Table 2.
Description of studies utilising ultrasonography to assess skin toxicity following breast cancer radiotherapy.
| Author(s), Year, and Country | Study Design | Demographic Information |
US Machine | RT Delivery Protocol | Type of Breast Surgery | Clinical Assessment | Time of Clinical and US Assessments |
|---|---|---|---|---|---|---|---|
| (Borm et al. 2021) [39] Germany |
Prospective | Total patients: 166, after hierarchal clustering: 80 Mean age: 58.6 Mean BMI: 24.9 |
Philips EPIQ 7 w Probe: 18–4b MHz linear array |
CF: 50.4 Gy, (n = 105) HF: 40.05 Gy, (n = 61) Photon boost except 1 patient electron |
BCS (n = 71) Mastectomy (n = 8) Others (n = 1) |
CTCAE (v5.0) | Before, at the end of RT, and 6 weeks post RT |
| (Landoni et al. 2013) [40] Italy |
Prospective | Total patients: 89 Median age: 62, range (31–79 years) |
Sequoia 512 scanner (Siemens Medical Systems, USA) Probe: 8.0–15.0 MHz linear array (15L8 W) |
HF: 34 Gy in 2 weeks with an electron boost of 8 Gy | BCS | CTCAEv3 | 11.4–85.7 months post RT (median 20.5 months) |
| (Garnier et al. 2017) [41] France |
Prospective | Total patients: 34 Median age: 61.5, range (53–68 years) Median BMI: 23.5 Smoking (n = 2) Median BV: 425 mL (307–577) |
1-Dermcup 2020, Atys Médical, Soucieu-en-Jarrest, France Probe: 20 MHz 2-LOGIQ7S Probe: 18 MHz |
CF: 50 Gy Photon boost of 16 Gy |
BCS | CTCAE v4.0 | At the end of RT |
| (Wang et al. 2020) [33] USA |
Prospective | Total patients: 109 CF = 63, median age 58, range (26–75 y), mean BMI 29.8, mean BV: 1904.5 cm3 (223.3–6988.29), smoking history (n = 14) HF = 46, median age 54.5, range (38–78 years), mean BMI 31.9, mean BV: 1961.2 cm3 (472.7–4113.62), smoking history (n = 12) |
NR | CF: 50 Gy (n = 63) HF: 39.9 Gy (n = 46) Combined electron and photon boost in both groups |
BCS | Breast retraction assessment | Before RT, the last day of RT, 12 weeks, and 1-year post RT |
| (Torres et al. 2016) [32] USA |
Prospective | Total patients: 70 Mean age 57, range (26–75 years) Mean BMI 29.3 Mean BV: 1819.9 cm3 (223.3–6988.3) Smoking history (n = 14) |
NR | CF: 50 Gy 10–16 Gy electron or photon boost |
BCS | RTOG | Before RT, at week 6, and 6 weeks post RT |
| (Lin et al. 2019) [9] USA |
Prospective | Total patients: 66 Mean age 56.3, range (26–75 years) Mean BMI: 29.9 Mean BV: 1919.9 cm3 (223.3–6988.3) Smoking history (n = 12) |
NR | CF: 50 Gy Majority received an electron boost of 10–16 Gy |
BCS | NR | Before RT, week 6 of RT, and 6 weeks, 6 months, and 1 year post RT |
| (Yoshida et al. 2012) [34] USA |
Prospective | Total patients: 26 Mean age 55, range (42 to 74 years) |
Sonix RP (Ultrasonix Medical Corporation, BC, Canada) Probe: 12-MHz linear |
CF: 50.0–50.4 Gy Electron boost of 10.0–16.0 Gy |
BCS | RTOG | Acute toxicity group (n = 8): before, during, and up to 6 months post RT Late toxicity group (n = 18): received one US study ≥6 months post RT |
| (Yoshida et al. 2011) [35] USA |
Prospective | Total patients: 18 Mean age 56, range (44–74 years) |
Sonix RP (Ultrasonix Medical Corporation, BC, Canada) Probe and US setting: 10 MHz linear array, 1.25 cm focal length, 4 cm depth, 72% gain, and 80 dB dynamic range |
CF: 50.0 to 50.4 Gy Electron boost of 10.0 to 16.0 Gy |
BCS | RTOG | 6 to 92 months post RT (median, 22 months) |
| (Liu et al. 2010) [31] USA |
Prospective |
Total patients: 18 Mean age 56, range (44–74 years) |
