ArticleFrontiers in oncology2026
Factors associated with grade ≥2 acute radiation dermatitis after adjuvant radiotherapy in breast cancer patients with immediate breast reconstruction: a single-center study using penalized regression.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Immediate breast reconstruction is increasingly performed in women with breast cancer, yet many such patients also require post-mastectomy radiotherapy (PMRT), during which acute radiation dermatitis (RD) is common and may compromise reconstruction outcomes and quality of life. Risk factors for RD have been characterized mainly in non-reconstructed or breast-conserving populations, and data specific to immediately-reconstructed patients are scarce. Methods: We retrospectively analyzed 61 women with immediate reconstruction (implant/expander or autologous tissue) who completed adjuvant radiotherapy. All patients received intensity-modulated radiotherapy (IMRT) delivered in 25 fractions with a routine 0.5-cm chest-wall bolus; the prescribed chest-wall/breast target dose was ≥50 Gy (EQD2 50 Gy) in 57 of 61 patients (93%) and slightly lower (<50 Gy) in the remaining 4. Acute RD was graded with the Radiation Therapy Oncology Group (RTOG) scale and dichotomized at grade ≥2. Univariable comparisons used the Mann -Whitney U and Fisher exact tests. Because of the small sample, imbalanced outcome and quasi-separation, Firth penalized-likelihood logistic regression with profile penalized-likelihood 95% confidence intervals (CIs) was used as the primary method. A parsimonious model (age plus supraclavicular irradiation) was pre-specified from clinical priors and univariable P<0.10, and evaluated by likelihood-ratio test, area under the receiver-operating-characteristic curve (AUC) and 1000-fold bootstrap optimism correction. Results: Grade ≥2 RD occurred in 72.1% of patients (44/61). In the multivariable model, older age (odds ratio [OR] 2.30 per 10 years, 95% CI 1.11 -5.87; P=0.023) and supraclavicular irradiation (OR 6.40, 95% CI 1.37 -37.37; P=0.018) were associated with grade ≥2 RD; the event rate was 76.9% (40/52) with versus 44.4% (4/9) without supraclavicular irradiation. The model likelihood-ratio χ Conclusion: In conclusion, grade ≥2 acute RD was common after adjuvant radiotherapy in immediately-reconstructed patients, and older age and supraclavicular (regional nodal) irradiation were associated with the outcome. These hypothesis-generating findings support intensified skin-protective strategies for high-risk patients and warrant validation in larger, multicenter cohorts.
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