. Most patients, 95.5%, were treated with a 0.5-cm bolus throughout treatment. There were no significant differences in patient characteristics in black versus non-black patients. At RT completion, Moist Desquamation was more common in black patients (73.1% vs 47.6%, respectively, P =.023), in postmenopausal patients (63.5% vs 40.4%, respectively, P =.016), and in those with BMI of ≥25 (60.3% vs 37.5%, respectively, P =.030). On multivariate analysis, the effects of black race (odds ratio [OR] = 7.46, P =.031), BMI ≥25 (OR = 2.95, P =.043) and postmenopausal status (OR = 8.26, P =.004) remained significant risk factors for Moist Desquamation. Conclusions In this prospectively followed, racially diverse cohort of breast cancer patients receiving PMRT delivered in a uniform fashion, including the routine use of chest wall boost and bolus, black race, higher BMI, and postmenopausal status emerged as significant predictors of Moist Desquamation. There was a high frequency of Moist Desquamation, particularly in those patients with elevated risk. Continued study of patient selection for chest wall boost and bolus as well improved skin toxicity management strategies are needed.

  • abstract 76 rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery
    Cancer Research, 2013
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao
    Abstract:

    Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC OBJECTIVE: Although skin toxicity is expected to be more severe in the setting of post-mastectomy radiation (PMRT) compared to breast conserving surgery + intact breast radiation (BCT), the actual incidence of Moist Desquamation (MD) in patients treated with PMRT has not been well quantified. We prospectively determined rates of MD in patients treated with PMRT compared to BCT and identified risk factors for the development of MD. MATERIALS/ METHODS: 284 breast cancer patients enrolled on two parallel prospectively managed observational studies to assess skin reaction to RT (one in the setting of BCT and the other PMRT) were included in this analysis. All received tangential photons to the intact breast or chest wall (CW) following definitive surgery, with a dose of 45-50 Gy to the breast/CW +/- supraclavicular nodes (SCV). BCT patients had a 10 Gy lumpectomy cavity boost. PMRT patients received daily 0.5 cm bolus with a 10 Gy scar boost. Skin toxicities and rates of MD were rated by the treating physician on a weekly basis during RT, using the CTCAE v3.0 scale. Logistic regression analysis was used to assess risk factors associated with MD. RESULTS: Overall, 19% were black, 64% Hispanic white, and 17 % non-Hispanic white/other. Patients receiving PMRT were younger (median age 51.5 vs 57, p 30, p=0.011), and increasing breast cancer stage (21.7% stage 0, 24.5% stage I, 29.5% stage II, 49% stage III, p=0.018). On multivariate analysis, the use of PMRT (OR 3.84, 95% CI 1.76-8.87, p=0.001) and increasing BMI (OR 2.42, 95% CI 1.10-5.30 (p=0.028) for BMI 25-29.9 vs <25; OR 3.10, 95% CI 1.46-6.59 (p=0.003) for BMI ≥30 vs <25) retained statistical significance as risk factors for MD, but stage was no longer significant. There was no difference in rate of MD by race or ethnicity. CONCLUSIONS: The rate of MD is more than double in patients receiving PMRT vs BCT, 55.2% vs 23%, even when accounting for increasing stage and BMI. This information is important in counseling our patients regarding the potential toxicities of adjuvant radiation treatment for breast cancer. Citation Format: Jean L. Wright, Cristiane Takita, Isildinha Reis, Wei Zhao, Jennifer J. Hu. Rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 76. doi:10.1158/1538-7445.AM2013-76

  • Abstract 76: Rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery.
    Clinical Research, 2013
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao
    Abstract:

    Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC OBJECTIVE: Although skin toxicity is expected to be more severe in the setting of post-mastectomy radiation (PMRT) compared to breast conserving surgery + intact breast radiation (BCT), the actual incidence of Moist Desquamation (MD) in patients treated with PMRT has not been well quantified. We prospectively determined rates of MD in patients treated with PMRT compared to BCT and identified risk factors for the development of MD. MATERIALS/ METHODS: 284 breast cancer patients enrolled on two parallel prospectively managed observational studies to assess skin reaction to RT (one in the setting of BCT and the other PMRT) were included in this analysis. All received tangential photons to the intact breast or chest wall (CW) following definitive surgery, with a dose of 45-50 Gy to the breast/CW +/- supraclavicular nodes (SCV). BCT patients had a 10 Gy lumpectomy cavity boost. PMRT patients received daily 0.5 cm bolus with a 10 Gy scar boost. Skin toxicities and rates of MD were rated by the treating physician on a weekly basis during RT, using the CTCAE v3.0 scale. Logistic regression analysis was used to assess risk factors associated with MD. RESULTS: Overall, 19% were black, 64% Hispanic white, and 17 % non-Hispanic white/other. Patients receiving PMRT were younger (median age 51.5 vs 57, p 30, p=0.011), and increasing breast cancer stage (21.7% stage 0, 24.5% stage I, 29.5% stage II, 49% stage III, p=0.018). On multivariate analysis, the use of PMRT (OR 3.84, 95% CI 1.76-8.87, p=0.001) and increasing BMI (OR 2.42, 95% CI 1.10-5.30 (p=0.028) for BMI 25-29.9 vs

Wei Zhao - One of the best experts on this subject based on the ideXlab platform.

  • Prospective evaluation of radiation-induced skin toxicity in a race/ethnically diverse breast cancer population.
    Cancer medicine, 2016
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao, Eunkyung Lee, Omar L. Nelson
    Abstract:

    We evaluated predictors of radiation-induced skin toxicity in a prospective study of a tri-racial/ethnic breast cancer population. We evaluated patient demographics, tumor characteristics, and treatment variables in the first 392 patients in a prospective study assessing radiation-induced skin toxicity. Logistic regression analyses were conducted to evaluate potential predictors of skin toxicity. The study consists of 59 non-Hispanic whites (NHW; 15%), 241 Hispanic Whites (HW; 62%), 79 black or African Americans (AA; 20%), and 13 others (3%). Overall, 48% developed grade 0-1 skin toxicity, 49.8% grade 2, and 2.2% grade 3 by the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) scale. Twenty-one percent developed Moist Desquamation. In multivariate analysis, higher body mass index (BMI; OR = 2.09; 95%CI = 1.15, 3.82), higher disease stage (OR = 1.82; 95%CI = 1.06, 3.11), ER-positive/PR-negative status (OR = 2.74; 95%CI = 1.26, 5.98), and conventionally fractionated regimens (OR = 3.25; 95%CI = 1.76, 6.01) were significantly associated with higher skin toxicity grade after adjustment for age, race, ethnicity, ER status, and breast volume. B MI specifically predicted for Moist Desquamation, but not degree of erythema. In this racially and ethnically diverse cohort of breast cancer patients receiving radiation to the intact breast, risk factors including BMI, disease stage, and conventionally fractionated radiation predicted for higher skin toxicity grade, whereas age, race, ethnicity, and breast volume did not. BMI specifically predicted for Moist Desquamation, suggesting that preventive measures to address this particular outcome should be investigated.

  • Racial variations in radiation-induced skin toxicity severity: data from a prospective cohort receiving postmastectomy radiation
    International journal of radiation oncology biology physics, 2014
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao, Eunkyung Lee
    Abstract:

    Purpose Radiation-induced skin toxicity is one of the most symptomatic side effects of postmastectomy radiation therapy (PMRT). We sought to determine whether the severity of acute skin toxicity was greater in black patients in a prospective cohort receiving PMRT and to identify other predictors of more severe skin toxicity. Methods and Materials We evaluated the first 110 patients in an ongoing prospective study assessing radiation-induced skin toxicity in patients receiving PMRT. We recorded patient demographics, body mass index (BMI), and disease and treatment characteristics. Logistic regression analyses were conducted to evaluate the effect of potential predictors on the risk of skin toxicity. Results A total of 23.6% respondents self-identified as black, 5.5% as non-Hispanic white, 69.1% as Hispanic white, and 1.8% as other; 57% were postmenopausal, and 70.9% had BMI of >25. Median chest wall dose was 50 Gy, and mastectomy scar dose was 60 Gy. Most patients, 95.5%, were treated with a 0.5-cm bolus throughout treatment. There were no significant differences in patient characteristics in black versus non-black patients. At RT completion, Moist Desquamation was more common in black patients (73.1% vs 47.6%, respectively, P =.023), in postmenopausal patients (63.5% vs 40.4%, respectively, P =.016), and in those with BMI of ≥25 (60.3% vs 37.5%, respectively, P =.030). On multivariate analysis, the effects of black race (odds ratio [OR] = 7.46, P =.031), BMI ≥25 (OR = 2.95, P =.043) and postmenopausal status (OR = 8.26, P =.004) remained significant risk factors for Moist Desquamation. Conclusions In this prospectively followed, racially diverse cohort of breast cancer patients receiving PMRT delivered in a uniform fashion, including the routine use of chest wall boost and bolus, black race, higher BMI, and postmenopausal status emerged as significant predictors of Moist Desquamation. There was a high frequency of Moist Desquamation, particularly in those patients with elevated risk. Continued study of patient selection for chest wall boost and bolus as well improved skin toxicity management strategies are needed.

