{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:44:39Z","timestamp":1791895479515,"version":"4.3.4"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100018493","name":"Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["109HCP-03"],"award-info":[{"award-number":["109HCP-03"]}],"id":[{"id":"10.13039\/100018493","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100024990","name":"National Yang Ming Chiao Tung University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100024990","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Breast Cancer"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Radiodermatitis is the predominant acute toxicity in locally advanced breast cancer (BC) radiotherapy. Early-onset radiodermatitis substantially increases the risk of high-grade injury and potential treatment interruption. This study aimed to identify risk factors for early-onset radiodermatitis by analyzing patient characteristics and dose-distribution profiles from step-and-shoot intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective analysis included 128 women with locally advanced unilateral BC who received postoperative IMRT or VMAT. Patient demographics, treatment parameters, and three-dimensional dose\u2013volume metrics were extracted. Early-onset radiodermatitis was defined as CTCAE v5.0 grade\u2009\u2265\u20091 developing before the 20th treatment fraction. Univariable and multivariable logistic regression identified independent risk factors, and dosimetric variables were compared between IMRT and VMAT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Early-onset radiodermatitis was observed in 35 of 128 patients (27.3%). Four independent predictors were identified: treatment technique (IMRT versus VMAT: odds ratio [OR] 4.25; 95% confidence interval [CI] 1.30\u201313.94;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017), left-sided irradiation (OR 20.98; 95% CI 2.39\u2013184.27;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006), heart\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>5<\/jats:sub>\n                      (OR 0.85 per 1% increase; 95% CI 0.74\u20130.97;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012), and PTV\n                      <jats:sub>Breast<\/jats:sub>\n                      volume (OR 1.002 per cc; 95% CI 1.000\u20131.004;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023). VMAT provided superior target coverage and reduced high-dose exposure to the heart and ipsilateral lung (\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>40<\/jats:sub>\n                      ), whereas IMRT better limited low-dose spill to the contralateral breast and lung and to the ipsilateral lung (\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>5<\/jats:sub>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      IMRT, left-sided irradiation, low heart\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>5<\/jats:sub>\n                      , and large PTV\n                      <jats:sub>Breast<\/jats:sub>\n                      volume were independent risk factors for early-onset radiodermatitis. Awareness of these factors can guide prophylactic skin care and adaptive planning. While VMAT provides advantages in target coverage and cardiac\/high-dose lung sparing against IMRT\u2019s superior control of low-dose exposure to normal tissues.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12282-025-01762-y","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:19:47Z","timestamp":1756282787000},"page":"1354-1365","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk factors for early-onset radiodermatitis in patients with locally advanced breast cancer: a comparative analysis of volumetric modulated arc therapy and intensity-modulated radiotherapy"],"prefix":"10.1007","volume":"32","author":[{"given":"Chih-Chieh","family":"Chang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Wei","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang-Chun","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo-Ting","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Ming","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"1762_CR1","first-page":"229","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74:229\u201363.","journal-title":"CA Cancer J Clin"},{"key":"1762_CR2","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.radonc.2014.08.027","volume":"114","author":"S Corradini","year":"2015","unstructured":"Corradini S, Niyazi M, Niemoeller OM, Li M, Roeder F, Eckel R, et al. Adjuvant radiotherapy after breast conserving surgery\u2014a comparative effectiveness research study. Radiother Oncol. 2015;114:28\u201334.","journal-title":"Radiother Oncol"},{"key":"1762_CR3","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.1016\/S0140-6736(14)60488-8","volume":"383","author":"P McGale","year":"2014","unstructured":"McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383:2127\u201335.","journal-title":"Lancet"},{"key":"1762_CR4","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1186\/s13014-015-0568-4","volume":"10","author":"W Budach","year":"2015","unstructured":"Budach W, B\u00f6lke E, Kammers K, Gerber PA, Nestle-Kr\u00e4mling C, Matuschek C. Adjuvant radiation therapy of regional lymph nodes in breast cancer\u2014a meta-analysis of randomized trials\u2014an update. Radiat Oncol. 