KEY POINTS
- The systematic review identified 8 eligible studies published from 2012–2024: six observational cohorts and two randomized trials, with 5,509 patients evaluable for chest-wall pain occurring more than three months after RT.
- Across studies, pooled descriptive prevalence of late chest-wall pain was 34.0%. Most cases were mild (26.1%), while 5.7% were classified as moderate or severe.
- Reported prevalence varied dramatically across cohorts—from 0% to 56%—reflecting major differences in population, treatment volume, fractionation and how pain was measured. A formal meta-analysis was therefore not considered appropriate.
- Seven of eight studies relied on clinician-reported toxicity, while only one used a patient-reported outcome measure; that patient-reported study identified a comparatively high prevalence, suggesting routine clinician scoring may underestimate symptom burden.
- Potential associations included younger age, use of a tumor-bed boost and high-dose regions >107% of prescription, but findings were inconsistent and the review could not establish any of these as independent risk factors.
- Longitudinal information was particularly weak. Most studies assessed pain cross-sectionally or at sparse intervals, and baseline pre-RT chest-wall pain was generally unavailable, making onset and resolution impossible to define reliably.
- The review also highlights that the chest wall is rarely contoured as a dedicated OAR in breast RT, despite bone, muscle and neural structures potentially contributing to persistent pain through fibrosis, rib injury and neuropathic mechanisms.
CLINICAL TAKEAWAY
Chest-wall pain appears common enough after breast RT to deserve recognition as a distinct late effect rather than being buried within generic breast pain scores. What is still missing is a standardized anatomical definition, routine patient-reported measurement and modern dose-volume data capable of identifying preventable risk factors.
SOURCE
Technical Innovations & Patient Support in Radiation Oncology