  • abstract 76 rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery
    Cancer Research, 2013
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao
    Abstract:

    Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC OBJECTIVE: Although skin toxicity is expected to be more severe in the setting of post-mastectomy radiation (PMRT) compared to breast conserving surgery + intact breast radiation (BCT), the actual incidence of Moist Desquamation (MD) in patients treated with PMRT has not been well quantified. We prospectively determined rates of MD in patients treated with PMRT compared to BCT and identified risk factors for the development of MD. MATERIALS/ METHODS: 284 breast cancer patients enrolled on two parallel prospectively managed observational studies to assess skin reaction to RT (one in the setting of BCT and the other PMRT) were included in this analysis. All received tangential photons to the intact breast or chest wall (CW) following definitive surgery, with a dose of 45-50 Gy to the breast/CW +/- supraclavicular nodes (SCV). BCT patients had a 10 Gy lumpectomy cavity boost. PMRT patients received daily 0.5 cm bolus with a 10 Gy scar boost. Skin toxicities and rates of MD were rated by the treating physician on a weekly basis during RT, using the CTCAE v3.0 scale. Logistic regression analysis was used to assess risk factors associated with MD. RESULTS: Overall, 19% were black, 64% Hispanic white, and 17 % non-Hispanic white/other. Patients receiving PMRT were younger (median age 51.5 vs 57, p 30, p=0.011), and increasing breast cancer stage (21.7% stage 0, 24.5% stage I, 29.5% stage II, 49% stage III, p=0.018). On multivariate analysis, the use of PMRT (OR 3.84, 95% CI 1.76-8.87, p=0.001) and increasing BMI (OR 2.42, 95% CI 1.10-5.30 (p=0.028) for BMI 25-29.9 vs <25; OR 3.10, 95% CI 1.46-6.59 (p=0.003) for BMI ≥30 vs <25) retained statistical significance as risk factors for MD, but stage was no longer significant. There was no difference in rate of MD by race or ethnicity. CONCLUSIONS: The rate of MD is more than double in patients receiving PMRT vs BCT, 55.2% vs 23%, even when accounting for increasing stage and BMI. This information is important in counseling our patients regarding the potential toxicities of adjuvant radiation treatment for breast cancer. Citation Format: Jean L. Wright, Cristiane Takita, Isildinha Reis, Wei Zhao, Jennifer J. Hu. Rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 76. doi:10.1158/1538-7445.AM2013-76

  • Abstract 76: Rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery.
    Clinical Research, 2013
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao
    Abstract:

    Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC OBJECTIVE: Although skin toxicity is expected to be more severe in the setting of post-mastectomy radiation (PMRT) compared to breast conserving surgery + intact breast radiation (BCT), the actual incidence of Moist Desquamation (MD) in patients treated with PMRT has not been well quantified. We prospectively determined rates of MD in patients treated with PMRT compared to BCT and identified risk factors for the development of MD. MATERIALS/ METHODS: 284 breast cancer patients enrolled on two parallel prospectively managed observational studies to assess skin reaction to RT (one in the setting of BCT and the other PMRT) were included in this analysis. All received tangential photons to the intact breast or chest wall (CW) following definitive surgery, with a dose of 45-50 Gy to the breast/CW +/- supraclavicular nodes (SCV). BCT patients had a 10 Gy lumpectomy cavity boost. PMRT patients received daily 0.5 cm bolus with a 10 Gy scar boost. Skin toxicities and rates of MD were rated by the treating physician on a weekly basis during RT, using the CTCAE v3.0 scale. Logistic regression analysis was used to assess risk factors associated with MD. RESULTS: Overall, 19% were black, 64% Hispanic white, and 17 % non-Hispanic white/other. Patients receiving PMRT were younger (median age 51.5 vs 57, p 30, p=0.011), and increasing breast cancer stage (21.7% stage 0, 24.5% stage I, 29.5% stage II, 49% stage III, p=0.018). On multivariate analysis, the use of PMRT (OR 3.84, 95% CI 1.76-8.87, p=0.001) and increasing BMI (OR 2.42, 95% CI 1.10-5.30 (p=0.028) for BMI 25-29.9 vs

Pauline T Truong - One of the best experts on this subject based on the ideXlab platform.

