Genetic Susceptibility to Radiation-Induced Skin Reactions in Racial/Ethnic Groups of Patients With Breast Cancer

• Occurrence of RT-induced early adverse skin reaction (EASR) defined as a grade 4 or higher toxicity (based on the ONS criteria) during the 2 months follow-up [ Designated as safety issue: Yes ]
• nsSNPs from multiple candidate pathways have dominant, recessive, additive, and/or multiplicative effects on RT-induced EASR [ Designated as safety issue: No ]
• Individual's cellular responses to ionizing radiation contribute to RT-induced EASRs in normal tissue [ Designated as safety issue: No ]
• Effect of gene-gene and gene-smoking interactions on RT-induced skin reactions [ Designated as safety issue: No ]
• Race-ethnic differences in RT-induced skin reactions, DNA damage, and radiosensitivity [ Designated as safety issue: No ]

RATIONALE: Radiation therapy uses high-energy x rays to kill tumor cells. Radiation therapy may cause skin reactions when patients are exposed to high-energy x rays. Studying the genetic pattern of patients before and after radiation therapy may help doctors prevent toxicity and plan the best treatment.

PURPOSE: This clinical trial studies genetic susceptibility to radiation-induced skin reactions in racial/ethnic groups of patients with breast cancer.

OBJECTIVES:

• To develop and validate prediction biomarkers for radiation therapy (RT)-induced acute and chronic skin reactions and quality of life in five racial/ethnic groups of breast cancer patients, Whites*, Black/African Americans, Hispanic/Latinos, Asians/Native Hawaiians/Pacific Islanders, and American Indians/Alaskan Natives. NOTE: *This stratum is closed as of April 25, 2012.
• To develop polygenic models of RT-induced skin reactions with a comprehensive evaluation of genome-wide nonsynonymous single nucleotide polymorphisms (nsSNPs).
• To evaluate the levels of DNA damage (Comet assay) and radiosensitivity (Cell Cycle G2 Delay assay) in lymphocytes before and after RT.
• To test the effect of gene-gene and gene-smoking interactions on RT-induced skin reactions.
• To assess race-ethnic differences in RT-induced skin reactions, DNA damage, and radiosensitivity and to determine if the gene effects are consistent across race-ethnicity (gene-race/ethnic interactions).

OUTLINE: This is a multicenter study. Patients are stratified according to race/ethnicity (Whites* vs Black/African Americans vs Hispanic/Latinos vs Asians/Native Hawaiians/Pacific Islanders vs American Indians/Alaskan Natives). NOTE: *This stratum is closed as of April 25, 2012.

Patients undergo adjuvant radiotherapy after breast-conserving surgery.

Blood and urine samples are collected at baseline and last day of radiotherapy for genotyping, DNA damage, cell cycle assays, urine cotinine, inflammatory immune response biomarkers, and tumor-killing activity by BeadArray System, Comet assay, flow cytometry-based assay, Cell-Cycle G2 Delay Assay, Oxygen Radical Absorbance Capacity (ORAC) assay, and ELISA.

Patients are assessed for acute toxicity by research staff using the ONS Criteria for Radiation-Induced Acute Skin Toxicity at baseline, week 3, and at 1 and 2 months after radiotherapy. Patients are also assessed for chronic toxicity by research staff using the Chronic skin toxicity questionnaire (RTOG SOMA Criteria for RT- Induced Breast/Chest Wall Late Skin Toxicity) at 6 and 12 months after completion of radiotherapy. Photographs of the breast, chest wall, and contralateral breast are also taken at baseline, week 3, last day of radiotherapy, and at 1, 2, 6, and 12 months after completion of radiotherapy.

Patients complete the Breast Cancer Risk Study Questionnaire, the Functional Assessment of Cancer Therapy Breast (FACT-B), the Modified Skindex, and the B39 Quality-of-Life (QOL) Questionnaire at baseline, last day of radiotherapy, and at 1, 2, 6, and 12 months after radiotherapy.

Race/ethnicity to include Whites*, Black/African Americans (AA), Hispanic/Latinos, Asians/Native Hawaiians/Pacific Islanders, and Native American or Alaskan

• Breast Cancer
• Cognitive Ability, General
• Fatigue
• Pain
• Psychosocial Deprivation
• Radiation Toxicity
• Skin Abnormalities

• Genetic: DNA analysis
  Genetic
• Genetic: gene expression analysis
  Genetic
• Other: enzyme-linked immunosorbent assay
  Genetic
• Other: flow cytometry
  Genetic
• Other: laboratory biomarker analysis
  Genetic
• Other: questionnaire administration
  Genetic
• Procedure: adjuvant therapy
  Genetic
• Procedure: assessment of therapy complications
  Genetic
• Procedure: quality-of-life assessment
  Genetic
• Radiation: 3-dimensional conformal radiation therapy
  Genetic
• Radiation: breast irradiation
  Genetic
• Radiation: external beam radiation therapy
  Genetic
• Radiation: hypofractionated radiation therapy
  Genetic
• Radiation: intensity-modulated radiation therapy
  Genetic
• Radiation: whole breast irradiation
  Genetic

DISEASE CHARACTERISTICS:

• Female patients newly diagnosed with breast carcinoma including ductal carcinoma in situ (DCIS)

  • Stage 0-IIIA disease
• Status post-lumpectomy, -quadrantectomy, or -mastectomy
• Plan to receive adjuvant radiation to the whole breast or chest wall and/or regional lymph nodes
• No sites that cannot send blood/urine specimens to Wake Forest by overnight (next day) express shipping

PATIENT CHARACTERISTICS:

• *This stratum is closed as of April 25, 2012.
• No patients who do not understand English and are unable to complete form with assistance

PRIOR CONCURRENT THERAPY:

• Total dose > 40 Gy, dose per fraction > 1.8 - 2.0 Gy, use of 2D, 3D-conformal, or intensity-modulated radiation therapy (IMRT) treatment techniques allowed; a daily fraction of 2.7 Gy to the whole breast is suggested for hypofractionated regimens
• Concurrent and sequential boost techniques are allowed for both standard and hypofractionated regimens
• Adjuvant hormonal therapy will be allowed prior to, during, and/or after radiotherapy (RT) at the discretion of a medical oncologist
• Targeted therapies, such as Herceptin, will be allowed prior to, during, and/or after RT at the discretion of the medical oncologist
• No prior radiation to the involved breast or chest wall
• No concurrent chemotherapy

• No patients who underwent breast reconstruction following mastectomy

  • Placement of tissue expanders and implants are not allowed
• No patients who have undergone MammoSite® or any other form of brachytherapy as well as those who will be treated with skin-sparing IMRT

• Patients may not be concurrently enrolled in a protocol that involves treatment of the skin, i.e., applying lotions/moisturizers

  • Protocols that do not involve treatment of the skin are allowed