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Smoking and Radiation-induced Skin Injury: Analysis of a Multiracial, Multiethnic Prospective Clinical Trial

Published:September 16, 2022DOI:https://doi.org/10.1016/j.clbc.2022.09.003

      Highlights

      • Analysis of radiation-induced skin injury (RISI) after breast radiotherapy (RT)
      • Urinary cotinine (UCot) was measured in 980 patients at baseline and end RT
      • The risk of moderate-severe late RISI was weakly associated with UCot
      • No association between UCot and acute RISI was identified

      Abstract

      Introduction

      Smoking during breast radiotherapy (RT) may be associated with radiation-induced skin injury (RISI). We aimed to determine if a urinary biomarker of tobacco smoke exposure is associated with increased rates of RISI during and after breast RT.

      Patients and Methods

      Women with Stage 0-IIIA breast cancer treated with breast-conserving surgery or mastectomy followed by RT to the breast or chest wall with or without regional nodal irradiation were prospectively enrolled on a multicenter study assessing acute/late RISI. 980 patients with urinary cotinine (UCot) measurements (baseline and end-RT) were categorized into three groups. Acute and late RISI was assessed using the ONS Acute Skin Reaction scale and the LENT-SOMA Criteria.

      Results

      Late Grade 2+ and Grade 3+ RISI occurred in 18.2% and 1.9% of patients, respectively—primarily fibrosis, pain, edema, and hyperpigmentation. Grade 2+ late RISI was associated with UCot group (p=0.006). Multivariable analysis identified UCot-based light smoker/secondhand smoke exposure (HR 1.79, p=0.10) and smoking (HR 1.60, p=0.06) as non-significantly associated with increased risk of late RISI. Hypofractionated breast RT was associated with decreased risk of late RISI (HR 0.51, p=0.03). UCot was not associated with acute RISI, multivariable analysis identified race, obesity, RT site/fractionation, and bra size to be associated with acute RISI.

      Conclusions

      Tobacco exposure during breast RT may be associated with an increased risk of late RISI without an effect on acute toxicity. Smoking cessation should be encouraged prior to radiotherapy to minimize these and other ill effects of smoking.
      MicroAbstract
      In this analysis of a prospective study of radiation-induced skin injury in breast cancer patients treated with radiotherapy (RT), urinary cotinine (UCot) was measured for 980 participants at baseline and end RT. High UCot was associated with a higher rate of late RISI but not acute RISI. Smoking cessation is recommended to reduce the risk of late RISI.

      Keywords

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