Spatial dose-distribution-based risk mapping to predict moist desquamation in breast radiotherapy

Area of Science:

• Radiation Oncology
• Medical Physics
• Clinical Dermatology

Background:

• Moist desquamation (MD) is a common side effect of breast radiotherapy.
• Predicting MD is challenging due to complex dose distributions on the skin.
• Current predictive metrics lack regional specificity.

Purpose of the Study:

• To develop and validate a novel dose-distance based metric for predicting regional skin dose and subsequent moist desquamation (MD) in breast radiotherapy.
• To compare the performance of this new metric against existing dose-area and dose-volume metrics.
• To assess the metric's utility in identifying high-risk regions for severe skin toxicity.

Main Methods:

• Utilized a dataset of 56 patients undergoing breast radiotherapy.
• Extracted skin dose distributions from AcurosXB treatment plans.
• Developed a dose-distance metric and compared its sensitivity and specificity against dose-area and dose-volume metrics for predicting MD.

Main Results:

• The dose-distance metric demonstrated superior performance (70% sensitivity, 72% specificity) compared to dose-area (45%, 55%) and dose-volume (43%, 56%) metrics.
• Excluding confounding factors like breast support devices improved the dose-distance metric's performance to 81% sensitivity and specificity.
• The metric effectively identified regional variations in skin dose related to MD.

Conclusions:

• A novel dose-distance metric offers improved regional prediction of moist desquamation in breast radiotherapy.
• This metric can be integrated into treatment planning to map skin toxicity risk and guide clinical decisions.
• The findings support enhanced patient safety and personalized radiotherapy approaches.