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Tissue Fibrosis after Radiation Treatment for Breast Cancer

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Toxicities of Radiation Treatment for Breast Cancer

Abstract

Radiation-induced fibrosis (RIF) is a late side effect from radiation therapy, occurring 4–12 months after radiation therapy, and can be seen in approximately 5–30% of patients receiving radiation therapy to the breast or chest wall. Typical effects of RIF include decreased tissue compliance, atrophy, skin retraction, and induration. Factors influencing the development of RIF include radiation dose, volume, radiation treatment technique, surgical complications, and the use of chemotherapy. Patient-related factors such as age, breast size, genetic background, and expression of molecular markers during radiation therapy are also associated with the development of RIF. Radiation-induced fibrosis may be partially reversible, and treatment strategies to potentially ameliorate the effects of RIF include physical therapy, medical management, and surgery. However, many of these techniques are preliminary, and further research is necessary before widespread clinical adoption.

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References

  1. Delanian S, Lefaix J-L. Current management for late normal tissue injury: radiation-induced fibrosis and necrosis. Semin Radiat Oncol. 2007;17(2):99–107.

    PubMed  Google Scholar 

  2. O’Sullivan B, Levin W. Late radiation-related fibrosis: pathogenesis, manifestations, and current management. Semin Radiat Oncol. 2003;13(3):274–89.

    PubMed  Google Scholar 

  3. Straub JM, New J, Hamilton CD, Lominska C, Shnayder Y, Thomas SM. Radiation-induced fibrosis: mechanisms and implications for therapy. J Cancer Res Clin Oncol. 2015;141(11):1985–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Westbury CB, Yarnold JR. Radiation fibrosis – current clinical and therapeutic perspectives. Clin Oncol (R Coll Radiol). 2012;24(10):657–72.

    CAS  Google Scholar 

  5. Mukesh MB, Harris E, Collette S, Coles CE, Bartelink H, Wilkinson J, et al. Normal tissue complication probability (NTCP) parameters for breast fibrosis: pooled results from two randomised trials. Radiother Oncol. 2013;108(2):293–8.

    Google Scholar 

  6. Mukesh M, Harris E, Jena R, Evans P, Coles C. Relationship between irradiated breast volume and late normal tissue complications: a systematic review. Radiother Oncol. 2012;104(1):1–10.

    PubMed  Google Scholar 

  7. Mukesh MB, Barnett GC, Wilkinson JS, Moody AM, Wilson C, Dorling L, et al. Randomized controlled trial of intensity-modulated radiotherapy for early breast cancer: 5-year results confirm superior overall cosmesis. J Clin Oncol. 2013;31(36):4488–95.

    PubMed  Google Scholar 

  8. Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–20.

    CAS  PubMed  Google Scholar 

  9. Pignol JP, Truong P, Rakovitch E, Sattler MG, Whelan TJ, Olivotto IA. Ten years results of the Canadian breast intensity modulated radiation therapy (IMRT) randomized controlled trial. Radiother Oncol. 2016;121(3):414–9.

    PubMed  Google Scholar 

  10. Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14(11):1086–94.

    PubMed  Google Scholar 

  11. Sarsenov D, Aktepe F, Özmen V. Radiation fibrosis syndrome imitating breast cancer recurrence; a case report. J Breast Health. 2017;13(1):40–2.

    PubMed  PubMed Central  Google Scholar 

  12. Claßen J, Nitzsche S, Wallwiener D, Kristen P, Souchon R, Bamberg M, et al. Fibrotic changes after postmastectomy radiotherapy and reconstructive surgery in breast cancer. Strahlenther Onkol. 2010;186(11):630–6.

    PubMed  Google Scholar 

  13. Marinus J, Niel CG, de Bie RA, Wiggenraad RG, Schoppink EM, Beukema LH. Measuring radiation fibrosis: the interobserver reliability of two methods of determining the degree of radiation fibrosis. Int J Radiat Oncol Biol Phys. 2000;47(5):1209–17.

    CAS  PubMed  Google Scholar 

  14. Wernicke AG, Greenwood EA, Coplowitz S, Parashar B, Kulidzhanov F, Christos PJ, et al. Tissue compliance meter is a more reproducible method of measuring radiation-induced fibrosis than late effects of normal tissue-subjective objective management analytical in patients treated with intracavitary brachytherapy accelerated partial breast irradiation: results of a prospective trial. Breast J. 2013;19(3):250–8.