2015;10:258.","journal-title":"Radiat Oncol"},{"key":"1762_CR5","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1056\/NEJMoa1415369","volume":"373","author":"PM Poortmans","year":"2015","unstructured":"Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373:317\u201327.","journal-title":"N Engl J Med"},{"key":"1762_CR6","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1056\/NEJMoa1415340","volume":"373","author":"TJ Whelan","year":"2015","unstructured":"Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373:307\u201316.","journal-title":"N Engl J Med"},{"key":"1762_CR7","doi-asserted-by":"publisher","first-page":"199","DOI":"10.15537\/smj.2024.45.2.20230438","volume":"45","author":"G Temiz","year":"2024","unstructured":"Temiz G, Cankaya G, Ozturk A, Ozgen Z. Acute side effects and health care requirements in breast cancer patients treated with radiotherapy. Saudi Med J. 2024;45:199\u2013204.","journal-title":"Saudi Med J"},{"key":"1762_CR8","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/S1040-8428(01)00143-3","volume":"41","author":"BA Jereczek-Fossa","year":"2002","unstructured":"Jereczek-Fossa BA, Marsiglia HR, Orecchia R. Radiotherapy-related fatigue. Crit Rev Oncol Hematol. 2002;41:317\u201325.","journal-title":"Crit Rev Oncol Hematol"},{"key":"1762_CR9","doi-asserted-by":"publisher","first-page":"1712","DOI":"10.3390\/cancers13071712","volume":"13","author":"A D\u00edaz-Gavela","year":"2021","unstructured":"D\u00edaz-Gavela A, Figueiras-Graillet L, Luis \u00c1, Salas Segura J, Ci\u00e9rvide R, Del Cerro PE, et al. Breast radiotherapy-related cardiotoxicity. When, how, why risk prevention and control strategies. Cancers. 2021;13:1712.","journal-title":"Cancers"},{"key":"1762_CR10","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1038\/jid.2011.411","volume":"132","author":"JL Ryan","year":"2012","unstructured":"Ryan JL. Ionizing radiation: the good, the bad, and the ugly. J Invest Dermatol. 2012;132:985\u201393.","journal-title":"J Invest Dermatol"},{"key":"1762_CR11","doi-asserted-by":"publisher","first-page":"5928","DOI":"10.3390\/cancers13235928","volume":"13","author":"S Allali","year":"2021","unstructured":"Allali S, Kirova Y. Radiodermatitis and fibrosis in the context of breast radiation therapy: a critical review. Cancers. 2021;13:5928.","journal-title":"Cancers"},{"key":"1762_CR12","doi-asserted-by":"publisher","first-page":"4955","DOI":"10.3389\/fonc.2021.738851","volume":"11","author":"Y Xie","year":"2021","unstructured":"Xie Y, Wang Q, Hu T, Chen R, Wang J, Chang H, et al. Risk factors related to acute radiation dermatitis in breast cancer patients after radiotherapy: a systematic review and meta-analysis. Front Oncol. 2021;11:4955.","journal-title":"Front Oncol"},{"key":"1762_CR13","doi-asserted-by":"publisher","first-page":"1641","DOI":"10.1200\/JCO.2016.72.0722","volume":"35","author":"C Taylor","year":"2017","unstructured":"Taylor C, Correa C, Duane FK, Aznar MC, Anderson SJ, Bergh J, et al. Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol. 2017;35:1641\u20139.","journal-title":"J Clin Oncol"},{"key":"1762_CR14","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.1016\/S0140-6736(11)61629-2","volume":"378","author":"S Darby","year":"2011","unstructured":"Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707\u201316.","journal-title":"Lancet"},{"key":"1762_CR15","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/S0360-3016(01)02275-1","volume":"51","author":"PJ Keall","year":"2001","unstructured":"Keall PJ, Arnfield MR, Arthur DW, Lloyd R, Lauterbach MH, Siebers JV, et al. An IMRT technique to reduce the heart and lung dose for early stage breast cancer. Int J Radiat Oncol. 2001;51:247\u20138.","journal-title":"Int J Radiat Oncol"},{"key":"1762_CR16","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1093\/jrr\/rrv052","volume":"56","author":"M Tyran","year":"2015","unstructured":"Tyran M, Mailleux H, Tallet A, Fau P, Gonzague L, Minsat M, et al. Volumetric-modulated arc therapy for left-sided breast cancer and all regional nodes improves target volumes coverage and reduces treatment time and doses to the heart and left coronary artery, compared with a field-in-field technique. J Radiat Res (Tokyo). 2015;56:927\u201337.","journal-title":"J Radiat Res (Tokyo)"},{"key":"1762_CR17","doi-asserted-by":"publisher","DOI":"10.3390\/jpm14010063","volume":"14","author":"E Konstantinou","year":"2024","unstructured":"Konstantinou E, Varveris A, Solomou G, Antoniadis C, Tolia M, Mazonakis M. Radiation dose to critical cardiac structures from three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques for left-sided breast cancer. J Pers Med. 2024;14: 63.","journal-title":"J Pers Med"},{"key":"1762_CR18","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1186\/s13014-021-01895-2","volume":"16","author":"Y Zhang","year":"2021","unstructured":"Zhang Y, Huang Y, Ding S, Yuan X, Shu Y, Liang J, et al. A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer. Radiat Oncol. 2021;16:171.","journal-title":"Radiat Oncol"},{"key":"1762_CR19","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1016\/j.meddos.2018.09.004","volume":"44","author":"Y Xu","year":"2019","unstructured":"Xu Y, Wang J, Hu Z, Tian Y, Ma P, Li S, et al. Locoregional irradiation including internal mammary nodal region for left-sided breast cancer after breast conserving surgery: dosimetric evaluation of 4 techniques. Med Dosim. 