  • prospective evaluation of severe skin toxicity and pain during postmastectomy radiation therapy
    International Journal of Radiation Oncology Biology Physics, 2015
    Co-Authors: Jeanphilippe Pignol, Thi Trinh Thuc Vu, Gunita Mitera, Sandy Bosnic, Helena M Verkooijen, Pauline T Truong
    Abstract:

    Purpose To prospectively capture acute toxicities and pain associated with postmastectomy radiation therapy (PMRT), to analyze patient and treatment risk factors for severe side effects. Methods and Materials Women referred for PMRT were prospectively enrolled and assessed weekly during and after radiation therapy. The endpoint included severe National Cancer Institute Common Terminology Criteria for Adverse Effects grade 3 Moist Desquamation, other skin symptoms, and pain. Results Of 257 patients, 73 (28.4%) experienced extensive Moist Desquamation, 84 (32.7%) Common Terminology Criteria for Adverse Effects skin toxicity grade 3, and 57 (22.2%) a pain impacting on daily life activities. Among symptoms only grade 3 Moist Desquamation was significantly associated with severe pain ( P Conclusions The present cohort study suggests excessive radiation toxicity after PMRT. Among factors associated with an increase of toxicity are smoking habits and the use of skin bolus.

  • Prospective Evaluation of Severe Skin Toxicity and Pain During Postmastectomy Radiation Therapy
    International journal of radiation oncology biology physics, 2015
    Co-Authors: Jeanphilippe Pignol, Gunita Mitera, Sandy Bosnic, Helena M Verkooijen, Pauline T Truong
    Abstract:

    Purpose To prospectively capture acute toxicities and pain associated with postmastectomy radiation therapy (PMRT), to analyze patient and treatment risk factors for severe side effects. Methods and Materials Women referred for PMRT were prospectively enrolled and assessed weekly during and after radiation therapy. The endpoint included severe National Cancer Institute Common Terminology Criteria for Adverse Effects grade 3 Moist Desquamation, other skin symptoms, and pain. Results Of 257 patients, 73 (28.4%) experienced extensive Moist Desquamation, 84 (32.7%) Common Terminology Criteria for Adverse Effects skin toxicity grade 3, and 57 (22.2%) a pain impacting on daily life activities. Among symptoms only grade 3 Moist Desquamation was significantly associated with severe pain ( P Conclusions The present cohort study suggests excessive radiation toxicity after PMRT. Among factors associated with an increase of toxicity are smoking habits and the use of skin bolus.

  • A Multicenter Randomized Trial of Breast Intensity-Modulated Radiation Therapy to Reduce Acute Radiation Dermatitis
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008
    Co-Authors: Jeanphilippe Pignol, Pauline T Truong, Ivo A. Olivotto, Eileen Rakovitch, Sandra Gardner, Katharina E. Sixel, Wayne Beckham, Ida Ackerman, Lawrence F. Paszat
    Abstract:

    Purpose Dermatitis is a frequent adverse effect of adjuvant breast radiotherapy. It is more likely in full-breasted women and when the radiation is distributed nonhomogeneously in the breast. Breast intensity-modulated radiation therapy (IMRT) is a technique that ensures a more homogeneous dose distribution. Patients and Methods A multicenter, double-blind, randomized clinical trial was performed to test if breast IMRT would reduce the rate of acute skin reaction (notably Moist Desquamation), decrease pain, and improve quality of life compared with standard radiotherapy using wedges. Patients were assessed each week during and up to 6 weeks after radiotherapy. Results A total of 358 patients were randomly assigned between July 2003 and March 2005 in two Canadian centers, and 331 were included in the analysis. Breast IMRT significantly improved the dose distribution compared with standard radiation. This translated into a lower proportion of patients experiencing Moist Desquamation during or up to 6 weeks after their radiation treatment; 31.2% with IMRT compared with 47.8% with standard treatment (P .002). A multivariate analysis found the use of breast IMRT (P .003) and smaller breast size (P .001) were significantly associated with a decreased risk of Moist Desquamation. The use of IMRT did not correlate with pain and quality of life, but the presence of Moist Desquamation did significantly correlate with pain (P .002) and a reduced quality of life (P .003). Conclusion Breast IMRT significantly reduced the occurrence of Moist Desquamation compared with a standard wedged technique. Moist Desquamation was correlated with increased pain and reduction in the quality of life. J Clin Oncol 26:2085-2092. © 2008 by American Society of Clinical Oncology