Sonix RP (Ultrasonix Medical Corporation, Richmond, BC, Canada) Probe: 12-MHz linear array | CF: 50.0 to 50.4 Gy Electron boost of 10.0 to 16.0 Gy |
BCS | RTOG | 6 to 94 months post RT (median, 22 months) |
| (Liu et al. 2008) [42] USA |
Prospective | Total patients: 12 | Sonix RP system Probe: 6 MHz linear array (L14–5/38) The RF data were acquired with a 20 MHz sampling frequency |
CF: 50–50.4 Gy Electron boost of 10–16 Gy |
BCS | NR | 6 to 94 months post RT (Median, 22 months) |
| (Keskikuru et al. 2004) [43] Finland |
Prospective | Total patients: 21 | Dermascan, Denmark Probe: 20 MHz |
CF: 50 Gy Boost not mentioned |
BCS | Modified Dische classification for erythema at the end of RT; subcutaneous induration scoring at 1 and 2 years | Before RT, at 2.5 weeks, at the end of RT, and 1, 4, 7, 12, and 24 months post RT |
| (Wratten et al. 2002) [37] Australia |
Prospective | Total patients: 13 age range (43–77 years) | Dermascan C, Cortex Technology, Denmark Probe: 20 MHz, an axial resolution of 60µm, a lateral resolution of 200µm, and a depth of up to 15 mm | CF: 50–64 Gy ± electron boost | BCS | Visual for the presence of oedema | Before RT and before fractions 4, 6, 9, 11, 16, 21, and 26 |
| (Wratten et al. 2000) [38] Australia |
Prospective | Total patients: 11 age range (35–72 years) | Dermascan C, Cortex Technology, Denmark Probe: 20 MHz, an axial resolution of 60µm, a lateral resolution of 200µm, and a depth of up to 15 mm | CF: 44–50 Gy Electron boost of 10–20 Gy |
BCS | Visual for the presence of oedema | Different time assessments for different patients: baseline, during, and post RT, including one patient up to 22 years post RT |
| (Warszawski et al. 1998) [44] Germany |
Prospective | Total patients: 29 Median age: 58, range (39–72 years) |
Taberna pro Medicum (DUB 20) (Luneburg, Germany) Probe: Digital linear 20 MHz, axial, and lateral resolutions of 70 and 150 mm, respectively |
CF: 46–50 Gy 10 Gy electron boost for patients with BCS |
BCS (n = 23) + Mastectomy (n = 6) | RTOG | ≤3 months in 18 patients and 6–135 months post RT in 11 patients |
| (Schack et al. 2016) [45] Denmark |
Prospective | Total patients: 15 Median age 66, range (44–75 years) Median BV: 715 mL (177–1627) |
DermaScan C from Cortex Technology ApS, Denmark Probe: 20 MHz with a maximum depth of 6 mm |
40 or 50 Gy (no details) | BCS | LENT-SOMA Scale | Baseline, post RT (median 3.0 years (1.0–4.6 years)) |
| (Wong et al. 2011) [46] Singapore |
Prospective | Total patients: 32 Median age: 52.5, range (37–68 years) |
Sequoia® 512 scanner (Siemens Medical Systems, USA) Probe: linear array (15L8 W), 14 MHz centre frequency, and a maximum depth of 80 mm |
46–50 Gy No boost |
Mastectomy | RTOG | 16–39 months post RT (median, 27.5 months) |
| (Wratten et al. 2007) [36] Australia |
Prospective | Total patients: 54 Median age: 55, range (31–74 years) |
Dermascan C, Cortex Technology, Smedevaenget, Denmark Probe: 20 MHz |
CF: 50–66 Gy Electron boost 10–20 Gy (n = 21) |
BCS | NR | Baseline, weekly during RT, at 2 weeks, 6 weeks, 4 months, 6 months, 12 months, and 24 months post RT |
Abbreviations: RT = radiotherapy, US = ultrasound, NR = not reported, BV = breast volume, RF = radiofrequency, RTOG = Radiation Therapy Oncology Group, CTCAE = Common Terminology Criteria for Adverse Events, CF = conventional fractionation, HF = hypofractionation, LENT-SOMA = late effects normal tissues-subjective, objective, management, analytic.