PURPOSE: Radiation dermatitis (RD) is common in patients undergoing breast radiotherapy. Mepitel film (MF) can reduce RD, but the results from two randomized controlled trials are conflicting. We aimed to conduct a confirmatory randomized controlled trial in patients at risk of RD. METHODS: Patients were randomly assigned to receive MF or standard care (2:1 ratio). Patients with large breasts after lumpectomy (bra size ≥ 36 inches or cup size ≥ C) or after mastectomy were eligible. Stratification factors included surgery type, dose fractionation, and administration of boost/bolus. The primary end point was grade (G) 2 or 3 RD using the Common Terminology Criteria for Adverse Events v5.0. Secondary end points included patient- and clinician-reported outcomes. RESULTS: Between January 2020 and May 2022, 376 patients were included in the modified intention-to-treat analysis. The incidence of G2 or 3 RD was significantly lower in MF patients compared with standard care (n = 39/251, 15.5%; 95% CI, 11.3 to 20.6% v n = 57/125, 45.6%; 95% CI, 36.7 to 54.8% respectively, odds ratio (OR): 0.20, P < .0001). Benefits of MF remained significant in patients who developed G 3 RD (n = 7, 2.8%; 95% CI, 1.1 to 5.7% v n = 17, 13.6%; 95% CI, 8.1 to 20.9%, OR: 0.19) and moist desquamation (n = 20, 8.0%; 95% CI, 4.9 to 12.0% v n = 24, 19.2%; 95% CI, 12.7 to 27.1%, OR: 0.36). When evaluating the combined patient and health care provider score using Radiation-Induced Skin Reaction Assessment Scale, the MF arm had significantly lower scores ( P < .0001). Individual items on the Radiation-Induced Skin Reaction Assessment Scale also favored the MF for both patient- and clinician-reported outcomes. Blistering/peeling, erythema, pigmentation, and edema were significantly reduced in the MF arm. Three patients removed the film prematurely because of rash (n = 2) and excessive pruritus (n = 1). CONCLUSION: MF significantly reduces RD in patients undergoing breast radiotherapy.

Introduction: RIntroductionadiation-induced brain necrosis [“radionecrosis” (RN)] is a relatively uncommon but potentially severe adverse effect of stereotactic radiosurgery (SRS) for brain metastasis. Although dose, volume, and hypofractionation have been suggested to affect RN rates, patient and treatment variability in this population make it difficult to clearly delineate the risk. We set out to establish the effect of fractionation on RN rates by reviewing patients receiving simultaneous multi-fraction and single-fraction treatment at our centre. Methods: Patients receiving simultaneous (within 1 month) 1-fraction (SSRS) and 3-fraction (FSRS) radiosurgery treatments during 2012–2015 were identified in our institution’s database. Serial post-srs magnetic resonance imaging (MRI) was reviewed to determine RN and local recurrence. The effect of maximum dose, volume, whole-brain radiotherapy (WBRT), and fractionation on RN development was assessed using logistic regression for paired data. Results are reported using odds ratios (ORS) and corresponding 95% confidence intervals (CIS). Results: Of 90 patients identified, 22 had at least a 6-month mri follow-up. Median follow-up was 320 days. The most common primary tumour type was non-small-cell lung cancer, followed by breast and rectal cancer. Radionecrosis developed in 16 patients [21 of 62 lesions (34%), with 4 being symptomatic (20%)]. Of the 21 lesions in which RN developed, 11 received 3 fractions, and 10 received 1 fraction. The or for the association between the incidence of RN and maximum dose was 1.0 (95% CI: 0.9 to 1.1); for fractionation it was 1.0 (95% CI: 0.3 to 3.6); for previous wbrt, it was 0.4 (95% CI: 0.2 to 1.2); and for a 10-unit increase in volume, it was 3.1 (95% CI: 1.0 to 9.6). Local recurrence developed in 8 patients (12%), 6 of whom belonged to the ssrs group. Conclusions: Our results indicate that patients receiving srs for multiple brain metastases experience a higher rate of RN than is reported in the literature and poorer survival despite having equivalent local control. Maximum dose did not appear to be associated with RN risk in our cohort, but volume was significantly associated with RN risk. Although fractionated treatment did not directly lower the rate of RN in this population, it might have played a role in reducing the magnitude of the RN risk in large-volume lesions. Further investigation will help to delineate optimal dose and fractionation so as to minimize RN while maintaining local control in this group.

Background: Radiation-induced chest wall pain (CWP) and rib fracture (RF) are late adverse effects after stereotactic body radiation therapy (SBRT) for stage i non-small-cell lung cancer (NSCLC); however, the literature about their incidence and risk factors shows variability. We performed a systematic review to determine the pooled incidence of CWP and RF in the relevant population. Methods: A literature search using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines considered English publications in MEDLINE and EMBASE from January 1996 to August 2017. Abstracts were screened, followed by full-text review and data extraction. Results: The database searches identified 547 records. Twenty-eight publications comprising 3892 patients met the inclusion criteria. Median reported ages and follow-up durations fell into the ranges 67–82 years and 12–84 months. Prescriptions fell into the range of 40–70 Gy in 3–10 fractions. Despite study heterogeneity, the pooled incidences of CWP and RF were estimated to be 8.94% and 5.27% respectively. Nineteen studies reported cwp grade: 58 of 308 patients (18.8%) experienced grades 3–4 CWP (no grade 5 events reported). Thirteen studies reported RF grade: grades 3–4 RF were observed in 9 of 113 patients (7.96%). A high chest wall V30 was an important predictor of CWP and RF. Conclusions: In patients with stage i nsclc, rates of CWP and RF after SBRT are low; however, tumour location, accurate toxicity reporting, and dose–fractionation schemes might alter those rates. Prospective correlation with dosimetry and quality of life assessment will further improve the understanding of CWP and RF after sbrt.