Bonomo P, Talamonti C, Desideri I, et al. - This frequency-matched cohort analysis was undertaken to determine if the pattern of intensity-modulated radiotherapy (IMRT) dose distribution to the skin may be associated with the development of G3/G4 radiation dermatitis (RD). This investigation was conducted on patients treated with IMRT and concurrent cisplatin or cetuximab. In 90 patients included (50% vs 36.6% in the cetuximab and cisplatin cohorts, respectively), the incidence of G3/G4 RD was 41.1%. PS ≥ 1 and weight loss at RT completion > 10 kg were the only factors that retained significance in multivariate analysis. Data reported that 19.9 cc and 5.8 cc of skin ring 2 mm V50 and V60, respectively, provided the best dosimetric predictive accuracy. The pattern of dose distribution to a ring structure localized 2 mm below the patient's surface, along with clinical factors, may help predict severe RD development.