Evaluation of acute skin toxicity during radiotherapy for breast cancer in elderly patients

BACKGROUND: For women with early stage breast cancer, the hypofractionation is the standard of care, whereas for women in other situations the standard dose is still recommended. Although the hypofractionation studies included elderly patients (>70 years), many studies excluded this population. The goals of this study are to demonstrate our results in terms of acute skin toxicity in elderly patients, and to show that they can receive the same treatment as young patients. METHODS: We conducted a retrospective study searching our database for patients at least 70 years old at the beginning of the treatment for breast cancer. The treatment planning and the medical records were reviewed to check not only the details of the treatment but also the skin reactions developed. The RTOG (Radiation Therapy Oncology Group) was used to take note of the skin toxicity. RESULTS: Two hundred and seventy-six patients treated from June 2015 to May 2019 were included in the final analysis. The vast majority of patients (72.99%) developed only a RTOG grade 1 reaction, the only two patients which presented with RTOG 4 had ulceration of skin, achieving full recovery. Regarding the volume of treatment, the percentages for RTOG 1 were similar for “Breast” and “Breast plus Drainage” (~75%). Patients receiving treatment aiming breast, drainage and boost had the higher percentage of RTOG 4 (6.2%). Patients that received the hypofractionation showed slightly better results than the standard fractionation, with no patient with RTOG 4 and lesser patients with RTOG 2 and 3, RTOG 1 was predominant for all sub-groups analyzed. Mild erythema and dry desquamation are common reactions that usually do not greatly affect the quality of life of the patients. The volume of treatment has an important effect on skin reactions with the number of events increasing considerably at larger volumes. Overall, there is a benefit in favor of hypofractionation in terms of acute skin toxicity. CONCLUSIONS: It can clearly be seen that elderly patients can tolerate the acute side effects of the radiotherapy and they should receive the same treatment as young patients. Larger volumes of treatment increased the toxicity, hence these patients should be more carefully evaluated during the treatment.