Journal of Medicine and Life Science

Institute for Medical Science (제주대학교 의과학연구소)
권호 표지
DOI QR코드

DOI QR Code

Consideration of fractionation or field size prior to radiation therapy in patients with breast cancer and psoriasis: a case report

  • Jin Yi Hyun (Department of Medicine, Jeju National University College of Medicine) ;
  • So Hyun Park (Department of Radiation Oncology, Jeju National University Hospital, Jeju National University College of Medicine) ;
  • Dae-Hyun Kim (Department of Radiation Oncology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jinhyun Choi (Department of Radiation Oncology, Jeju National University Hospital, Jeju National University College of Medicine)
  • Received : 2023.01.04
  • Accepted : 2023.02.17
  • Published : 2023.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

We present three cases of patients with breast cancer and psoriasis who received radiotherapy following breast-conserving surgery. One patient developed an extensive flare-up of psoriasis during chemotherapy. After discontinuing chemotherapy, she received conventional radiotherapy to the ipsilateral whole breast, axillary, and supraclavicular lymph nodes with 50.4 Gy in 28 fractions and boosted with 10 Gy in five fractions to the tumor bed. Two patients received hypofractionated whole-breast radiotherapy at a total dose of 40.05-42.4 Gy in 15-16 fractions. In all three cases, there was no flare-up of psoriatic events at least 6 months after the completion of radiotherapy. We hypothesized that there is a close relationship between psoriatic events and the extent of trauma rather than the daily dose of the fraction. Therefore, we confirmed that the effect of radiotherapy on psoriatic events is minimal if the radiation field size does not exceed that of the whole breast.

Keywords

Acknowledgement

This work was supported by a research grant from Jeju National University Hospital in 2021.

References

  1. Hawilo A, Zaraa I, Benmously R, Mebazaa A, El Euch D, Mokni M, et al. Erythrodermic psoriasis: epidemiological clinical and therapeutic features about 60 cases. Tunis Med 2011;89:841-7. 
  2. Yang H, Brand JS, Li J, Ludvigsson JF, Ugalde-Morales E, Chiesa F, et al. Risk and predictors of psoriasis in patients with breast cancer: a Swedish population-based cohort study. BMC Med 2017;15:154. 
  3. Obradors M, Blanch C, Comellas M, Figueras M, Lizan L. Health-related quality of life in patients with psoriasis: a systematic review of the European literature. Qual Life Res 2016;25:2739-54.  https://doi.org/10.1007/s11136-016-1321-7
  4. Ben-Yosef R, Soyfer V, Vexler A. Radiation therapy in cancer patients with psoriasis. The fractionated daily dose and the Koebner phenomenon. Radiother Oncol 2005;74:21-3.  https://doi.org/10.1016/j.radonc.2004.08.019
  5. Martin JM, Conde A, Pinazo I, Garcia L, Sanchez AL, Pinazo J, et al. Reverse koebnerization after radiotherapy in a woman with a mastectomy for a breast carcinoma. J Am Acad Dermatol 2006;55(5 Suppl):S90-1.  https://doi.org/10.1016/j.jaad.2004.03.042
  6. Weiss G, Shemer A, Trau H. The Koebner phenomenon: review of the literature. J Eur Acad Dermatol Venereol 2002;16:241-8.  https://doi.org/10.1046/j.1473-2165.2002.00406.x
  7. Farber EM, Nall ML. The natural history of psoriasis in 5,600 patients. Dermatologica 1974;148:1-18.  https://doi.org/10.1159/000251595
  8. Park SH, Choi J. Analysis of geometric and dosimetric effects of bra application to support large or pendulous breasts during radiotherapy planning: a retrospective single-center study. Technol Cancer Res Treat 2021;20:15330338211027909. 
  9. Isohashi F, Konishi K, Umegaki N, Tanei T, Koizumi M, Yoshioka Y. A case of bullous pemphigoid exacerbated by irradiation after breast conservative radiotherapy. Jpn J Clin Oncol 2011;41:811-3.  https://doi.org/10.1093/jjco/hyr049
  10. Wu CC, Wang S, An JJ, Smith DR, Chin C, Jadeja PH, et al. Koebner phenomenon: consideration when choosing fractionation for breast irradiation. Adv Radiat Oncol 2017;3:108-10.