Radiation-induced fibrosis in the boost area after three-dimensional conformal radiotherapy with a simultaneous integrated boost technique for early-stage breast cancer: A multivariable prediction model.

Hammer, C; Maduro, J H; Bantema-Joppe, E J; van der Schaaf, A; van der Laan, H P; Langendijk, J A; Crijns, A P G · Radiother Oncol · 2017

prospective_cohort · Level II

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Abstract

To develop a multivariable prediction model for the risk of grade⩾2 fibrosis in the boost area after breast conserving surgery (BCS) followed by three-dimensional conformal radiotherapy (RT) with a simultaneous integrated photon boost (3D-CRT-SIB), five years after RT. This prospective cohort study included 1,030 patients treated with RT for breast cancer (stage 0-III), after BCS. Data regarding physician-rated fibrosis and dose-volume parameters were available in 546 patients. A multivariable logistic regression model for grade⩾2 fibrosis was generated. At 5years, grade⩾2 fibrosis was observed in 13.4% of the patients. The multivariable analysis resulted in a prediction model for grade⩾2 fibrosis in the boost area including three independent variables: patient age, breast volume receiving⩾55Gy (V55 CTV breast) and the maximum radiation dose in the breast (D<sub>max</sub>). A multivariable prediction model was developed including age, V55 CTV breast and D<sub>max</sub> for grade⩾2 fibrosis in the boost area after breast cancer RT using a 3D-CRT-SIB technique. This model can be used to estimate the risk of fibrosis and to optimize dose distributions aiming at reducing this risk.

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