Radiation-induced skin fibrosis after treatment of breast cancer: profilometric analysis

Background/aim: Treatment of breast cancer involves an association of conservative surgery and radiotherapy. This implies various cutaneous complications, well known for their clinical and histological aspects. Little data are available concerning modifications of the cutaneous microrelief after radiotherapy. We have done a profilometric analysis of the skin of breast cancer patients treated with surgery and radiotherapy. The results obtained on the irradiated breast have been compared with the ones of the controlateral normal breast. Methods: Twenty women, 43-55 year old were enrolled in the study 6-16 months after the end of a treatment associating conservative surgery and radiotherapy for breast cancer. Imprints using a silicone rubber material were performed over symmetrical areas of the treated breast and the controlateral one. All measures were performed over the upper-medial quadrant of each breast. The imprints are then blindly analysed using an image analyser. The following parameters were measured: RA (average roughness of the skin), RZ (average of the furrows depth), RS (residual length), Rn (number of furrows) and AR (space between the furrows). Results: The comparison of the imprints shows important modifications of the microrelief after irradiation. We observe a slight increase of the skin roughness (RA: 26, 39+/-2, 58 versus 21, 84+/-1, 59), a significantly increase of the furrows depth (RZ: 121, 66+/-10, 46 versus 101, 26+/-6, 99) along with an increase of the residual length (RS: 580, 60+/-60, 60 versus 450, 46+/-48, 43). The number of furrows has not significantly decreased but the space between the furrows has increased on the irradiated breast. Conclusion: This study shows a breakdown effect of irradiation on the skin in correlation with the fibrosis inducing by ionising radiation. The imprints modifications are clearly different from those usually observed in the ageing process. Our results can be a basis for studying the effects of treatments on cutaneous complications linked to the radiation-induced fibrosis.