ABSTRACT
PURPOSE: Radiation-induced dermatitis is a common side effect of breast irradiation, with hypofractionation being a well-known risk factor. In the context of the widespread adoption of hypofractionated breast radiotherapy, we evaluated the effect of hypofractionated radiotherapy on the incidence of skin toxicity in patients receiving adjuvant chemotherapy. PATIENTS AND METHODS: We retrospectively reviewed the records of patients with breast cancer treated from 2004 to 2006 at a single institution. Patients undergoing lumpectomy with or without adjuvant chemotherapy followed by hypofractionated radiotherapy consisting of 42.4 Gy in 16 fractions were included in the study. Using cosmetic and skin toxicity scales, all patients were evaluated weekly during treatment and at scheduled follow-up visits with the radiation oncologist. RESULTS: During the study period, 162 patients underwent radiotherapy, and 30% of those (n = 48) received chemotherapy. Radiotherapy boost to the tumour bed was more common in the chemotherapy group [n = 20 (42%)] than in the radiotherapy-alone group [n = 30 (26%)]. We observed no statistically significant difference between the groups with regard to acute skin toxicity of grade 3 or higher (2.1% in the chemotherapy group vs. 4.4% in the radiation-alone group, p = 0.67) or of grades 1-2 toxicity (62.5% vs. 51.7% respectively, p = 0.23). There was also no significant difference in late grade 3 or higher skin toxicity between the groups (2.1% vs. 0% respectively, p = 0.30) or in grades 1-2 toxicity (20.8% vs. 25.5% respectively, p = 0.69). Similarly, excellent or good cosmetic result scores were similar in both groups (p = 0.80) CONCLUSIONS: In our single-institution review, we observed no adverse effects of chemotherapy in combination with hypofractionated whole-breast irradiation. Further investigations are necessary to better elucidate the effects of chemotherapy on skin toxicity in the context of hypofractionated irradiation.
ABSTRACT
Forty soil samples collected from central Jordan were analyzed by atomic absorption spectrophotometry for Pb, Cd, Zn, Cr, and Hg. The samples were also investigated for mineralogy using X-ray, electron, and optical microscopes. Sequential extraction procedures were used to predict the percentages of the Pb, Zn, Cd, and Cr present in each of the soil geochemical phases. The clay mineral assemblage encountered in the analyzed samples is composed of kaolinite, smectite, illite, and illite/smectite mixed-layer. The nonclay minerals of the sand-sized fraction are composed mainly of quartz and calcite as major minerals with pyroxene, biotite, and feldspars as minor minerals. The enrichment factors of the measured heavy metals Pb, Cd, Zn, Cr, and Hg in the clay fraction (<2 microm) of the collected samples are 3.1, 16.6, 1.5, 0.9, and 4.5, respectively. According to the index of geoaccumulation, the soils of the study area are considered to be moderately contaminated with respect to Cd, uncontaminated to moderately contaminated with respect to Pb, Hg, and Zn, and uncontaminated with respect to Cr. The measured metals correlated positively with the determined physicochemical factors such as pH, clay content, organic matter content, and carbonate content. The relatively high concentrations of Cd, Pb, and Hg in the soils of the study area are related to anthropogenic sources such as cement industry, fertilizers, and vehicle exhausts. It was found that Pb, Zn, and Cr are associated mainly with the residual phases and are relatively immobile. On the other hand Cd is enriched in the carbonate phase of the analyzed soil samples. It is possible to suggest the sequence of mobility for Pb, Zn, Cd, and Cr in the analyzed soil samples as the following: Cd>>Pb>Cr>Zn.