Cristiane Takita - One of the best experts on this subject based on the ideXlab platform.

  • Prospective evaluation of radiation-induced skin toxicity in a race/ethnically diverse breast cancer population.
    Cancer medicine, 2016
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao, Eunkyung Lee, Omar L. Nelson
    Abstract:

    We evaluated predictors of radiation-induced skin toxicity in a prospective study of a tri-racial/ethnic breast cancer population. We evaluated patient demographics, tumor characteristics, and treatment variables in the first 392 patients in a prospective study assessing radiation-induced skin toxicity. Logistic regression analyses were conducted to evaluate potential predictors of skin toxicity. The study consists of 59 non-Hispanic whites (NHW; 15%), 241 Hispanic Whites (HW; 62%), 79 black or African Americans (AA; 20%), and 13 others (3%). Overall, 48% developed grade 0-1 skin toxicity, 49.8% grade 2, and 2.2% grade 3 by the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) scale. Twenty-one percent developed Moist Desquamation. In multivariate analysis, higher body mass index (BMI; OR = 2.09; 95%CI = 1.15, 3.82), higher disease stage (OR = 1.82; 95%CI = 1.06, 3.11), ER-positive/PR-negative status (OR = 2.74; 95%CI = 1.26, 5.98), and conventionally fractionated regimens (OR = 3.25; 95%CI = 1.76, 6.01) were significantly associated with higher skin toxicity grade after adjustment for age, race, ethnicity, ER status, and breast volume. B MI specifically predicted for Moist Desquamation, but not degree of erythema. In this racially and ethnically diverse cohort of breast cancer patients receiving radiation to the intact breast, risk factors including BMI, disease stage, and conventionally fractionated radiation predicted for higher skin toxicity grade, whereas age, race, ethnicity, and breast volume did not. BMI specifically predicted for Moist Desquamation, suggesting that preventive measures to address this particular outcome should be investigated.

  • Racial variations in radiation-induced skin toxicity severity: data from a prospective cohort receiving postmastectomy radiation
    International journal of radiation oncology biology physics, 2014
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao, Eunkyung Lee
    Abstract:

    Purpose Radiation-induced skin toxicity is one of the most symptomatic side effects of postmastectomy radiation therapy (PMRT). We sought to determine whether the severity of acute skin toxicity was greater in black patients in a prospective cohort receiving PMRT and to identify other predictors of more severe skin toxicity. Methods and Materials We evaluated the first 110 patients in an ongoing prospective study assessing radiation-induced skin toxicity in patients receiving PMRT. We recorded patient demographics, body mass index (BMI), and disease and treatment characteristics. Logistic regression analyses were conducted to evaluate the effect of potential predictors on the risk of skin toxicity. Results A total of 23.6% respondents self-identified as black, 5.5% as non-Hispanic white, 69.1% as Hispanic white, and 1.8% as other; 57% were postmenopausal, and 70.9% had BMI of >25. Median chest wall dose was 50 Gy, and mastectomy scar dose was 60 Gy. Most patients, 95.5%, were treated with a 0.5-cm bolus throughout treatment. There were no significant differences in patient characteristics in black versus non-black patients. At RT completion, Moist Desquamation was more common in black patients (73.1% vs 47.6%, respectively, P =.023), in postmenopausal patients (63.5% vs 40.4%, respectively, P =.016), and in those with BMI of ≥25 (60.3% vs 37.5%, respectively, P =.030). On multivariate analysis, the effects of black race (odds ratio [OR] = 7.46, P =.031), BMI ≥25 (OR = 2.95, P =.043) and postmenopausal status (OR = 8.26, P =.004) remained significant risk factors for Moist Desquamation. Conclusions In this prospectively followed, racially diverse cohort of breast cancer patients receiving PMRT delivered in a uniform fashion, including the routine use of chest wall boost and bolus, black race, higher BMI, and postmenopausal status emerged as significant predictors of Moist Desquamation. There was a high frequency of Moist Desquamation, particularly in those patients with elevated risk. Continued study of patient selection for chest wall boost and bolus as well improved skin toxicity management strategies are needed.