2019;44:e13\u20138.","journal-title":"Med Dosim"},{"key":"1762_CR20","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1186\/s13014-015-0531-4","volume":"10","author":"H Zhao","year":"2015","unstructured":"Zhao H, He M, Cheng G, Han D, Wu N, Shi D, et al. A comparative dosimetric study of left sided breast cancer after breast-conserving surgery treated with VMAT and IMRT. Radiat Oncol. 2015;10:231.","journal-title":"Radiat Oncol"},{"key":"1762_CR21","unstructured":"Common Terminology Criteria for Adverse Events (CTCAE) Version 5. Published: November 27. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute"},{"key":"1762_CR22","unstructured":"White JAT, MacDonald SLM, Recht AR, Vicini WW. Breast cancer atlas for radiation therapy planning: consensus definitions collaborators. Breast cancer atlas for radiation therapy planning. 2009."},{"key":"1762_CR23","first-page":"S3","volume":"76","author":"SM Bentzen","year":"2010","unstructured":"Bentzen SM, Constine LS, Deasy JO, Eisbruch A, Jackson A, Marks LB, et al. Quantitative analyses of normal tissue effects in the clinic (QUANTEC): an introduction to the scientific issues. Quant Anal Norm Tissue Eff Clin. 2010;76:S3-9.","journal-title":"Quant Anal Norm Tissue Eff Clin"},{"key":"1762_CR24","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.radi.2019.12.006","volume":"26","author":"A Southworth","year":"2020","unstructured":"Southworth A, Clough H, Roberts N. An audit of radiation-induced skin reactions in the inframammary fold; does breast size impact on the severity of the reaction? Radiography. 2020;26:192\u20137.","journal-title":"Radiography"},{"key":"1762_CR25","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.2146\/ajhp120467","volume":"70","author":"LJ Radvansky","year":"2013","unstructured":"Radvansky LJ, Pace MB, Siddiqui A. Prevention and management of radiation-induced dermatitis, mucositis, and xerostomia. Am J Health-Syst Pharm. 2013;70:1025\u201332.","journal-title":"Am J Health-Syst Pharm"},{"key":"1762_CR26","doi-asserted-by":"publisher","first-page":"4","DOI":"10.7573\/dic.2020-4-7","volume":"9","author":"NA Iacovelli","year":"2020","unstructured":"Iacovelli NA, Torrente Y, Ciuffreda A, Guardamagna AV, Gentili M, Giacomelli L, et al. Topical treatment of radiation-induced dermatitis: current issues and potential solutions. Drugs Context. 2020;9:4\u20137.","journal-title":"Drugs Context."},{"key":"1762_CR27","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1093\/jrr\/rrad045","volume":"64","author":"Y Huang","year":"2023","unstructured":"Huang Y, Gong C, Luo M, Yuan X, Ding S, Wang X, et al. Comparative dosimetric and radiobiological assessment of left-sided whole breast and regional nodes with advanced radiotherapy techniques. J Radiat Res (Tokyo). 2023;64:677\u201384.","journal-title":"J Radiat Res (Tokyo)"},{"key":"1762_CR28","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/s13014-019-1363-4","volume":"14","author":"D Karpf","year":"2019","unstructured":"Karpf D, Sakka M, Metzger M, Grabenbauer GG. Left breast irradiation with tangential intensity modulated radiotherapy (t-IMRT) versus tangential volumetric modulated arc therapy (t-VMAT): trade-offs between secondary cancer induction risk and optimal target coverage. Radiat Oncol. 2019;14:156.","journal-title":"Radiat Oncol"},{"key":"1762_CR29","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1007\/s13246-017-0558-y","volume":"40","author":"A Munshi","year":"2017","unstructured":"Munshi A, Sarkar B, Anbazhagan S, Giri UK, Kaur H, Jassal K, et al. Short tangential arcs in VMAT based breast and chest wall radiotherapy lead to conformity of the breast dose with lesser cardiac and lung doses: a prospective study of breast conservation and mastectomy patients. Australas Phys Eng Sci Med. 2017;40:729\u201336.","journal-title":"Australas Phys Eng Sci Med"},{"key":"1762_CR30","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1002\/jmrs.534","volume":"69","author":"C Stanton","year":"2022","unstructured":"Stanton C, Bell LJ, Le A, Griffiths B, Wu K, Adams J, et al. Comprehensive nodal breast VMAT: solving the low-dose wash dilemma using an iterative knowledge-based radiotherapy planning solution. J Med Radiat Sci. 2022;69:85\u201397.","journal-title":"J Med Radiat Sci"}],"container-title":["Breast Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12282-025-01762-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12282-025-01762-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12282-025-01762-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T17:12:42Z","timestamp":1761325962000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12282-025-01762-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,27]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["1762"],"URL":"https:\/\/doi.org\/10.1007\/s12282-025-01762-y","relation":{},"ISSN":["1340-6868","1880-4233"],"issn-type":[{"value":"1340-6868","type":"print"},{"value":"1880-4233","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,27]]},"assertion":[{"value":"15 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval for this study was obtained from the Joint Institutional Review Board of Taipei Medical University, Taiwan (Permit number: N201912025).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This study was approved by the Joint Institutional Review Board of Taipei Medical University, Taiwan (Permit number: N201912025).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Trial registration"}}]}}