Comparison of Radiation Dermatitis Between Hypofractionated and Conventionally Fractionated Postoperative Radiotherapy: Objective, Longitudinal Assessment of Skin Color

Sci Rep. 2018 Aug 17;8(1):12306. doi: 10.1038/s41598-018-30710-4.


This study aimed to quantitatively compare radiation dermatitis due to hypofractionated (Hypo) and conventionally fractionated (Conv) external-beam radiotherapy in patients who underwent postoperative radiotherapy after breast-conserving surgery. Skin color changes, in terms of L* (brightness, white-black), a* (red-green), and b* (yellow-blue) values, due to external-beam radiotherapy were examined at alternate fractions using an objective method. Twenty-six patients were included in the Hypo group (42.56 Gy/16 fractions) and 46 in the Conv group (50 Gy/25 fractions). Radiotherapy decreased the L* value (darker) and increased the a* value (redder) gradually. These color alterations progressed linearly according to elapsed fractions and were similar between Hypo and Conv per fraction. The Hypo group showed significantly milder alterations in L* and a* values than the Conv group. The maximal dosage was significantly correlated to alterations in L* and a* values. Common Terminology Criteria for Adverse Events v4 assessment did not show a statistically significant difference between the Hypo (Grade 0:1:2 = 2:24:1) and Conv (1:39:6, p = 0.25) groups. The results of our objective analysis revealed that patients undergoing Hypo show milder color alteration than those undergoing Conv and that the maximal dosage is a useful predicator of color alteration.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / surgery
  • Dose Fractionation, Radiation
  • Female
  • Humans
  • Middle Aged
  • Radiation Injuries / diagnosis
  • Radiodermatitis / diagnosis*
  • Radiotherapy, Adjuvant / adverse effects
  • Skin Pigmentation / physiology