Dual-scale evaluation of pain after hypofractionated post-mastectomy radiotherapy
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Abstract
Background: Post-mastectomy radiotherapy (PMRT) pain encompassing somatic shoulder and chest wall pain (SCWP) and neuropathic pain (NP) is a clinically significant late toxicity following hypofractionated radiotherapy (HFRT) for breast cancer. Limited data exist regarding its incidence, temporal evolution, and determinants across different HFRT regimens.
Objectives: To evaluate the incidence and predictors of SCWP and NP in patients receiving chest wall and regional nodal HFRT, across three HFRT schedules.
Materials and methods: Breast cancer patients were treated with one of three HFRT regimens: 26 Gy in 5 fractions, 34 Gy in 10 fractions, or 40 Gy in 15 fractions. PMRT pain was evaluated using the Common Terminology Criteria for Adverse Events, version 5.0 (CTCAE v5.0) for SCWP, and NP using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale. The temporal patterns of both pains were analyzed. Dosimetric parameters of the chest wall (CW), brachial plexus (BP), axillary levels I-III, and supraclavicular fossa (SCF), anatomical parameter (CW thickness), and clinical parameters (age, BMI) were correlated with pain outcomes.
Results: The mean duration of SCWP was 6 months (range, 3-36 months), which was most frequently observed with HFRT-C (40%), followed by HFRT-B (22.9%) and HFRT-A (23.3%) (p=0.09). Patients with Grade≥2 SCWP had significantly thinner CW (p=0.04) and higher CW Dmax EQD2 values (p=0.04). NP occurred with a mean onset of 12 months (range, 3-24 months) and was most common in HFRT-C (60%), versus 40% in HFRT-A and 28.6% in HFRT-B (p=0.001). On multivariate analysis, Level III axillary dissection (0.049) and higher BP Dmax EQD2(p=0.001), axillary level III Dmean EQD2 (p=0.049) were found to be significant predictors of NP.
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Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
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