Skip to main content
SpringerLink
Log in
Book cover

Skin Care in Radiation Oncology pp 93–122Cite as

Breast Cancer

  • Chapter
  • First Online:

  • 1432 Accesses

Abstract

Radiation is an integral component of the treatment of early-stage breast cancer. Acute radiation dermatitis is common in these patients and can include erythema, dry desquamation, moist desquamation, and breast edema. Patient-related factors that have been associated with increased acute reactions include higher body mass index, larger bra cup size, smoking, and African-American ethnicity. Treatment-related factors that have been associated with increased acute reactions include the use and frequency of bolus, as well as concurrent use of tamoxifen, aromatase inhibitors, and chemotherapy. Late effects from radiation include recall dermatitis, telangiectasia, morphea, and fibrosis.

Preventive measures for acute radiation dermatitis include the use of topical agents. Examples of these products and agents are moisturizers and emollients, topical steroids, skin barriers, and silicone dressings.

Treatment of moist desquamation includes topical agents such as zinc and bacitracin; dressings such as Telfa, soft absorbent silicone (Mepilex Lite or Mepilex), and Aquacel Ag; as well as cleansers such as Hibiclens and Skintegrity.

Treatment recommendations, week by week, to address erythema, dry desquamation, moist desquamation, candidiasis, cellulitis, folliculitis, and hyperpigmentation are presented.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Cancer Facts and Figures 2015. American Cancer Society. 2015. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2015/index. Accessed 16 Apr 2015

    Google Scholar 

  2. Albornoz CR, Cordeiro PG, Pusic AL, McCarthy CM, Mehrara BJ, Disa JJ, et al. Diminishing relative contraindications for immediate breast reconstruction: a multicenter study. J Am Coll Surg. 2014;219:788–95. doi:10.1016/j.jamcollsurg.2014.05.012.

    Article  PubMed  Google Scholar 

  3. Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150:9–16. doi:10.1001/jamasurg.2014.2895.

    Article  PubMed  Google Scholar 

  4. Jagsi R, Abrahamse P, Morrow M, Hawley ST, Griggs JJ, Graff JJ, et al. Patterns and correlates of adjuvant radiotherapy receipt after lumpectomy and after mastectomy for breast cancer. J Clin Oncol. 2010;28:2396–403. doi:10.1200/JCO.2009.26.8433.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008;26:2085–92. doi:10.1200/JCO.2007.15.2488.

    Article  PubMed  Google Scholar 

  6. Pignol JP, Vu TT, Mitera G, Bosnic S, Verkooijen HM, Truong P. Prospective evaluation of severe skin toxicity and pain during postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys. 2015;91:157–64. doi:10.1016/j.ijrobp.2014.09.022.

    Article  PubMed  Google Scholar 

  7. Hindley A, Zain Z, Wood L, Whitehead A, Sanneh A, Barber D, et al. Mometasone furoate cream reduces acute radiation dermatitis in patients receiving breast radiation therapy: results of a randomized trial. Int J Radiat Oncol Biol Phys. 2014;90:748–55. doi:10.1016/j.ijrobp.2014.06.033.

    Article  CAS  PubMed  Google Scholar 

  8. Hoopfer D, Holloway C, Gabos Z, Alidrisi M, Chafe S, Krause B, et al. Three-arm randomized phase iii trial: quality aloe and placebo cream versus powder as skin treatment during breast cancer radiation therapy. Clin Breast Cancer. 2014. doi:10.1016/j.clbc.2014.12.006.

    PubMed  Google Scholar 

  9. RTOG Acute Radiation Morbidity Scoring Criteria. Radiation Therapy Oncology Group. 2015. http://www.rtog.org/ResearchAssociates/AdverseEventReporting/AcuteRadiationMorbidityScoringCriteria.aspx. Accessed 4 May 2015.

    Google Scholar 

  10. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. In: Cancer Therapy Evaluation Program. National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. 2010. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010–06–14_QuickReference_8.5x11.pdf. Accessed 16 Apr 2015.

    Google Scholar 

  11. Porock D, Kristjanson L, Nikoletti S, Cameron F, Pedler P. Predicting the severity of radiation skin reactions in women with breast cancer. Oncol Nurs Forum. 1998;25:1019–29.

    CAS  PubMed  Google Scholar 

  12. Freedman GM, Li T, Nicolaou N, Chen Y, Ma CC, Anderson PR. Breast intensity-modulated radiation therapy reduces time spent with acute dermatitis for women of all breast sizes during radiation. Int J Radiat Oncol Biol Phys. 2009;74:689–94. doi:10.1016/j.ijrobp.2008.08.071.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wright JL, Takita C, Reis IM, Zhao W, Lee E, Hu JJ. Racial variations in radiation-induced skin toxicity severity: data from a prospective cohort receiving postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2014;90:335–43. doi:10.1016/j.ijrobp.2014.06.042.

    Article  PubMed  Google Scholar 

  14. Fisher J, Scott C, Stevens R, Marconi B, Champion L, Freedman GM, et al. Randomized phase III study comparing Best Supportive Care to Biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: Radiation Therapy Oncology Group (RTOG) 97–13. Int J Radiat Oncol Biol Phys. 2000;48:1307–10.

