{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:29:15Z","timestamp":1792726155378,"version":"4.5.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2013,5,7]],"date-time":"2013-05-07T00:00:00Z","timestamp":1367884800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cancer"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To identify predictive factors of radiation-induced skin toxicity in breast cancer patients by the analysis of dosimetric and clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>339 patients treated between January 2007 and December 2010 are included in the present analysis. Whole breast irradiation was delivered with Conventional Fractionation (CF) (50Gy, 2.0\/day, 25 fractions) and moderate Hypofractionated Schedule (HS) (44Gy, 2.75Gy\/day, 16 fractions) followed by tumour bed boost. The impact of patient clinical features, systemic treatments and, in particular, dose inhomogeneities on the occurrence of different levels of skin reaction has been retrospectively evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>G2 and G3 acute skin toxicity were 42% and 13% in CF patients and 30% and 7.5% in HS patients respectively. The retrieval and revaluation of 200 treatment plans showed a strong correlation between areas close to the skin surface, with inhomogeneities &gt;107% of the prescribed dose, and the desquamation areas as described in the clinical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In our experience dose inhomogeneity underneath G2 \u2013 G3 skin reactions seems to be the most important predictor for acute skin damage and in these patients more complex treatment techniques should be considered to avoid skin damage. Genetic polymorphisms too have to be investigated as possible promising candidates for predicting acute skin reactions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/1471-2407-13-230","type":"journal-article","created":{"date-parts":[[2013,5,7]],"date-time":"2013-05-07T19:58:44Z","timestamp":1367956724000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":69,"title":["Standard or hypofractionated radiotherapy in the postoperative treatment of breast cancer: a retrospective analysis of acute skin toxicity and dose inhomogeneities"],"prefix":"10.1186","volume":"13","author":[{"given":"Grazia","family":"Tortorelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana","family":"Di Murro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaria","family":"Barbarino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Cicchetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"di Cristino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Daniela","family":"Falco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahlia","family":"Fedele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Ingrosso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania","family":"Janniello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Morelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Murgia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Ponti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Terenzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Tolu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Santoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2013,5,7]]},"reference":[{"key":"3870_CR1","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.1016\/S0140-6736(05)67887-7","volume":"366","author":"M Clarke","year":"2005","unstructured":"Clarke M, Collins R, Darby S, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, Mackinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y: Early Breast cancer Trialists\u2019 Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet. 2005, 366: 2087-2106.","journal-title":"Lancet"},{"key":"3870_CR2","doi-asserted-by":"publisher","first-page":"24","DOI":"10.3109\/02841860903352959","volume":"49","author":"O Matzinger","year":"2010","unstructured":"Matzinger O, Heimsoth I, Poortmans P, Collette L, Struikmans H, Van Den Bogaert W, Fourquet A, Bartelink H, Ataman F, Gulyban A, Pierart M, Van Tienhoven G: EORTC Radiation Oncology and Breast Cancer Groups. Toxicity at three years with and without irradiation of the internal mammary and medial supraclavicular lymph node chain in stage I to III breast Cancer (EORTC trial 22922\/10925). Acta Oncol. 