Acute and Late Skin Toxicities of Hypofractionated Radiotherapy in Breast Cancer Among Young and Elderly Women
Authors: - Salma El Baz , - Asmae Hamdan , - Hanan El Kacemi , - Tayeb Kebdani , - Khalid Hassouni , - K. Nouni , - A. Lachgar , - O. Eddarif 
Published: July 2024

Objective: The aim of this study is to determine predictive factors and compare the acute and late skin toxicities of hypofractionated radiotherapy on breast cancer patients, focusing on differences between young and elderly women.
Materials and Methods: Our study is a retrospective analysis that included 208 patients (142 young patients aged 40 years or younger, and 66 elderly patients aged 65 years or older) out of a total of 1442, treated between January 2019 and January 2021, with invasive breast cancer. All our patients were treated with hypofractionated RT doses ranging from 42 to 53.2 Gy, 2.8 Gy per fraction, 5 fractions per week. Acute radiotherapy skin toxicities were assessed on the last day of treatment,and late skin toxicities after three months during the follow-up consultation after radiation treatment compliance and every 3 months thereafter. Toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. All data were entered and analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. The significance level for all statistical analyses was set at p<0.05.
Results :
•	In the group of elderly women, the age ranges from 68 to 88 with a mean of 74.72 +/- 4.18. The BMI of the patients was less than 18.5 in 2 patients , between 18.5 and 25 in 22 patients , between 25 and 30 in 23 patients , and above 30 in 19 patients . Regarding medical history, 39.4% have hypertension followed by diabetes in 28.8% and thyroid disorders in 9.1%. All patients underwent surgery, with mastectomy in 40.90% and lumpectomy in 59.09%, with axillary lymph node dissection or sentinel lymph node biopsy.Chemotherapy was received by 71.2% of patients.Acute toxicities were represented by radiodermatitis, which was observed in all patients (Grade 1 78.8% and Grade 2 21.2%). Local edema was observed in 53% of cases. Regarding late toxicities, hyperpigmentation was observed in 56.1% and fibrosis in 31.8%
•	In the group of young women, the age ranged from 25 to 40 with a mean of 34.83 +/- 3.60. The BMI of the patients was less than 18.5 in 2 patients, between 18.5 and 25 in 58 patients, between 25 and 30 in 43 patients, and above 30 in 24 patients. Regarding medical history, hypertension was present in 7.7% of cases, diabetes in 7.7%, and thyroid disorders in 7%. . All patients underwent surgery, with mastectomy in 56.3% and lumpectomy in 43.6%, with axillary lymph node dissection or sentinel lymph node biopsy.The most frequent TNM stage was T2 in 64.1% and N0 in 55.6%. Chemotherapy was received by 71.2% of patients.
Acute toxicities were represented by radiodermatitis, observed in 79.6% of patients (G1 67.6% and G2 12%). Local edema was observed in 24.6% of cases. Regarding late toxicities, hyperpigmentation was observed in 60.6% and fibrosis in 36.6%.
•	In univariate analysis, we notice that both elderly and young women show similar results regarding radiodermatitis, especially grade 2, which is more frequent in women with a BMI higher than 25, diabetic women, and those with thyroid disorders, with a p-value <0.048. Local edema was frequent in eledery and young patients who underwent lumpectomy with a p-value of 0.000, as well as in young patients with a BMI over 30 with a p-value of 0.037, with no significant value among elderly women. As for hyperpigmentation, it is more frequent in elderly and young women who underwent mastectomy, whereas fibrosis is more common in cases of lumpectomy, with a p-value of 0.000.
Conclusion :These results underline the importance of considering comorbidities and surgical interventions in managing toxicities associated with breast cancer radiation. Future studies could further explore these associations and investigate other potential risk factors to better understand and optimize patient management.