    Article  CAS  PubMed  Google Scholar 

  15. Back M, Guerrieri M, Wratten C, Steigler A. Impact of radiation therapy on acute toxicity in breast conservation therapy for early breast cancer. Clin Oncol (R Coll Radiol). 2004;16:12–6.

    Article  CAS  Google Scholar 

  16. Rutter C, Qin L, Higgins S, Moran M, Evans S. Dosimetric and clinical predictors of the development of moist desquamation in breast cancer irradiation. J Radiat Oncol. 2014;3:147–52. doi:10.1007/s13566-013-0129-0.

    Article  Google Scholar 

  17. Freedman GM, Anderson PR, Goldstein LJ, Ma CM, Li J, Swaby RF, et al. Four-week course of radiation for breast cancer using hypofractionated intensity modulated radiation therapy with an incorporated boost. Int J Radiat Oncol Biol Phys. 2007;68:347–53. doi:10.1016/j.ijrobp.2006.12.035.

    Article  PubMed  Google Scholar 

  18. De Langhe S, Mulliez T, Veldeman L, Remouchamps V, van Greveling A, Gilsoul M, et al. Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy. BMC Cancer. 2014;14:711. doi:10.1186/1471-2407-14-711.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. McDonald MW, Godette KD, Butker EK, Davis LW, Johnstone PA. Long-term outcomes of IMRT for breast cancer: a single-institution cohort analysis. Int J Radiat Oncol Biol Phys. 2008;72:1031–40. doi:10.1016/j.ijrobp.2008.02.053.

    Article  PubMed  Google Scholar 

  20. Harsolia A, Kestin L, Grills I, Wallace M, Jolly S, Jones C, et al. Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy. Int J Radiat Oncol Biol Phys. 2007;68:1375–80. doi:10.1016/j.ijrobp.2007.02.044.

    Article  PubMed  Google Scholar 

  21. Graham PH, Plant N, Graham JL, Browne L, Borg M, Capp A, et al. A paired, double-blind, randomized comparison of a moisturizing durable barrier cream to 10% glycerine cream in the prophylactic management of postmastectomy irradiation skin care: trans Tasman Radiation Oncology Group (TROG) 04.01. Int J Radiat Oncol Biol Phys. 2013;86:45–50. doi:10.1016/j.ijrobp.2012.12.009.

    Article  CAS  PubMed  Google Scholar 

  22. Ma J, Li J, Xie J, Chen J, Zhu C, Cai G, et al. Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities. Radiat Oncol. 2013;8:81. doi:10.1186/1748-717X-8-81.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Spierer MM, Hong LX, Wagman RT, Katz MS, Spierer RL, McCormick B. Postmastectomy CT-based electron beam radiotherapy: dosimetry, efficacy, and toxicity in 118 patients. Int J Radiat Oncol Biol Phys. 2004;60:1182–9. doi:10.1016/j.ijrobp.2004.04.044.

    Article  PubMed  Google Scholar 

  24. Cuaron JJ, Chon B, Tsai H, Goenka A, DeBlois D, Ho A, et al. Early toxicity in patients treated with postoperative proton therapy for locally advanced breast cancer. Int J Radiat Oncol Biol Phys. 2015;92:284–91. doi:10.1016/j.ijrobp.2015.01.005.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Freedman GM, Anderson PR, Bleicher RJ, Litwin S, Li T, Swaby RF, et al. Five-year local control in a phase II study of hypofractionated intensity modulated radiation therapy with an incorporated boost for early stage breast cancer. Int J Radiat Oncol Biol Phys. 2012;84:888–93. doi:10.1016/j.ijrobp.2012.01.091.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Vicini F, Jones P, Rivers A, Wallace M, Mitchell C, Kestin L, et al. Differences in disease presentation, management techniques, treatment outcome, and toxicities in African-American women with early stage breast cancer treated with breast-conserving therapy. Cancer. 2010;116:3485–92. doi:10.1002/cncr.25088.

    Article  PubMed  Google Scholar 

  27. Verbelen H, Gebruers N, Beyers T, De Monie AC, Tjalma W. Breast edema in breast cancer patients following breast-conserving surgery and radiotherapy: a systematic review. Breast Cancer Res Treat. 2014;147:463–71. doi:10.1007/s10549-014-3110-8.

    Article  PubMed  Google Scholar 

  28. Adriaenssens N, Verbelen H, Lievens P, Lamote J. Lymphedema of the operated and irradiated breast in breast cancer patients following breast conserving surgery and radiotherapy. Lymphology. 2012;45:154–64.

    CAS  PubMed  Google Scholar 

  29. Barnett GC, Wilkinson JS, Moody AM, Wilson CB, Twyman N, Wishart GC, et al. The Cambridge Breast Intensity-modulated Radiotherapy Trial: patient- and treatment-related factors that influence late toxicity. Clin Oncol (R Coll Radiol). 2011;23:662–73. doi:10.1016/j.clon.2011.04.011.

    Article  CAS  Google Scholar 

  30. Fowble B, Fein DA, Hanlon AL, Eisenberg BL, Hoffman JP, Sigurdson ER, et al. The impact of tamoxifen on breast recurrence, cosmesis, complications, and survival in estrogen receptor-positive early-stage breast cancer. Int J Radiat Oncol Biol Phys. 1996;35:669–77.