    PubMed  Google Scholar 

  15. Hoeller U, Grzyska B, Lorenzen J, Kuhlmey A, Alberti W, Adam G. Is grading of breast fibrosis with mammography feasible? Strahlenther Onkol. 2005;181(5):307–12.

    PubMed  Google Scholar 

  16. Campana F, Zervoudis S, Perdereau B, Gez E, Fourquet A, Badiu C, et al. Topical superoxide dismutase reduces post-irradiation breast cancer fibrosis. J Cell Mol Med. 2004;8(1):109–16.

    CAS  PubMed  Google Scholar 

  17. Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25(22):3259–65.

    PubMed  Google Scholar 

  18. Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47–56.

    PubMed  Google Scholar 

  19. Poortmans PM, Collette L, Horiot JC, Van den Bogaert WF, Fourquet A, Kuten A, et al. Impact of the boost dose of 10 Gy versus 26 Gy in patients with early stage breast cancer after a microscopically incomplete lumpectomy: 10-year results of the randomised EORTC boost trial. Radiother Oncol. 2009;90(1):80–5.

    PubMed  Google Scholar 

  20. Collette S, Collette L, Budiharto T, Horiot J-C, Poortmans PM, Struikmans H, et al. Predictors of the risk of fibrosis at 10 years after breast conserving therapy for early breast cancer – a study based on the EORTC trial 22881–10882 ‘boost versus no boost’. Eur J Cancer. 2008;44(17):2587–99.

    PubMed  Google Scholar 

  21. Borger JH, Kemperman H, Sillevis Smitt H, Hart A, van Dongen J, Lebesque J, et al. Dose and volume effects on fibrosis after breast conservation therapy. Int J Radiat Oncol Biol Phys. 1994;30(5):1073–81.

    Google Scholar 

  22. Clarke D, Martinez A, Cox RS. Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation. Int J Radiat Oncol Biol Phys. 1983;9(12):1807–13.

    CAS  PubMed  Google Scholar 

  23. Ribeiro GG, Magee B, Swindell R, Harris M, Banerjee SS. The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol (R Coll Radiol). 1993;5(5):278–83.

    CAS  Google Scholar 

  24. Polgar C, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, et al. Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(2):259–68.

    PubMed  Google Scholar 

  25. Livi L, Meattini I, Marrazzo L, Simontacchi G, Pallotta S, Saieva C, et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51(4):451–63.

    PubMed  Google Scholar 

  26. Olivotto IA, Whelan TJ, Parpia S, Kim D-H, Berrang T, Truong PT, et al. Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol. 2013;31(32):4038–45.

    PubMed  Google Scholar 

  27. Rodriguez N, Sanz X, Dengra J, Foro P, Membrive I, Reig A, et al. Five-year outcomes, cosmesis, and toxicity with 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2013;87(5):1051–7.

    PubMed  Google Scholar 

  28. Coles CE, Griffin CL, Kirby AM, Titley J, Agrawal RK, Alhasso A, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet. 2017;390(10099):1048–60.

    PubMed  PubMed Central  Google Scholar 

  29. Galland-Girodet S, Pashtan I, MacDonald SM, Ancukiewicz M, Hirsch AE, Kachnic LA, et al. Long-term cosmetic outcomes and toxicities of proton beam therapy compared with photon-based 3-dimensional conformal accelerated partial-breast irradiation: a phase 1 trial. Int J Radiat Oncol Biol Phys. 2014;90(3):493–500.

    PubMed  Google Scholar 

  30. Avanzo M, Stancanello J, Trovo M, Jena R, Roncadin M, Trovo MG, et al. Complication probability model for subcutaneous fibrosis based on published data of partial and whole breast irradiation. Phys Med. 2012;28(4):296–306.

    PubMed  Google Scholar 

  31. Toledano A, Garaud P, Serin D, Fourquet A, Bosset JF, Breteau N, et al. Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conserving surgery enhances late toxicities: long-term results of the ARCOSEIN multicenter randomized study. Int J Radiat Oncol Biol Phys. 2006;65(2):324–32.

