Tonsillitis toxicity for breast cancer radiation therapy and control over this by ARIA Visual Care Path

Abstract Radiation therapy (RT) is a cornerstone in the treatment of breast cancer, with advances in technology improving both precision and patient outcomes. However, RT can cause various toxicities, traditionally focused on skin, lung, and cardiac complications. Tonsillitis, a less common but emerging complication, may arise due to unintended radiation exposure to nearby structures like the thyroid. This study investigates the occurrence of tonsillitis in breast cancer patients undergoing RT and evaluates the effectiveness of the ARIA Visual Care Path (VCP) in mitigating this complication. A retrospective analysis was conducted on 137 breast cancer patients treated at the Almaty Oncology Center. Patients were divided into two groups: hypofractionated radiation therapy (HFRT, n=68) and standard radiation therapy (SRT, n=69). Tonsillitis was observed in 29.2% of patients, with a higher incidence in the SRT group (33.3%) compared to the HFRT group (25.0%). Tonsillitis development was significantly associated with higher mean thyroid doses (>22 Gy, p=0.009) and lower body mass index (BMI ≤ 25, p=0.001). Following the implementation of the Breast Care Path algorithm, the incidence of tonsillitis was significantly reduced from 29.2% to 4.9% (p=0.0001). Skin reactions were less severe in the HFRT group, and no significant differences were observed in cardiac or lung doses between groups. Tonsillitis toxicity, while not typically a recognized complication of breast cancer RT, was linked to higher thyroid doses and lower BMI. The Breast Care Path algorithm proved effective in reducing tonsillitis rates, highlighting the importance of dosimetric planning and personalized care pathways in improving patient outcomes.