الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breast cancer patients who receive post-operative adjuvant RT have a better overall survival rate and a lower rate of recurrence. It is indicated for all patients who have undergone BCS and in some treated with MRM. It is delivered by 3D conformal modality, using a hypofractionation o convectional regimen.
In our study, we included both right and left sided breast cancer patients with a median age of 54 years. Majority of our patients underwent MRM (70.0%) and ALND (86.0%), with the minority undergoing BCS and SLNB (30% and 14% respectively). Patients with clinic-pathological stage 2 disease represented most of the cases at 43%, with 29% stage 3 disease, 17% stage 1 disease and 11% had undergone complete pCR after neoadjuvant chemotherapy representing stage 0 disease.
Breast radiotherapy is associated with adverse effects. Some of the common acute adverse effects include fatigue, dermatitis, lymph edema and rib fractures. Cardiac toxicity, radiation pneumonitis, and lung fibrosis are the some of the late side effects of breast radiotherapy that lead to increased morbidity and mortality rates. The new guidelines recommend regional nodal irradiation (RNI) for all breast cancer patients with positive lymph nodes. With these recommendations comes the increased risk of side effects such as ARIE.
In our study, we selected patients who had been prescribed RT to the breast/chest wall plus RNI. A total of 100 patients were selected and prospectively followed throughout the treatment period with weekly evaluation of any complains or symptoms associated with ARIE. ARIE was graded according to the CTCAE Version 5.
The incidence of ARIE in our study was 48%. We had a higher percentage of patients complaining of grade 2 ARIE during the second and third week of treatment (42% and 29% respectively), this was mainly because most of our patients underwent treatment with the hypofractionation regimen (89%). We did not find any correlation between patient’s characteristics such as age, BMI, GERD, history of previous head and neck surgery with the development of ARIE.
In our study, we found that the mean dose to the cervical esophagus above 13Gy was associated with an higher risk of developing ≥grade2 esophagitis. Mean cervical esophagus dose was the most important independent factor for developing ARIE. The mean dose above 13Gy was associated with a 24-fold risk of developing ARIE.
Contouring of the cervical esophagus is easy and feasible and should be used to determine the mean dose in order to decrease the incidence and severity of ARIE. We recommend that for all breast cancer patients treated with supraclavicular field, the mean cervical esophagus dose should be kept below 13Gy.