    CAS  PubMed  Google Scholar 

  32. Johansen J, Overgaard J, Overgaard M. Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation. Acta Oncol (Stockholm, Sweden). 2007;46(4):525–33.

    Google Scholar 

  33. Ahn PH, Vu HT, Lannin D, Obedian E, DiGiovanna MP, Burtness B, et al. Sequence of radiotherapy with tamoxifen in conservatively managed breast cancer does not affect local relapse rates. J Clin Oncol. 2005;23(1):17–23.

    CAS  PubMed  Google Scholar 

  34. Harris EE, Christensen VJ, Hwang WT, Fox K, Solin LJ. Impact of concurrent versus sequential tamoxifen with radiation therapy in early-stage breast cancer patients undergoing breast conservation treatment. J Clin Oncol. 2005;23(1):11–6.

    CAS  PubMed  Google Scholar 

  35. Ishitobi M, Komoike Y, Motomura K, Koyama H, Nishiyama K, Inaji H. Retrospective analysis of concurrent vs. sequential administration of radiotherapy and hormone therapy using aromatase inhibitor for hormone receptor-positive postmenopausal breast cancer. Anticancer Res. 2009;29(11):4791–4.

    PubMed  Google Scholar 

  36. Bourgier C, Kerns S, Gourgou S, Lemanski C, Gutowski M, Fenoglietto P, et al. Concurrent or sequential letrozole with adjuvant breast radiotherapy: final results of the CO-HO-RT phase II randomized trial. Ann Oncol. 2016;27(3):474–80.

    CAS  PubMed  Google Scholar 

  37. Bourgier C, Castan F, Riou O, Nguyen TD, Peignaux K, Lemanski C, et al. Impact of adjuvant hormonotherapy on radiation-induced breast fibrosis according to the individual radiosensitivity: results of a multicenter prospective French trial. Oncotarget. 2018;9(21):15757–65.

    PubMed  PubMed Central  Google Scholar 

  38. Azria D, Riou O, Castan F, Nguyen TD, Peignaux K, Lemanski C, et al. Radiation-induced CD8 T-lymphocyte apoptosis as a predictor of breast fibrosis after radiotherapy: results of the prospective multicenter French trial. EBioMedicine. 2015;2(12):1965–73.

    PubMed  PubMed Central  Google Scholar 

  39. Hille-Betz U, Vaske B, Bremer M, Soergel P, Kundu S, Klapdor R, et al. Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy : risk-modifying factors. Strahlenther Onkol. 2016;192(1):8–16.

    PubMed  Google Scholar 

  40. Lilla C, Ambrosone CB, Kropp S, Helmbold I, Schmezer P, von Fournier D, et al. Predictive factors for late normal tissue complications following radiotherapy for breast cancer. Breast Cancer Res Treat. 2007;106(1):143–50.

    PubMed  Google Scholar 

  41. Terrazzino S, La Mattina P, Gambaro G, Masini L, Franco P, Canonico PL, et al. Common variants of GSTP1, GSTA1, and TGFβ1 are associated with the risk of radiation-induced fibrosis in breast cancer patients. Int J Radiat Oncol Biol Phys. 2012;83(2):504–11.

    Google Scholar 

  42. Andreassen CN, Overgaard J, Alsner J, Overgaard M, Herskind C, Cesaretti JA, et al. ATM sequence variants and risk of radiation-induced subcutaneous fibrosis after postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys. 2006;64(3):776–83.

    PubMed  Google Scholar 

  43. Quarmby S, Fakhoury H, Levine E, Barber J, Wylie J, Hajeer AH, et al. Association of transforming growth factor beta-1 single nucleotide polymorphisms with radiation-induced damage to normal tissues in breast cancer patients. Int J Radiat Biol. 2003;79(2):137–43.

    CAS  PubMed  Google Scholar 

  44. Barnett GC, Elliott RM, Alsner J, Andreassen CN, Abdelhay O, Burnet NG, et al. Individual patient data meta-analysis shows no association between the SNP rs1800469 in TGFB and late radiotherapy toxicity. Radiother Oncol. 2012;105(3):289–95.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Li C, Wilson PB, Levine E, Barber J, Stewart AL, Kumar S. TGF-beta1 levels in pre-treatment plasma identify breast cancer patients at risk of developing post-radiotherapy fibrosis. Int J Cancer. 1999;84(2):155–9.

