Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Akke Bakker, M.Willemijn Kolff, Rebecca Holman, Caspar M. van Leeuwen, Linda Korshuize-van Straten, Rianne de Kroon-Oldenhof, Coen R.N. Rasch, Geertjan van Tienhoven, Hans Crezee
During reirradiation plus hyperthermia for recurrent breast cancer, thermal skin damage (TSD) occurs in a median of 21.4% of patients. TSD presents as a 2nd degree burn and may result in long-term ulceration. Current clinically used temperature threshold values are based on healthy human skin data. Patients with recurrent breast cancer have had previous surgery and/or irradiation. Scar tissue, particularly when irradiated, is less perfused than healthy skin and might be more at risk of developing TSD.In this observational study, temperature characteristics of hyperthermia sessions were analyzed in 262 patients with recurrent breast cancer treated in the XXXX between 2010 and 2014 with reirradiation and weekly hyperthermia for one hour. Skin temperature was measured using a median of 42 (range 29-82) measurement points per hyperthermia session.Sixty-eight patients (26%) developed 79 sites of TSD; after the first (n=26), second (n=17), third (n=27) and fourth (n=9) hyperthermia session. 70% of TSD occurred on or near scar tissue. Scar tissue reached higher temperatures than other skin tissue (0.4°C, p-value<0.001). One-hundred-and-two measurement points corresponded to actual TSD sites in 35/79 sessions where TSD developed. TSD sites had much higher maximum temperatures than non-TSD sites (2.8°C, p-value<0.001). Generalized linear mixed models showed that the probability of TSD is related to temperature and thermal dose values (p-value<0.001) and that scar tissue is more at risk (odds ratio 0.4, p-value<0.001). Limiting the maximum temperature of a measurement point to 43.7ºC would mean that the probability of observing TSD was at most 5%.
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