Chronic skin toxicities in breast cancer survivors: a systematic review and meta-analysis of radiotherapy techniques

Abstract

PurposeThis study assessed the impact of radiotherapy (RT) techniques on chronic skin reactions and health-related quality of life (HRQoL) in breast cancer patients, comparing conventional RT with modern techniques such as intensity-modulated RT (IMRT).MethodsA comprehensive search was conducted in Embase, MEDLINE, and Cochrane CENTRAL from inception to April 26, 2024. Conventional RT, which uses 2D or 3D imaging to shape radiation beams without dynamic intensity modulation, was compared with alternate RT techniques for adjuvant breast cancer treatment. Primary outcomes included chronic grade >= 2 skin toxicities (hyperpigmentation, breast fibrosis, telangiectasia, edema, and atrophy/retraction) and HRQoL, assessed mainly with EORTC QLQ-C30 and QLQ-BR23 modules. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.ResultsFrom 1305 screened studies, nine articles representing seven studies (2418 patients), including three randomized controlled trials, met inclusion criteria. Most studies used conventional fractionation (45-50 Gray in 25 fractions). IMRT was associated with a lower incidence of chronic grade >= 2 hyperpigmentation (RR: 0.39, 95%CI: 0.17-0.89, I2 = 0%) compared to conventional RT. No significant differences were found for grade >= 2 breast fibrosis, telangiectasia, edema, and atrophy/retraction. Cosmetic outcomes from IMRT were favorable in the short term, with no long-term differences. Three studies reported no significant HRQoL differences between IMRT and conventional RT.ConclusionIMRT may reduce certain chronic skin toxicities compared to conventional RT. However, consistent long-term differences in cosmetic outcomes or HRQoL were not observed. These findings are limited by the small number of studies and variability in reporting standards.