    CAS  PubMed  Google Scholar 

  46. Boothe DL, Coplowitz S, Greenwood E, Barney CL, Christos PJ, Parashar B, et al. Transforming growth factor β-1 (TGF-β1) is a serum biomarker of radiation induced fibrosis in patients treated with intracavitary accelerated partial breast irradiation: preliminary results of a prospective study. Int J Radiat Oncol Biol Phys. 2013;87(5):1030–6.

    Google Scholar 

  47. Hernandez S, Evans SB, Wazer DE. Severe acute toxicity from whole breast radiotherapy in the setting of collagen vascular disease. Am J Clin Oncol. 2006;29(6):647–8.

    PubMed  Google Scholar 

  48. Robertson JM, Clarke DH, Pevzner MM, Matter RC. Breast conservation therapy. Severe breast fibrosis after radiation therapy in patients with collagen vascular disease. Cancer. 1991;68(3):502–8.

    CAS  PubMed  Google Scholar 

  49. Fleck R, McNeese MD, Ellerbroek NA, Hunter TA, Holmes FA. Consequences of breast irradiation in patients with pre-existing collagen vascular diseases. Int J Radiat Oncol Biol Phys. 1989;17(4):829–33.

    CAS  PubMed  Google Scholar 

  50. McCormick B. Selection criteria for breast conservation. The impact of young and old age and collagen vascular disease. Cancer. 1994;74(1 Suppl):430–5.

    CAS  PubMed  Google Scholar 

  51. Chen AM, Obedian E, Haffty BG. Breast-conserving therapy in the setting of collagen vascular disease. Cancer J. 2001;7(6):480–91.

    CAS  PubMed  Google Scholar 

  52. Kontos M, Fentiman IS. Systemic lupus erythematosus and breast cancer. Breast J. 2008;14(1):81–6.

    PubMed  Google Scholar 

  53. Shah DJ, Hirpara R, Poelman CL, Woods A, Hummers LK, Wigley FM, et al. Impact of radiation therapy on scleroderma and cancer outcomes in scleroderma patients with breast cancer. Arthritis Care Res. 2018.

    Google Scholar 

  54. Dong Y, Li T, Churilla TM, Shaikh T, Sigurdson ER, Bleicher RJ, et al. Impact of rheumatoid arthritis on radiation-related toxicity and cosmesis in breast cancer patients: a contemporary matched-pair analysis. Breast Cancer Res Treat. 2017;166(3):787–91.

    PubMed  Google Scholar 

  55. Box RC, Reul-Hirche HM, Bullock-Saxton JE, Furnival CM. Shoulder movement after breast cancer surgery: results of a randomised controlled study of postoperative physiotherapy. Breast Cancer Res Treat. 2002;75(1):35–50.

    PubMed  Google Scholar 

  56. Lauridsen MC, Christiansen P, Hessov I. The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: a randomized study. Acta Oncol (Stockholm, Sweden). 2005;44(5):449–57.

    Google Scholar 

  57. Bourgeois JF, Gourgou S, Kramar A, Lagarde JM, Guillot B. A randomized, prospective study using the LPG technique in treating radiation-induced skin fibrosis: clinical and profilometric analysis. Skin Res Technol: Off J Int Soc Bioeng Skin (ISBS) Int Soc Digit Imaging Skin (ISDIS) Int Soc Skin Imaging (ISSI). 2008;14(1):71–6.

    CAS  Google Scholar 

  58. Warpenburg MJ. Deep friction massage in treatment of radiation-induced fibrosis: rehabilitative care for breast cancer survivors. Integr Med (Encinitas). 2014;13(5):32–6.

    Google Scholar 

  59. Ward A, Clissold SP. Pentoxifylline. Drugs. 1987;34(1):50–97.

    CAS  PubMed  Google Scholar 

  60. Packer L, Weber SU, Rimbach G. Molecular aspects of alpha-tocotrienol antioxidant action and cell signalling. J Nutr. 2001;131(2):369S–73S.