2010, 49: 24-34. 10.3109\/02841860903352959.","journal-title":"Acta Oncol"},{"key":"3870_CR3","doi-asserted-by":"publisher","first-page":"2085","DOI":"10.1200\/JCO.2007.15.2488","volume":"26","author":"JP Pignol","year":"2008","unstructured":"Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, Vu TT, Truong P, Ackerman I, Paszat L: A Multicenter randomised trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008, 26: 2085-2092. 10.1200\/JCO.2007.15.2488.","journal-title":"J Clin Oncol"},{"key":"3870_CR4","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.radonc.2008.10.017","volume":"90","author":"AG Morganti","year":"2009","unstructured":"Morganti AG, Cilla S, Valentini V, Diges\u00f9 C, Macchia G, Deodato F, Ferrandina G, Cece MG, Cirocco M, Garganese G, Di Lullo L, Traficante D, Scarabeo F, Panunzi S, De Gaetano A, Sallustio G, Cellini N, Sofo L, Piermattei A, Scambia G: Phase I-II studies on accelerated IMRT in breast carcinoma: technical comparison and acute toxicity in 332 patients. Radiother Oncol. 2009, 90: 86-92. 10.1016\/j.radonc.2008.10.017.","journal-title":"Radiother Oncol"},{"key":"3870_CR5","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.ijrobp.2008.04.036","volume":"73","author":"VJ Croog","year":"2009","unstructured":"Croog VJ, Wu AJ, McCormick B, Beal KP: Accelerated whole breast irradiation with intensity-modulated radiotherapy to the prone breast. Int J Radia Oncol Biol Phys. 2009, 73: 88-93. 10.1016\/j.ijrobp.2008.04.036.","journal-title":"Int J Radia Oncol Biol Phys"},{"key":"3870_CR6","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/S0360-3016(97)00292-7","volume":"39","author":"TA Bucholoz","year":"1997","unstructured":"Bucholoz TA, Gurgoze E, Bice WS, Prestidge BR: Dosimetric analysis of intact breast irradiation in off-axis planes. Int J Radia Oncol Biol Phys. 1997, 39: 261-67.","journal-title":"Int J Radia Oncol Biol Phys"},{"key":"3870_CR7","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1186\/1471-2407-10-508","volume":"10","author":"MF Chen","year":"2010","unstructured":"Chen MF, Chen WC, Lai CH, Hung CH, Liu KC, Cheng YH: Predective factors of radiation-induced skin toxicity in breast cancer patients. BMC Cancer. 2010, 10: 508-10.1186\/1471-2407-10-508.","journal-title":"BMC Cancer"},{"issue":"1","key":"3870_CR8","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.ijrobp.2011.05.074","volume":"83","author":"PL Dorn","year":"2012","unstructured":"Dorn PL, Corbin KS, Al-HAllaq H, Hasan Y, Chmura SJ: Feasibility and acute toxicity of hypofractionated radiation in large-breasted patients. Int J Radiat Oncol Biol Phys. 2012 May 1, 83 (1): 79-83. 10.1016\/j.ijrobp.2011.05.074.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"3870_CR9","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1259\/bjr\/31372149","volume":"83","author":"JF Fowler","year":"2010","unstructured":"Fowler JF: 21\u2009years of Biologically Effective Dose. Br J Radiol. 2010, 83: 554-568. 10.1259\/bjr\/31372149.","journal-title":"Br J Radiol"},{"key":"3870_CR10","volume-title":"ICRU report. Volume 50","author":"ICRU","year":"1993","unstructured":"ICRU: Prescribing, recording, and reporting photon beam therapy. ICRU report. Volume 50. 1993, Bethesda: International Commission on Radiation Units and Measurements"},{"key":"3870_CR11","volume-title":"ICRU Report. Volume 62","author":"ICRU","year":"1999","unstructured":"ICRU: Prescribing, recording, and reporting photon beam therapy (supplement to ICRU report 50). ICRU Report. Volume 62. 1999, Bethesda: International Commission on Radiation Units and Measurements"},{"key":"3870_CR12","first-page":"97","volume":"7","author":"MD Falco","year":"2012","unstructured":"Falco MD, D'Andrea M, Lo Bosco A, Rebuzzi M, Ponti E, Tolu B, Tortorelli G, Barbarino R, Di Murro L, Santoni R: Is the in vivo dosimetry with the OneDosePlusTM system able to detect intra-fraction motion?. A retrospective analysis of in vivo data from breast and prostate patients. Radiat Oncol. 