Women with breast cancer have less dermatitis when treated with intensity-modulated radiation therapy

All women treated with radiation therapy for breast cancer are at risk of developing dermatitis - a sometimes-painful skin condition caused by radiation as it makes its way through the skin to the tumor area and tissue within the breast.

But researchers at Fox Chase Cancer Center say women being treated with IMRT (intensity-modulated radiation therapy) are less likely to have serious dermatitis. The research was presented today at the American Society for Therapeutic Radiology and Oncology's 49th Annual Meeting in Los Angeles.

A reddening of the skin, dermatitis is often likened to a bad sunburn. It can begin in the first weeks of treatment as mild redness, dryness or itching of the skin and progress to a more intense skin reaction by the last week of radiation. When dermatitis is acute and severe, causing peeling, it is can be extremely painful, interfering with normal life activities and sometimes interrupting treatment.

“Dermatitis is a major quality-of-life concern,” said Gary Freedman, M.D., a radiation oncologist at Fox Chase Cancer Center who studies the side effects of breast cancer treatment. “It can be so painful that wearing a bra or snug-fitting clothing isn't possible. In the most severe cases, the skin will actually bleed or be at risk of infection.”

Freedman says IMRT can reduce the risk of dermatitis. IMRT allows the radiation to be distributed in more beams across the skin, avoiding the full-on assault of conventional radiation.

In this study, Freedman and his colleagues looked at the records of 804 consecutive patients with early-stage breast cancer. The women were treated with breast-conserving surgery and radiation therapy between 2001 and 2006.

In the earlier part of the study period, women were treated with conventional radiation therapy (n=405). Later in the study period, women were primarily treated with IMRT (n=399).

Of those treated with IMRT, 48 percent had grade 0/1 dermatitis and 52 percent had grade 2/3. Of those treated with conventional radiation, 25 percent had grade 0/1 dermatitis and 75 percent had grade 2/3.

“In addition to statistically fewer patients with serious dermatitis, women treated with IMRT who developed dermatitis had it for a shorter time period than those treated with conventional radiation,” added Freedman. “These benefits were shown in all patients regardless of breast size.”

He concluded, “This study confirms our current practice of recommending IMRT for all patients. The study seeks to provide further evidence for patients, physicians and insurance companies that IMRT should be standard practice.”