    CAS  PubMed  Google Scholar 

  61. Delanian S, Porcher R, Balla-Mekias S, Lefaix JL. Randomized, placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis. J Clin Oncol. 2003;21(13):2545–50.

    CAS  PubMed  Google Scholar 

  62. Delanian S, Porcher R, Rudant J, Lefaix JL. Kinetics of response to long-term treatment combining pentoxifylline and tocopherol in patients with superficial radiation-induced fibrosis. J Clin Oncol. 2005;23(34):8570–9.

    PubMed  Google Scholar 

  63. Jacobson G, Bhatia S, Smith BJ, Button AM, Bodeker K, Buatti J. Randomized trial of pentoxifylline and vitamin E vs standard follow-up after breast irradiation to prevent breast fibrosis, evaluated by tissue compliance meter. Int J Radiat Oncol Biol Phys. 2013;85(3):604–8.

    Google Scholar 

  64. Cook M, Johnson N, Zegzula HD, Schray M, Glissmeyer M, Sorenson L. Prophylactic use of pentoxifylline (Trental) and vitamin E to prevent capsular contracture after implant reconstruction in patients requiring adjuvant radiation. Am J Surg. 2016;211(5):854–9.

    Google Scholar 

  65. Gothard L, Cornes P, Earl J, Hall E, MacLaren J, Mortimer P, et al. Double-blind placebo-controlled randomised trial of vitamin E and pentoxifylline in patients with chronic arm lymphoedema and fibrosis after surgery and radiotherapy for breast cancer. Radiother Oncol. 2004;73(2):133–9.

    CAS  PubMed  Google Scholar 

  66. Famoso JM, Laughlin B, McBride A, Gonzalez VJ. Pentoxifylline and vitamin E drug compliance after adjuvant breast radiation therapy. Adv Radiat Oncol. 2018;3(1):19–24.

    Google Scholar 

  67. Brooker S, Martin S, Pearson A, Bagchi D, Earl J, Gothard L, et al. Double-blind, placebo-controlled, randomised phase II trial of IH636 grape seed proanthocyanidin extract (GSPE) in patients with radiation-induced breast induration. Radiother Oncol. 2006;79(1):45–51.

    PubMed  Google Scholar 

  68. Delanian S, Baillet F, Huart J, Lefaix JL, Maulard C, Housset M. Successful treatment of radiation-induced fibrosis using liposomal Cu/Zn superoxide dismutase: clinical trial. Radiother Oncol. 1994;32(1):12–20.

    CAS  PubMed  Google Scholar 

  69. Monte M, Sacerdote de Lustig E. Free radicals of oxygen and superoxide dismutase. Biological and medical aspects. Medicina (B Aires). 1994;54(1):61–8.

    CAS  Google Scholar 

  70. Bennett MH, Feldmeier J, Hampson NB, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev. 2016;4:CD005005.

    PubMed  Google Scholar 

  71. Gothard L, Stanton A, MacLaren J, Lawrence D, Hall E, Mortimer P, et al. Non-randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema and tissue fibrosis after radiotherapy for early breast cancer. Radiother Oncol. 2004;70(3):217–24.

    CAS  PubMed  Google Scholar 

  72. Tahir AR, Westhuyzen J, Dass J, Collins MK, Webb R, Hewitt S, et al. Hyperbaric oxygen therapy for chronic radiation-induced tissue injuries: Australasia’s largest study. Asia Pac J Clin Oncol. 2015;11(1):68–77.

    PubMed  Google Scholar 

  73. Teguh DN, Bol Raap R, Struikmans H, Verhoef C, Koppert LB, Koole A, et al. Hyperbaric oxygen therapy for late radiation-induced tissue toxicity: prospectively patient-reported outcome measures in breast cancer patients. Radiat Oncol (London, England). 2016;11:130.

    Google Scholar 

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  1. Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Kristin A. Plichta, Wenqing Sun & John M. Buatti

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  1. Kristin A. Plichta
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  2. Wenqing Sun
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  1. Johns Hopkins University, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, USA

    Jean L. Wright

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Plichta, K.A., Sun, W., Buatti, J.M. (2019). Tissue Fibrosis after Radiation Treatment for Breast Cancer. In: Wright, J. (eds) Toxicities of Radiation Treatment for Breast Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-11620-0_9

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