J Wang*, b zhou, X Yang, J Lin, K Godette, S Kahn, M Torres, T Liu, Emory Univ, Atlanta, GA

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  J Wang

PO-GePV-T-452 (Sunday, 7/10/2022)   [Eastern Time (GMT-4)]

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Purpose: To propose an image-based scoring scheme to evaluate the severity of acute radiation-induced breast toxicity using ultrasound images.

Methods: Sixty-nine patients receiving hypofractionation radiotherapy (RT) were recruited and performed breast ultrasound (BUS) at four time points (pre-RT baseline, last day of RT, 3-4 weeks post RT, and 9-11 weeks post RT) to assess the radiation-induced acute changes. For each visit, both the untreated and irradiated breasts were scanned, at five locations: 12, 3, 6, 9 o’clock and tumor bed. In total, 2710 images were analyzed. A four-scale scoring system was proposed based on ultrasound findings such as skin thickening, dermis boundary blurring and subcutaneous tissue abnormality, staging no, minimal, mild, moderate, and severe breast toxicity. Two ultrasound experts graded the severity of breast toxicity independently.

Results: The spearman correlation of the scores from two experts was 0.86 and the inter-observer agreement was 0.74. Prior to RT, 15-25% patients had moderate to severe toxicity due to surgery. Within four weeks post RT, 40-44% patients experienced no toxicity, 24-32% mild, 17-27% moderate, and 7-10% severe toxicity, from two graders. For 9-11 weeks post RT, breast toxicity progressed with time, leading to a distribution of 26% with no toxicity, 32-41% mild, 25-29% moderate, and 9-14% severe toxicity. Spearman correlations between baseline and follow-up scores were 0.69-0.84. These image-based results were consistent with previously published toxicity reports based on clinicians’ physical examinations.

Conclusion: Breast ultrasound can display the cutaneous and subcutaneous tissue changes of breast before, during, and after RT. We propose a four-level ultrasound scoring scheme to grade the severity of acute breast toxicity and the results agree with previous literatures. The image-based scoring system can be utilized to differentiate breast changes and thus monitor the radiation toxicity in a more standard and objective manner.

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