    Article  CAS  PubMed  Google Scholar 

  31. 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;23:11–6. doi:10.1200/JCO.2005.09.056.

    Article  CAS  PubMed  Google Scholar 

  32. 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;69:145–53.

    Article  CAS  PubMed  Google Scholar 

  33. Moody AM, Mayles WP, Bliss JM, A’Hern RP, Owen JR, Regan J, et al. The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol. 1994;33:106–12.

    Article  CAS  PubMed  Google Scholar 

  34. Tuamokumo NL, Haffty BG. Clinical outcome and cosmesis in African-American patients treated with conservative surgery and radiation therapy. Cancer J. 2003;9:313–20.

    Article  PubMed  Google Scholar 

  35. Pierce L, Fowble B, Solin LJ, Schultz DJ, Rosser C, Goodman RL. Conservative surgery and radiation therapy in black women with early stage breast cancer. Patterns of failure and analysis of outcome. Cancer. 1992;69:2831–41.

    Article  CAS  PubMed  Google Scholar 

  36. Ulff E, Maroti M, Serup J, Falkmer U. A potent steroid cream is superior to emollients in reducing acute radiation dermatitis in breast cancer patients treated with adjuvant radiotherapy. A randomised study of betamethasone versus two moisturizing creams. Radiother Oncol. 2013;108:287–92. doi:10.1016/j.radonc.2013.05.033.

    Article  CAS  PubMed  Google Scholar 

  37. Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124:869–71.

    Article  CAS  PubMed  Google Scholar 

  38. Herst PM, Bennett NC, Sutherland AE, Peszynski RI, Paterson DB, Jasperse ML. Prophylactic use of Mepitel Film prevents radiation-induced moist desquamation in an intra-patient randomised controlled clinical trial of 78 breast cancer patients. Radiother Oncol. 2014;110:137–43. doi:10.1016/j.radonc.2014.01.005.

    Article  CAS  PubMed  Google Scholar 

  39. Chang-Claude J, Popanda O, Tan XL, Kropp S, Helmbold I, von Fournier D, et al. Association between polymorphisms in the DNA repair genes, XRCC1, APE1, and XPD and acute side effects of radiotherapy in breast cancer patients. Clin Cancer Res. 2005;11:4802–9. doi:10.1158/1078-0432.CCR-04-2657.

    Article  CAS  PubMed  Google Scholar 

  40. Tan XL, Popanda O, Ambrosone CB, Kropp S, Helmbold I, von Fournier D, et al. Association between TP53 and p21 genetic polymorphisms and acute side effects of radiotherapy in breast cancer patients. Breast Cancer Res Treat. 2006;97:255–62. doi:10.1007/s10549-005-9119-2.

    Article  CAS  PubMed  Google Scholar 

  41. Ho AY, Fan G, Atencio DP, Green S, Formenti SC, Haffty BG, et al. Possession of ATM sequence variants as predictor for late normal tissue responses in breast cancer patients treated with radiotherapy. Int J Radiat Oncol Biol Phys. 2007;69:677–84. doi:10.1016/j.ijrobp.2007.04.012.

    Article  PubMed  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;64:776–83. doi:10.1016/j.ijrobp.2005.09.014.

    Article  PubMed  Google Scholar 

  43. Iannuzzi CM, Atencio DP, Green S, Stock RG, Rosenstein BS. ATM mutations in female breast cancer patients predict for an increase in radiation-induced late effects. Int J Radiat Oncol Biol Phys. 2002;52:606–13.

    Article  CAS  PubMed  Google Scholar 

  44. Edvardsen H, Tefre T, Jansen L, Vu P, Haffty BG, Fossa SD, et al. Linkage disequilibrium pattern of the ATM gene in breast cancer patients and controls; association of SNPs and haplotypes to radio-sensitivity and post-lumpectomy local recurrence. Radiat Oncol. 2007;2:25. doi:10.1186/1748-717X-2-25.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Pierce LJ, Strawderman M, Narod SA, Oliviotto I, Eisen A, Dawson L, et al. Effect of radiotherapy after breast-conserving treatment in women with breast cancer and germline BRCA1/2 mutations. J Clin Oncol. 2000;18:3360–9.

    CAS  PubMed  Google Scholar 

  46. Shanley S, McReynolds K, Ardern-Jones A, Ahern R, Fernando I, Yarnold J, et al. Late toxicity is not increased in BRCA1/BRCA2 mutation carriers undergoing breast radiotherapy in the United Kingdom. Clin Cancer Res. 2006;12:7025–32. doi:10.1158/1078-0432.CCR-06-1244.

    Article  CAS  PubMed  Google Scholar 

  47. Huszno J, Budryk M, Kolosza Z, Nowara E. The influence of BRCA1/BRCA2 mutations on toxicity related to chemotherapy and radiotherapy in early breast cancer patients. Oncology. 2013;85:278–82. doi:10.1159/000354834.