2012, 7: 97-","journal-title":"A retrospective analysis of in vivo data from breast and prostate patients. Radiat Oncol"},{"key":"3870_CR13","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1056\/NEJMoa0906260","volume":"362","author":"TJ Whelan","year":"2010","unstructured":"Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, Shelley W, Grimard L, Bowen J, Lukka H, Perera F, Fyles A, Schneider K, Gulavita S, Freeman C: Long-term results of hypofractionated radiation therapy for breast cancer. N England J Med. 2010, 362: 513-520. 10.1056\/NEJMoa0906260.","journal-title":"N England J Med"},{"key":"3870_CR14","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/S1470-2045(08)70077-9","volume":"9","author":"SM Bentzen","year":"2008","unstructured":"Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bliss JM, Brown J, Dewar JA, Dobbs HJ, Haviland JS, Hoskin PJ, Hopwood P, Lawton PA, Magee BJ, Mills J, Morgan DA, Owen JR, Simmons S, Sumo G, Sydenham MA, Venables K, Yarnold JR: The UK Standardization of Breast Radiotherapy (START) trial A of radiotherapy hypofractionation for treatment of early breast cancer: A randomised trial. Lancet Oncol. 2008, 9: 331-341.","journal-title":"Lancet Oncol"},{"key":"3870_CR15","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1016\/S0140-6736(08)60348-7","volume":"371","author":"SM Bentzen","year":"2008","unstructured":"Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bliss JM, Brown J, Dewar JA, Dobbs HJ, Haviland JS, Hoskin PJ, Hopwood P, Lawton PA, Magee BJ, Mills J, Morgan DA, Owen JR, Simmons S, Sumo G, Sydenham MA, Venables K, Yarnold JR: The UK Standardisation of Breast Radiotherapy (START) trial B of radiotherapy hypofractionation for treatment of early breast cancer: A randomised trial. Lancet. 2008, 371: 1098-1107.","journal-title":"Lancet"},{"key":"3870_CR16","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1016\/j.ijrobp.2010.07.052","volume":"78","author":"JR White","year":"2010","unstructured":"White JR, Khalid N, Tao ML, Pierce LJ, DeRobertis A, Crozier C, Owen JB, Wilson JF: QRRO 2007 Practice Survey Documents Dramatic Technical Changes in How Radiotherapy for operable Breast Cancer is Delivered. Int J Radiat Oncol Biol Phys. 2010, 78: S4-","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"3870_CR17","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1111\/j.1754-9485.2010.02163.x","volume":"54","author":"P Dwyer","year":"2010","unstructured":"Dwyer P, Hickey B, Burmeister E, Burmeister B: Hypofractionated whole-breast radiotherapy: Impact on departmental waiting times an cost. J Med Imaging Radiat Oncol. 2010, 54: 229-234. 10.1111\/j.1754-9485.2010.02163.x.","journal-title":"J Med Imaging Radiat Oncol"},{"key":"3870_CR18","volume-title":"Am J Clin Oncol","author":"KS Corbin","year":"2013","unstructured":"Corbin KS, Dorn PL, Jain SK, Al-Hallaq HA, Hasan Y, Chmura SJ: Hypofractionated Radiotherapy Does Not Increase Acute Toxicity in Large-Breasted Women: Results From a Prospectively Collected Series. Am J Clin Oncol. 2013, Epub ahead of print"},{"issue":"1","key":"3870_CR19","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1186\/1748-717X-7-217","volume":"7","author":"U Kraus-Tiefenbacher","year":"2012","unstructured":"Kraus-Tiefenbacher U, Sfintizky A, Welzel G, Simeonova A, Sperk E, Siebenlist K, Mai S, Wenz F: Factors of influence on acute skin toxicity of breast cancer patients treated with standard external beam radiotherapy (EBRT) after breast conserving surgery (BCS). Radiat Oncol. 2012, 7 (1): 217-10.1186\/1748-717X-7-217. Epub ahead of print","journal-title":"Radiat Oncol"},{"issue":"1","key":"3870_CR20","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1097\/01.coc.0000197661.09628.03","volume":"29","author":"GM Freedman","year":"2006","unstructured":"Freedman GM, Anderson PR, Li J, Eisenberg DF, Hanlon AL, Wang L, Nicolaou N: Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer. Am J Clin Oncol. 2006 Feb, 29 (1): 66-70. 