  • abstract 76 rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery
    Cancer Research, 2013
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao
    Abstract:

    Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC OBJECTIVE: Although skin toxicity is expected to be more severe in the setting of post-mastectomy radiation (PMRT) compared to breast conserving surgery + intact breast radiation (BCT), the actual incidence of Moist Desquamation (MD) in patients treated with PMRT has not been well quantified. We prospectively determined rates of MD in patients treated with PMRT compared to BCT and identified risk factors for the development of MD. MATERIALS/ METHODS: 284 breast cancer patients enrolled on two parallel prospectively managed observational studies to assess skin reaction to RT (one in the setting of BCT and the other PMRT) were included in this analysis. All received tangential photons to the intact breast or chest wall (CW) following definitive surgery, with a dose of 45-50 Gy to the breast/CW +/- supraclavicular nodes (SCV). BCT patients had a 10 Gy lumpectomy cavity boost. PMRT patients received daily 0.5 cm bolus with a 10 Gy scar boost. Skin toxicities and rates of MD were rated by the treating physician on a weekly basis during RT, using the CTCAE v3.0 scale. Logistic regression analysis was used to assess risk factors associated with MD. RESULTS: Overall, 19% were black, 64% Hispanic white, and 17 % non-Hispanic white/other. Patients receiving PMRT were younger (median age 51.5 vs 57, p 30, p=0.011), and increasing breast cancer stage (21.7% stage 0, 24.5% stage I, 29.5% stage II, 49% stage III, p=0.018). On multivariate analysis, the use of PMRT (OR 3.84, 95% CI 1.76-8.87, p=0.001) and increasing BMI (OR 2.42, 95% CI 1.10-5.30 (p=0.028) for BMI 25-29.9 vs <25; OR 3.10, 95% CI 1.46-6.59 (p=0.003) for BMI ≥30 vs <25) retained statistical significance as risk factors for MD, but stage was no longer significant. There was no difference in rate of MD by race or ethnicity. CONCLUSIONS: The rate of MD is more than double in patients receiving PMRT vs BCT, 55.2% vs 23%, even when accounting for increasing stage and BMI. This information is important in counseling our patients regarding the potential toxicities of adjuvant radiation treatment for breast cancer. Citation Format: Jean L. Wright, Cristiane Takita, Isildinha Reis, Wei Zhao, Jennifer J. Hu. Rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 76. doi:10.1158/1538-7445.AM2013-76

  • Abstract 76: Rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery.
    Clinical Research, 2013
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao
    Abstract:

    Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC OBJECTIVE: Although skin toxicity is expected to be more severe in the setting of post-mastectomy radiation (PMRT) compared to breast conserving surgery + intact breast radiation (BCT), the actual incidence of Moist Desquamation (MD) in patients treated with PMRT has not been well quantified. We prospectively determined rates of MD in patients treated with PMRT compared to BCT and identified risk factors for the development of MD. MATERIALS/ METHODS: 284 breast cancer patients enrolled on two parallel prospectively managed observational studies to assess skin reaction to RT (one in the setting of BCT and the other PMRT) were included in this analysis. All received tangential photons to the intact breast or chest wall (CW) following definitive surgery, with a dose of 45-50 Gy to the breast/CW +/- supraclavicular nodes (SCV). BCT patients had a 10 Gy lumpectomy cavity boost. PMRT patients received daily 0.5 cm bolus with a 10 Gy scar boost. Skin toxicities and rates of MD were rated by the treating physician on a weekly basis during RT, using the CTCAE v3.0 scale. Logistic regression analysis was used to assess risk factors associated with MD. RESULTS: Overall, 19% were black, 64% Hispanic white, and 17 % non-Hispanic white/other. Patients receiving PMRT were younger (median age 51.5 vs 57, p 30, p=0.011), and increasing breast cancer stage (21.7% stage 0, 24.5% stage I, 29.5% stage II, 49% stage III, p=0.018). On multivariate analysis, the use of PMRT (OR 3.84, 95% CI 1.76-8.87, p=0.001) and increasing BMI (OR 2.42, 95% CI 1.10-5.30 (p=0.028) for BMI 25-29.9 vs

Isildinha M Reis - One of the best experts on this subject based on the ideXlab platform.