    Article  CAS  PubMed  Google Scholar 

  48. Park H, Choi DH, Noh JM, Huh SJ, Park W, Nam SJ, et al. Acute skin toxicity in Korean breast cancer patients carrying BRCA mutations. Int J Radiat Biol. 2014;90:90–4. doi:10.3109/09553002.2013.835504.

    Article  CAS  PubMed  Google Scholar 

  49. Mulliez T, Veldeman L, van Greveling A, Speleers B, Sadeghi S, Berwouts D, et al. Hypofractionated whole breast irradiation for patients with large breasts: a randomized trial comparing prone and supine positions. Radiother Oncol. 2013;108:203–8. doi:10.1016/j.radonc.2013.08.040.

    Article  PubMed  Google Scholar 

  50. Chadha M, Woode R, Sillanpaa J, Lucido D, Boolbol SK, Kirstein L, et al. Early-stage breast cancer treated with 3-week accelerated whole-breast radiation therapy and concomitant boost. Int J Radiat Oncol Biol Phys. 2013;86:40–4. doi:10.1016/j.ijrobp.2012.11.010.

    Article  PubMed  Google Scholar 

  51. Corbin KS, Dorn PL, Jain SK, Al-Hallaq HA, Hasan Y, Chmura SJ. Hypofractionated radiotherapy does not increase acute toxicity in large-breasted women: results from a prospectively collected series. Am J Clin Oncol. 2014;37:322–6. doi:10.1097/COC.0b013e31827b45b7.

    Article  PubMed  Google Scholar 

  52. Hannan R, Thompson RF, Chen Y, Bernstein K, Kabarriti R, Skinner W, et al. Hypofractionated whole-breast radiation therapy: does breast size matter? Int J Radiat Oncol Biol Phys. 2012;84:894–901. doi:10.1016/j.ijrobp.2012.01.093.

    Article  PubMed  Google Scholar 

  53. Tortorelli G, Di Murro L, Barbarino R, Cicchetti S, di Cristino D, Falco MD, et al. Standard or hypofractionated radiotherapy in the postoperative treatment of breast cancer: a retrospective analysis of acute skin toxicity and dose inhomogeneities. BMC Cancer. 2013;13:230. doi:10.1186/1471-2407-13-230.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Chen MF, Chen WC, Lai CH, Hung CH, Liu KC, Cheng YH. Predictive factors of radiation-induced skin toxicity in breast cancer patients. BMC Cancer. 2010;10:508. doi:10.1186/1471-2407-10-508.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  55. Theberge V, Harel F, Dagnault A. Use of axillary deodorant and effect on acute skin toxicity during radiotherapy for breast cancer: a prospective randomized noninferiority trial. Int J Radiat Oncol Biol Phys. 2009;75:1048–52. doi:10.1016/j.ijrobp.2008.12.046.

    Article  PubMed  Google Scholar 

  56. Gee A, Moffitt D, Churn M, Errington R. A randomised controlled trial to test a non-metallic deodorant used during a course of radiotherapy. J Radiother Pract. 2000;1:205–12. doi:10.1017/S1460396999000321.

    Article  Google Scholar 

  57. Bennett C. An investigation into the use of a non-metallic deodorant during radiotherapy treatment: a randomised controlled trial. J Radiother Pract. 2009;8:3–9. doi:10.1017/S146039690800647X.

    Article  Google Scholar 

  58. Watson LC, Gies D, Thompson E, Thomas B. Randomized control trial: evaluating aluminum-based antiperspirant use, axilla skin toxicity, and reported quality of life in women receiving external beam radiotherapy for treatment of Stage 0, I, and II breast cancer. Int J Radiat Oncol Biol Phys. 2012;83:e29–34. doi:10.1016/j.ijrobp.2011.12.006.

    Article  PubMed  Google Scholar 

  59. Lewis L, Carson S, Bydder S, Athifa M, Williams AM, Bremner A. Evaluating the effects of aluminum-containing and non-aluminum containing deodorants on axillary skin toxicity during radiation therapy for breast cancer: a 3-armed randomized controlled trial. Int J Radiat Oncol Biol Phys. 2014;90:765–71. doi:10.1016/j.ijrobp.2014.06.054.

    Article  CAS  PubMed  Google Scholar 

  60. Feight D, Baney T, Bruce S, McQuestion M. Putting evidence into practice. Clin J Oncol Nurs. 2011;15:481–92. doi:10.1188/11.CJON.481-492.

    Article  PubMed  Google Scholar 

  61. Dubey A, Recht A, Come SE, Gelman RS, Silver B, Harris JR, et al. Concurrent CMF and radiation therapy for early stage breast cancer: results of a pilot study. Int J Radiat Oncol Biol Phys. 1999;45:877–84.

    Article  CAS  PubMed  Google Scholar 

  62. Pietras RJ, Poen JC, Gallardo D, Wongvipat PN, Lee HJ, Slamon DJ. Monoclonal antibody to HER-2/neureceptor modulates repair of radiation-induced DNA damage and enhances radiosensitivity of human breast cancer cells overexpressing this oncogene. Cancer Res. 1999;59:1347–55.