10.1097\/01.coc.0000197661.09628.03.","journal-title":"Am J Clin Oncol"},{"issue":"5","key":"3870_CR21","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.1016\/S0360-3016(02)03746-X","volume":"54","author":"FA Vicini","year":"2002","unstructured":"Vicini FA, Sharpe M, Kestin L, Martinez A, Mitchell CK, Wallace MF, Matter R, Wong J: Optimizing breast cancer treatment efficacy with intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2002, 54 (5): 1336-44. 10.1016\/S0360-3016(02)03746-X.","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"5","key":"3870_CR22","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1016\/j.ijrobp.2007.02.044","volume":"68","author":"A Harsolia","year":"2007","unstructured":"Harsolia A, Kestin L, Grills I, Wallace M, Jolly S, Jones C, Lala M, Martinez A, Schell S, Vicini FA: Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy. Int J Radiat Oncol Biol Phys. 2007, 68 (5): 1375-80. 10.1016\/j.ijrobp.2007.02.044. Epub 2007 Jun 4","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1","key":"3870_CR23","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.clon.2003.08.005","volume":"16","author":"M Back","year":"2004","unstructured":"Back M, Guerrieri M, Wratten C, Steigler A: Impact of radiation therapy on acute toxicity in breast conservation therapy for early breast cancer. Clin Oncol (R Coll Radiol). 2004, 16 (1): 12-6. 10.1016\/j.clon.2003.08.005.","journal-title":"Clin Oncol (R Coll Radiol)"},{"issue":"4","key":"3870_CR24","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/0360-3016(94)00480-3","volume":"31","author":"ME Taylor","year":"1995","unstructured":"Taylor ME, Perez CA, Halverson KJ, Kuske RR, Philpott GW, Garcia DM, Mortimer JE, Myerson RJ, Radford D, Rush C: Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 1995, 31 (4): 753-64. 10.1016\/0360-3016(94)00480-3.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"3870_CR25","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.radonc.2006.12.008","volume":"82","author":"E Donovan","year":"2007","unstructured":"Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, Peckitt C, Reise S, Ross G, Sharp G, Symonds-Tayler R, Tait D, Yarnold J: Breast Technology Group. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007, 82: 254-264. 10.1016\/j.radonc.2006.12.008.","journal-title":"Radiother Oncol"},{"key":"3870_CR26","unstructured":"Barnett GC, Wilkinson J, Moody AM, Wilson CB, Sharma R, Klager S, Hoole ACF, Twyman N, Burnet NG, Coles CE: A randomized controlled trial of forward-planned radiotherapy (IMRT) for early breast cancer: Baseline characterisics and dosimetry results."},{"key":"3870_CR27","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.ijrobp.2010.04.023","volume":"81","author":"M Mangoni","year":"2011","unstructured":"Mangoni M, Bisanzi S, Carozzi F, Sani C, Biti G, Livi L, Barletta E, Costantini AS, Gorini G: Association between genetic polymorphisms in the XRCC1, XRCC3, XPD, GSTM1, GSTT1, MSH2, MLH1, MSH3, and MGMT genes and radiosensitivity in breast cancer patients. Int J Radiat Oncol Biol Phys. 2011, 81: 52-58. 10.1016\/j.ijrobp.2010.04.023.","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["BMC Cancer"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2407-13-230.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1471-2407-13-230\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2407-13-230","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2407-13-230.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T19:48:02Z","timestamp":1630525682000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccancer.biomedcentral.com\/articles\/10.1186\/1471-2407-13-230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,7]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2013,12]]}},"alternative-id":["3870"],"URL":"https:\/\/doi.org\/10.1186\/1471-2407-13-230","relation":{},"ISSN":["1471-2407"],"issn-type":[{"value":"1471-2407","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,5,7]]},"assertion":[{"value":"15 November 2012","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 April 2013","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2013","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"230"}}