External Validation of a Predictive Model for Acute Skin Radiation Toxicity in the REQUITE Breast Cohort
Creators: name: Rattay, Tim
name: Seibold, Petra
name: Aguado-Barrera, Miguel E.
name: Altabas, Manuel
name: Azria, David
name: Barnett, Gillian C.
name: Bultijnck, Renée
name: Chang-Claude, Jenny
name: Choudhury, Ananya
name: Coles, Charlotte E.
name: Dunning, Alison M.
name: Elliott, Rebecca M.
name: Farcy Jacquet, Marie-Pierre
name: Gutiérrez-Enríquez, Sara
name: Johnson, Kerstie
name: Müller, Anusha
name: Post, Giselle
name: Rancati, Tiziana
name: Reyes, Victoria
name: Rosenstein, Barry S.
name: De Ruysscher, Dirk
name: De Santis, Maria C.
name: Sperk, Elena
name: Stobart, Hilary
name: Symonds, R. Paul
name: Taboada-Valladares, Begoña
name: Vega, Ana
name: Veldeman, Liv
name: Webb, Adam J.
name: West, Catharine M.
name: Valdagni, Riccardo
name: Talbot, Christopher J.
name: REQUITE Consortium
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Oncology
validation
prediction model
early toxicity
radiotherapy
breast cancer

description: Background: Acute skin toxicity is a common and usually transient side-effect of breast radiotherapy although, if sufficiently severe, it can affect breast cosmesis, aftercare costs and the patient's quality-of-life. The aim of this study was to develop predictive models for acute skin toxicity using published risk factors and externally validate the models in patients recruited into the prospective multi-center REQUITE (validating pREdictive models and biomarkers of radiotherapy toxicity to reduce side-effects and improve QUalITy of lifE in cancer survivors) study. Methods: Patient and treatment-related risk factors significantly associated with acute breast radiation toxicity on multivariate analysis were identified in the literature. These predictors were used to develop risk models for acute erythema and acute desquamation (skin loss) in three Radiogenomics Consortium cohorts of patients treated by breast-conserving surgery and whole breast external beam radiotherapy (n = 2,031). The models were externally validated in the REQUITE breast cancer cohort (n = 2,057). Results: The final risk model for acute erythema included BMI, breast size, hypo-fractionation, boost, tamoxifen use and smoking status. This model was validated in REQUITE with moderate discrimination (AUC 0.65), calibration and agreement between predicted and observed toxicity (Brier score 0.17). The risk model for acute desquamation, excluding the predictor tamoxifen use, failed to validate in the REQUITE cohort. Conclusions: While most published prediction research in the field has focused on model development, this study reports successful external validation of a predictive model using clinical risk factors for acute erythema following radiotherapy after breast-conserving surgery. This model retained discriminatory power but will benefit from further re-calibration. A similar model to predict acute desquamation failed to validate in the REQUITE cohort. Future improvements and more accurate predictions are expected through the addition of genetic markers and application of other modeling and machine learning techniques.