  • Prospective evaluation of radiation-induced skin toxicity in a race/ethnically diverse breast cancer population.
    Cancer medicine, 2016
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao, Eunkyung Lee, Omar L. Nelson
    Abstract:

    We evaluated predictors of radiation-induced skin toxicity in a prospective study of a tri-racial/ethnic breast cancer population. We evaluated patient demographics, tumor characteristics, and treatment variables in the first 392 patients in a prospective study assessing radiation-induced skin toxicity. Logistic regression analyses were conducted to evaluate potential predictors of skin toxicity. The study consists of 59 non-Hispanic whites (NHW; 15%), 241 Hispanic Whites (HW; 62%), 79 black or African Americans (AA; 20%), and 13 others (3%). Overall, 48% developed grade 0-1 skin toxicity, 49.8% grade 2, and 2.2% grade 3 by the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) scale. Twenty-one percent developed Moist Desquamation. In multivariate analysis, higher body mass index (BMI; OR = 2.09; 95%CI = 1.15, 3.82), higher disease stage (OR = 1.82; 95%CI = 1.06, 3.11), ER-positive/PR-negative status (OR = 2.74; 95%CI = 1.26, 5.98), and conventionally fractionated regimens (OR = 3.25; 95%CI = 1.76, 6.01) were significantly associated with higher skin toxicity grade after adjustment for age, race, ethnicity, ER status, and breast volume. B MI specifically predicted for Moist Desquamation, but not degree of erythema. In this racially and ethnically diverse cohort of breast cancer patients receiving radiation to the intact breast, risk factors including BMI, disease stage, and conventionally fractionated radiation predicted for higher skin toxicity grade, whereas age, race, ethnicity, and breast volume did not. BMI specifically predicted for Moist Desquamation, suggesting that preventive measures to address this particular outcome should be investigated.

  • Racial variations in radiation-induced skin toxicity severity: data from a prospective cohort receiving postmastectomy radiation
    International journal of radiation oncology biology physics, 2014
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao, Eunkyung Lee
    Abstract:

    Purpose Radiation-induced skin toxicity is one of the most symptomatic side effects of postmastectomy radiation therapy (PMRT). We sought to determine whether the severity of acute skin toxicity was greater in black patients in a prospective cohort receiving PMRT and to identify other predictors of more severe skin toxicity. Methods and Materials We evaluated the first 110 patients in an ongoing prospective study assessing radiation-induced skin toxicity in patients receiving PMRT. We recorded patient demographics, body mass index (BMI), and disease and treatment characteristics. Logistic regression analyses were conducted to evaluate the effect of potential predictors on the risk of skin toxicity. Results A total of 23.6% respondents self-identified as black, 5.5% as non-Hispanic white, 69.1% as Hispanic white, and 1.8% as other; 57% were postmenopausal, and 70.9% had BMI of >25. Median chest wall dose was 50 Gy, and mastectomy scar dose was 60 Gy. Most patients, 95.5%, were treated with a 0.5-cm bolus throughout treatment. There were no significant differences in patient characteristics in black versus non-black patients. At RT completion, Moist Desquamation was more common in black patients (73.1% vs 47.6%, respectively, P =.023), in postmenopausal patients (63.5% vs 40.4%, respectively, P =.016), and in those with BMI of ≥25 (60.3% vs 37.5%, respectively, P =.030). On multivariate analysis, the effects of black race (odds ratio [OR] = 7.46, P =.031), BMI ≥25 (OR = 2.95, P =.043) and postmenopausal status (OR = 8.26, P =.004) remained significant risk factors for Moist Desquamation. Conclusions In this prospectively followed, racially diverse cohort of breast cancer patients receiving PMRT delivered in a uniform fashion, including the routine use of chest wall boost and bolus, black race, higher BMI, and postmenopausal status emerged as significant predictors of Moist Desquamation. There was a high frequency of Moist Desquamation, particularly in those patients with elevated risk. Continued study of patient selection for chest wall boost and bolus as well improved skin toxicity management strategies are needed.