    CAS  PubMed  Google Scholar 

  63. Belkacemi Y, Gligorov J, Ozsahin M, Marsiglia H, De Lafontan B, Laharie-Mineur H, et al. Concurrent trastuzumab with adjuvant radiotherapy in HER2-positive breast cancer patients: acute toxicity analyses from the French multicentric study. Ann Oncol. 2008;19:1110–6. doi:10.1093/annonc/mdn029.

    Article  CAS  PubMed  Google Scholar 

  64. Jacob J, Belin L, Pierga JY, Gobillion A, Vincent-Salomon A, Dendale R, et al. Concurrent administration of trastuzumab with locoregional breast radiotherapy: long-term results of a prospective study. Breast Cancer Res Treat. 2014;148:345–53. doi:10.1007/s10549-014-3166-5.

    Article  CAS  PubMed  Google Scholar 

  65. Caussa L, Kirova YM, Gault N, Pierga JY, Savignoni A, Campana F, et al. The acute skin and heart toxicity of a concurrent association of trastuzumab and locoregional breast radiotherapy including internal mammary chain: a single-institution study. Eur J Cancer. 2011;47:65–73. doi:10.1016/j.ejca.2010.08.013.

    Article  CAS  PubMed  Google Scholar 

  66. Bellon JR, Gover MT, Burstein HJ, Harris JR, Harris LN. Concurrent trastuzumab and radiation therapy (RT) in the adjuvant treatment of breast cancer. Int J Radiat Oncol Biol Phys. 2005;63:S55–6. doi:10.1016/j.ijrobp.2005.07.097.

    Article  Google Scholar 

  67. Halyard MY, Pisansky TM, Dueck AC, Suman V, Pierce L, Solin L, et al. Radiotherapy and adjuvant trastuzumab in operable breast cancer: tolerability and adverse event data from the NCCTG Phase III Trial N9831. J Clin Oncol. 2009;27:2638–44. doi:10.1200/JCO.2008.17.9549.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Fernando IN, Ford HT, Powles TJ, Ashley S, Glees JP, Torr M, et al. Factors affecting acute skin toxicity in patients having breast irradiation after conservative surgery: a prospective study of treatment practice at the Royal Marsden Hospital. Clin Oncol (R Coll Radiol). 1996;8:226–33.

    Article  CAS  Google Scholar 

  69. Bentzen SM, Overgaard M. Relationship between early and late normal-tissue injury after postmastectomy radiotherapy. Radiother Oncol. 1991;20:159–65.

    Article  CAS  PubMed  Google Scholar 

  70. 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;106:143–50. doi:10.1007/s10549-006-9480-9.

    Article  PubMed  Google Scholar 

  71. Bostrom A, Sjolin-Forsberg G, Wilking N, Bergh J. Radiation recall—another call with tamoxifen. Acta Oncol. 1999;38:955–9.

    Article  CAS  PubMed  Google Scholar 

  72. Kundranda MN, Daw HA. Tamoxifen-induced radiation recall dermatitis. Am J Clin Oncol. 2006;29:637–8. doi:10.1097/01.coc.0000189693.23157.8d.

    Article  PubMed  Google Scholar 

  73. Singer EA, Warren RD, Pennanen MF, Collins BT, Hayes DF. Tamoxifen-induced radiation recall dermatitis. Breast J. 2004;10:170–1.

    Article  PubMed  Google Scholar 

  74. Parry BR. Radiation recall induced by tamoxifen. Lancet. 1992;340:49.

    Article  CAS  PubMed  Google Scholar 

  75. Rhee J, Kim GE, Lee CH, Kwon JM, Han SH, Kim YS, et al. Radiation recall dermatitis induced by tamoxifen during adjuvant breast cancer treatment. Radiat Oncol J. 2014;32:262–5. doi:10.3857/roj.2014.32.4.262.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Haydaroglu A, Sert F, Kazandi AC, Unal I. Radiation recall reaction with anastrozole treatment in breast cancer. Pract Radiat Oncol. 2012;2:e65–8. doi:10.1016/j.prro.2012.03.001.

    Article  PubMed  Google Scholar 

  77. Foster LM, Mahoney ME, Harmon MW, Allen JW, Luh JY. Radiation recall reaction with letrozole therapy in breast cancer. Clin Breast Cancer. 2014;14:e95–7. doi:10.1016/j.clbc.2013.12.011.

    Article  PubMed  Google Scholar 

  78. Burris 3rd HA, Hurtig J. Radiation recall with anticancer agents. Oncologist. 2010;15:1227–37. doi:10.1634/theoncologist.2009-0090.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Haffty BG, Vicini FA, Beitsch P, Quiet C, Keleher A, Garcia D, et al. Timing of Chemotherapy after MammoSite radiation therapy system breast brachytherapy: analysis of the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Int J Radiat Oncol Biol Phys. 2008;72:1441–8. doi:10.1016/j.ijrobp.2008.02.070.

    Article  PubMed  Google Scholar 

  80. Ioannidis G, Gkogkou P, Charalampous P, Diamandi M, Ioannou R. Radiation-recall dermatitis with the everolimus/exemestane combination ten years after adjuvant whole-breast radiotherapy. Radiother Oncol. 2014;112:449–50. doi:10.1016/j.radonc.2014.08.030.

