Identification of Predictive Factors for Late Radiotherapy Induced Complications in Post Mastectomy Breast Cancer Survivors

Seyed Hoseini, Seyed Vahid; Nasseri, Ali Reza

doi:10.22034/mphrj.2026.587082.1106

Identification of Predictive Factors for Late Radiotherapy Induced Complications in Post Mastectomy Breast Cancer Survivors

Document Type : Original Article

Authors

Seyed Vahid Seyed Hoseini ¹

Ali Reza Nasseri ²

¹ Assistant Professor of Surgery, Department of General Surgery, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

² Assistant Professor of Radiotherapy, Department of Radiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

10.22034/mphrj.2026.587082.1106

Abstract

Introduction: Post mastectomy radiotherapy significantly improves locoregional control and survival in breast cancer patients but may lead to late complications such as fibrosis, cardiopulmonary toxicity, and lymphedema, which adversely affect long term quality of life. Identifying patients at higher risk is essential for personalized survivorship care. This study aims to determine predictive factors for late radiotherapy induced complications in post mastectomy breast cancer survivors.

Material and methods: This cross-sectional analytical study was conducted in 2025 at hospitals affiliated with Tabriz University of Medical Sciences and included 73 post-mastectomy breast cancer survivors. The study evaluated predictive factors for late radiotherapy-induced complications using demographic, clinical, surgical, oncologic, and dosimetric variables, along with treatment-related characteristics and late toxicity outcomes.

Results: Among 73 post mastectomy survivors, late complications were common, particularly skin fibrosis (30.14%) and shoulder limitation (28.77%). Severe toxicity (CTCAE ≥2) occurred in 35.62% and was associated with higher BMI (P = 0.004), smoking (P = 0.037), mean heart dose (P = 0.001), and lung V20 (P = 0.002). Lung V20 predicted severe events (AUC = 0.84; cut off = 20.57%; sensitivity = 84.62%; specificity = 72.34%).

Conclusion: Late radiotherapy induced complications remain prevalent in post mastectomy breast cancer survivors. Elevated BMI, smoking, and higher cardiopulmonary dose parameters—particularly lung V20—were associated with severe toxicity. These findings highlight the importance of optimizing radiation planning and addressing modifiable risk factors to reduce long term morbidity and improve survivorship outcomes.

Graphical Abstract

Identification of Predictive Factors for Late Radiotherapy Induced Complications in Post Mastectomy Breast Cancer Survivors

Keywords

Breast Cancer Survivorship

Post Mastectomy Radiotherapy

Late Radiation Toxicity

Lung V20

Subjects

Cancer

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