  • abstract 76 rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery
    Cancer Research, 2013
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao
    Abstract:

    Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC OBJECTIVE: Although skin toxicity is expected to be more severe in the setting of post-mastectomy radiation (PMRT) compared to breast conserving surgery + intact breast radiation (BCT), the actual incidence of Moist Desquamation (MD) in patients treated with PMRT has not been well quantified. We prospectively determined rates of MD in patients treated with PMRT compared to BCT and identified risk factors for the development of MD. MATERIALS/ METHODS: 284 breast cancer patients enrolled on two parallel prospectively managed observational studies to assess skin reaction to RT (one in the setting of BCT and the other PMRT) were included in this analysis. All received tangential photons to the intact breast or chest wall (CW) following definitive surgery, with a dose of 45-50 Gy to the breast/CW +/- supraclavicular nodes (SCV). BCT patients had a 10 Gy lumpectomy cavity boost. PMRT patients received daily 0.5 cm bolus with a 10 Gy scar boost. Skin toxicities and rates of MD were rated by the treating physician on a weekly basis during RT, using the CTCAE v3.0 scale. Logistic regression analysis was used to assess risk factors associated with MD. RESULTS: Overall, 19% were black, 64% Hispanic white, and 17 % non-Hispanic white/other. Patients receiving PMRT were younger (median age 51.5 vs 57, p 30, p=0.011), and increasing breast cancer stage (21.7% stage 0, 24.5% stage I, 29.5% stage II, 49% stage III, p=0.018). On multivariate analysis, the use of PMRT (OR 3.84, 95% CI 1.76-8.87, p=0.001) and increasing BMI (OR 2.42, 95% CI 1.10-5.30 (p=0.028) for BMI 25-29.9 vs <25; OR 3.10, 95% CI 1.46-6.59 (p=0.003) for BMI ≥30 vs <25) retained statistical significance as risk factors for MD, but stage was no longer significant. There was no difference in rate of MD by race or ethnicity. CONCLUSIONS: The rate of MD is more than double in patients receiving PMRT vs BCT, 55.2% vs 23%, even when accounting for increasing stage and BMI. This information is important in counseling our patients regarding the potential toxicities of adjuvant radiation treatment for breast cancer. Citation Format: Jean L. Wright, Cristiane Takita, Isildinha Reis, Wei Zhao, Jennifer J. Hu. Rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 76. doi:10.1158/1538-7445.AM2013-76

  • Abstract 76: Rate of Moist Desquamation in patients receiving radiation for breast cancer after mastectomy versus breast conserving surgery.
    Clinical Research, 2013
    Co-Authors: Jean L Wright, Cristiane Takita, Isildinha M Reis, Wei Zhao
    Abstract:

    Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC OBJECTIVE: Although skin toxicity is expected to be more severe in the setting of post-mastectomy radiation (PMRT) compared to breast conserving surgery + intact breast radiation (BCT), the actual incidence of Moist Desquamation (MD) in patients treated with PMRT has not been well quantified. We prospectively determined rates of MD in patients treated with PMRT compared to BCT and identified risk factors for the development of MD. MATERIALS/ METHODS: 284 breast cancer patients enrolled on two parallel prospectively managed observational studies to assess skin reaction to RT (one in the setting of BCT and the other PMRT) were included in this analysis. All received tangential photons to the intact breast or chest wall (CW) following definitive surgery, with a dose of 45-50 Gy to the breast/CW +/- supraclavicular nodes (SCV). BCT patients had a 10 Gy lumpectomy cavity boost. PMRT patients received daily 0.5 cm bolus with a 10 Gy scar boost. Skin toxicities and rates of MD were rated by the treating physician on a weekly basis during RT, using the CTCAE v3.0 scale. Logistic regression analysis was used to assess risk factors associated with MD. RESULTS: Overall, 19% were black, 64% Hispanic white, and 17 % non-Hispanic white/other. Patients receiving PMRT were younger (median age 51.5 vs 57, p 30, p=0.011), and increasing breast cancer stage (21.7% stage 0, 24.5% stage I, 29.5% stage II, 49% stage III, p=0.018). On multivariate analysis, the use of PMRT (OR 3.84, 95% CI 1.76-8.87, p=0.001) and increasing BMI (OR 2.42, 95% CI 1.10-5.30 (p=0.028) for BMI 25-29.9 vs