    Article  PubMed  Google Scholar 

  81. Lee HE, Jeong NJ, Lee Y, Seo YJ, Kim CD, Lee JH, et al. Radiation recall dermatitis and pneumonitis induced by trastuzumab (Herceptin(R)). Int J Dermatol. 2014;53:e159–60.

    Article  PubMed  Google Scholar 

  82. Chung C, Stuart D, Keyes M. Radiation recall reaction induced by adjuvant trastuzumab (herceptin). Case Rep Med. 2009;2009:307894. doi:10.1155/2009/307894.

    PubMed  PubMed Central  Google Scholar 

  83. Shrimali RK, McPhail NJ, Correa PD, Fraser J, Rizwanullah M. Trastuzumab-induced radiation recall dermatitis—first reported case. Clin Oncol (R Coll Radiol). 2009;21:634–5. doi:10.1016/j.clon.2009.03.003.

    Article  CAS  Google Scholar 

  84. 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;65:324–32. doi:10.1016/j.ijrobp.2005.12.020.

    Article  CAS  PubMed  Google Scholar 

  85. 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;31:4488–95. doi:10.1200/JCO.2013.49.7842.

    Article  PubMed  Google Scholar 

  86. Barnett GC, Wilkinson JS, Moody AM, Wilson CB, Twyman N, Wishart GC, et al. Randomized controlled trial of forward-planned intensity modulated radiotherapy for early breast cancer: interim results at 2 years. Int J Radiat Oncol Biol Phys. 2012;82:715–23. doi:10.1016/j.ijrobp.2010.10.068.

    Article  PubMed  Google Scholar 

  87. Sibaud V, Niec RE, Schindler K, Busam KJ, Roche H, Modi S, et al. Ado-trastuzumab emtansine-associated telangiectasias in metastatic breast cancer: a case series. Breast Cancer Res Treat. 2014;146:451–6. doi:10.1007/s10549-014-3001-z.

    Article  PubMed  Google Scholar 

  88. Dancey AL, Waters RA. Morphea of the breast. Two case reports and discussion of the literature. J Plast Reconstr Aesthet Surg. 2006;59:1114–7. doi:10.1016/j.bjps.2006.01.018.

    Article  CAS  PubMed  Google Scholar 

  89. Cheah NL, Wong DW, Chetiyawardana AD. Radiation-induced morphea of the breast: a case report. J Med Case Rep. 2008;2:136. doi:10.1186/1752-1947-2-136.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Ardern-Jones MR, Black MM. Widespread morphoea following radiotherapy for carcinoma of the breast. Clin Exp Dermatol. 2003;28:160–2.

    Article  CAS  PubMed  Google Scholar 

  91. Wernicke AG, Goltser Y, Trichter S, Sabbas A, Gaan J, Swistel AJ, et al. Morphea as a consequence of accelerated partial breast irradiation. Clin Breast Cancer. 2011;11:67–70. doi:10.3816/CBC.2011.n.012.

    Article  PubMed  Google Scholar 

  92. Bleasel NR, Stapleton KM, Commens C, Ahern VA. Radiation-induced localized scleroderma in breast cancer patients. Australas J Dermatol. 1999;40:99–102.

    Article  CAS  PubMed  Google Scholar 

  93. Davis DA, Cohen PR, McNeese MD, Duvic M. Localized scleroderma in breast cancer patients treated with supervoltage external beam radiation: radiation port scleroderma. J Am Acad Dermatol. 1996;35:923–7.

    Article  CAS  PubMed  Google Scholar 

  94. Walsh N, Rheaume D, Barnes P, Tremaine R, Reardon M. Postirradiation morphea: an underrecognized complication of treatment for breast cancer. Hum Pathol. 2008;39:1680–8. doi:10.1016/j.humpath.2008.04.010.

    Article  PubMed  Google Scholar 

  95. Schaffer JV, Carroll C, Dvoretsky I, Huether MJ, Girardi M. Postirradiation morphea of the breast presentation of two cases and review of the literature. Dermatology. 2000;200:67–71.

    Article  CAS  PubMed  Google Scholar 

  96. Holscher T, Bentzen SM, Baumann M. Influence of connective tissue diseases on the expression of radiation side effects: a systematic review. Radiother Oncol. 2006;78:123–30. doi:10.1016/j.radonc.2005.12.013.

    Article  PubMed  Google Scholar 

  97. 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;68:502–8.

    Article  CAS  PubMed  Google Scholar 

  98. 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;17:829–33.

    Article  CAS  PubMed  Google Scholar 

  99. Mayr NA, Riggs Jr CE, Saag KG, Wen BC, Pennington EC, Hussey DH. Mixed connective tissue disease and radiation toxicity. A case report. Cancer. 1997;79:612–8.

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  101. 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;29:647–8. doi:10.1097/01.coc.0000239164.01855.50.

    Article  PubMed  Google Scholar 

  102. Swift M, Morrell D, Cromartie E, Chamberlin AR, Skolnick MH, Bishop DT. The incidence and gene frequency of ataxia-telangiectasia in the United States. Am J Hum Genet. 1986;39:573–83.

    CAS  PubMed  PubMed Central  Google Scholar 

  103. Andreassen CN, Alsner J, Overgaard M, Overgaard J. Prediction of normal tissue radiosensitivity from polymorphisms in candidate genes. Radiother Oncol. 2003;69:127–35.

    Article  CAS  PubMed  Google Scholar 

  104. 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;79:137–43.

    Article  CAS  PubMed  Google Scholar 

  105. Moullan N, Cox DG, Angele S, Romestaing P, Gerard JP, Hall J. Polymorphisms in the DNA repair gene XRCC1, breast cancer risk, and response to radiotherapy. Cancer Epidemiol Biomarkers Prev. 2003;12:1168–74.

    CAS  PubMed  Google Scholar 

  106. Meyer A, Dork T, Sohn C, Karstens JH, Bremer M. Breast cancer in patients carrying a germ-line CHEK2 mutation: Outcome after breast conserving surgery and adjuvant radiotherapy. Radiother Oncol. 2007;82:349–53. doi:10.1016/j.radonc.2006.12.002.

    Article  CAS  PubMed  Google Scholar 

  107. 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;21:2545–50. doi:10.1200/JCO.2003.06.064.

    Article  CAS  PubMed  Google Scholar 

  108. Cuttino LW, Heffernan J, Vera R, Rosu M, Ramakrishnan VR, Arthur DW. Association between maximal skin dose and breast brachytherapy outcome: a proposal for more rigorous dosimetric constraints. Int J Radiat Oncol Biol Phys. 2011;81:e173–7. doi:10.1016/j.ijrobp.2010.12.023.

    Article  PubMed  Google Scholar 

  109. 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;25:3259–65. doi:10.1200/JCO.2007.11.4991.

    Article  PubMed  Google Scholar 

  110. Collette S, Collette L, Budiharto T, Horiot JC, 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;44:2587–99. doi:10.1016/j.ejca.2008.07.032.

    Article  PubMed  Google Scholar 

  111. Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007;82:254–64. doi:10.1016/j.radonc.2006.12.008.

    Article  PubMed  Google Scholar 

  112. Ho AL, Bovill ES, Macadam SA, Tyldesley S, Giang J, Lennox PA. Postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction: a University of British Columbia perspective. Plast Reconstr Surg. 2014;134:1–10. doi:10.1097/PRS.0000000000000292.

    Article  CAS  Google Scholar 

  113. Azria D, Gourgou S, Sozzi WJ, Zouhair A, Mirimanoff RO, Kramar A, et al. Concomitant use of tamoxifen with radiotherapy enhances subcutaneous breast fibrosis in hypersensitive patients. Br J Cancer. 2004;91:1251–60. doi:10.1038/sj.bjc.6602146.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Azria D, Belkacemi Y, Romieu G, Gourgou S, Gutowski M, Zaman K, et al. Concurrent or sequential adjuvant letrozole and radiotherapy after conservative surgery for early-stage breast cancer (CO-HO-RT): a phase 2 randomised trial. Lancet Oncol. 2010;11:258–65. doi:10.1016/S1470-2045(10)70013-9.

    Article  CAS  PubMed  Google Scholar 

  115. Valakh V, Trombetta MG, Werts ED, Labban G, Khalid MK, Kaminsky A, et al. Influence of concurrent anastrozole on acute and late side effects of whole breast radiotherapy. Am J Clin Oncol. 2011;34:245–8. doi:10.1097/COC.0b013e3181df4b62.

    Article  CAS  PubMed  Google Scholar 

  116. Westbury CB, Yarnold JR. Radiation fibrosis—current clinical and therapeutic perspectives. Clin Oncol (R Coll Radiol). 2012;24:657–72. doi:10.1016/j.clon.2012.04.001.

    Article  CAS  Google Scholar 

  117. Delanian S, Balla-Mekias S, Lefaix JL. Striking regression of chronic radiotherapy damage in a clinical trial of combined pentoxifylline and tocopherol. J Clin Oncol. 1999;17:3283–90.

    CAS  PubMed  Google Scholar 

  118. 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;23:8570–9. doi:10.1200/JCO.2005.02.4729.

    Article  PubMed  Google Scholar 

  119. van Geel AN, Lans TE, Haen R, Tjong Joe Wai R, Menke-Pluijmers MB. Partial mastectomy and m latissimus dorsi reconstruction for radiation-induced fibrosis after breast-conserving cancer therapy. World J Surg. 2011;35:568–72. doi:10.1007/s00268-010-0911-8.

    Article  PubMed  Google Scholar 

  120. Chan RJ, Mann J, Tripcony L, Keller J, Cheuk R, Blades R, et al. Natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer: a phase 3, double-blind, randomized, controlled trial. Int J Radiat Oncol Biol Phys. 2014;90:756–64. doi:10.1016/j.ijrobp.2014.06.034.

    Article  CAS  PubMed  Google Scholar 

  121. Rollmann DC, Novotny PJ, Petersen IA, Garces YI, Bauer HJ, Yan ES, et al. Double-blind, placebo-controlled pilot study of processed ultra emu oil versus placebo in the prevention of radiation dermatitis. Int J Radiat Oncol Biol Phys. 2015. doi:10.1016/j.ijrobp.2015.02.028.

    PubMed  Google Scholar 

  122. Heggie S, Bryant GP, Tripcony L, Keller J, Rose P, Glendenning M, et al. A Phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue. Cancer Nurs. 2002;25:442–51.

    Article  PubMed  Google Scholar 

  123. Williams MS, Burk M, Loprinzi CL, Hill M, Schomberg PJ, Nearhood K, et al. Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys. 1996;36:345–9.

    Article  CAS  PubMed  Google Scholar 

  124. Richardson J, Smith JE, McIntyre M, Thomas R, Pilkington K. Aloe vera for preventing radiation-induced skin reactions: a systematic literature review. Clin Oncol (R Coll Radiol). 2005;17:478–84.

    Article  CAS  Google Scholar 

  125. Gosselin TK, Schneider SM, Plambeck MA, Rowe K. A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy. Oncol Nurs Forum. 2010;37:619–26. doi:10.1188/10.ONF.619-626.

    Article  PubMed  Google Scholar 

  126. Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol. 2004;22:1447–53. doi:10.1200/JCO.2004.07.063.

    Article  CAS  PubMed  Google Scholar 

  127. Pinnix C, Perkins GH, Strom EA, Tereffe W, Woodward W, Oh JL, et al. Topical hyaluronic acid vs. standard of care for the prevention of radiation dermatitis after adjuvant radiotherapy for breast cancer: single-blind randomized phase III clinical trial. Int J Radiat Oncol Biol Phys. 2012;83:1089–94. doi:10.1016/j.ijrobp.2011.09.021.

    Article  CAS  PubMed  Google Scholar 

  128. Kirova YM, Fromantin I, De Rycke Y, Fourquet A, Morvan E, Padiglione S, et al. Can we decrease the skin reaction in breast cancer patients using hyaluronic acid during radiation therapy? Results of phase III randomised trial. Radiother Oncol. 2011;100:205–9. doi:10.1016/j.radonc.2011.05.014.

    Article  CAS  PubMed  Google Scholar 

  129. Meghrajani CF, Co HC, Ang-Tiu CM, Roa FC. Topical corticosteroid therapy for the prevention of acute radiation dermatitis: a systematic review of randomized controlled trials. Expert Rev Clin Pharmacol. 2013;6:641–9. doi:10.1586/17512433.2013.841079.

    Article  CAS  PubMed  Google Scholar 

  130. Bostrom A, Lindman H, Swartling C, Berne B, Bergh J. Potent corticosteroid cream (mometasone furoate) significantly reduces acute radiation dermatitis: results from a double-blind, randomized study. Radiother Oncol. 2001;59:257–65.

    Article  CAS  PubMed  Google Scholar 

  131. Miller RC, Schwartz DJ, Sloan JA, Griffin PC, Deming RL, Anders JC, et al. Mometasone furoate effect on acute skin toxicity in breast cancer patients receiving radiotherapy: a phase III double-blind, randomized trial from the North Central Cancer Treatment Group N06C4. Int J Radiat Oncol Biol Phys. 2011;79:1460–6. doi:10.1016/j.ijrobp.2010.01.031.

    Article  CAS  PubMed  Google Scholar 

  132. Graham P, Browne L, Capp A, Fox C, Graham J, Hollis J, et al. Randomized, paired comparison of No-Sting Barrier Film versus sorbolene cream (10% glycerine) skin care during postmastectomy irradiation. Int J Radiat Oncol Biol Phys. 2004;58:241–6.

    Article  PubMed  Google Scholar 

  133. Paterson D, Poonam P, Bennett N, Peszynski R, Van Beekhuizen M, Jasperse M, et al. Randomized intra-patient controlled trial of mepilex lite dressings versus aqueous cream in managing radiation-induced skin reactions post-mastectomy. J Cancer Sci Ther. 2012;4:347–56.

    Article  Google Scholar 

  134. Mcmillan MS, Wells M, MacBride S, Raab GM, Munro A, MacDougall H. Randomized comparison of dry dressings versus hydrogel in management of radiation-induced moist desquamation. Int J Radiat Oncol Biol Phys. 2007;68:864–72. doi:10.1016/j.ijrobp.2006.12.049.

    Article  CAS  Google Scholar 

  135. Spalek M, Jonska-Gmyrek J, Galecki J. Radiation-induced morphea—a literature review. J Eur Acad Dermatol Venereol. 2015;29:197–202. doi:10.1111/jdv.12704.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero, H1031, San Francisco, CA, 94115, USA

    Barbara Fowble MD, FACR, FASTRO, Catherine Park MD & Florence Yuen RN, MSN, AOCNP

Authors
  1. Barbara Fowble MD, FACR, FASTRO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherine Park MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Florence Yuen RN, MSN, AOCNP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara Fowble MD, FACR, FASTRO .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA

    Barbara Fowble

  2. Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA

    Sue S. Yom

  3. Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA

    Florence Yuen

  4. Department of Dermatology, University of California San Francisco, San Francisco, California, USA

    Sarah Arron

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Fowble, B., Park, C., Yuen, F. (2016). Breast Cancer. In: Fowble, B., Yom, S., Yuen, F., Arron, S. (eds) Skin Care in Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-31460-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-31460-0_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31458-7

  • Online ISBN: 978-3-319-31460-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation