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Perréard M, Heutte N, Clarisse B, Humbert M, Leconte A, Géry B, Boisserie T, Dadoun N, Martin L, Blanchard D, Babin E, Bastit V. Head and neck cancer patients under radiotherapy undergoing skin application of hydrogel dressing or hyaluronic acid: results from a prospective, randomized study. Support Care Cancer 2023; 32:7. [PMID: 38055076 DOI: 10.1007/s00520-023-08216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Acute radiodermatitis (ARD) is a frequent side effect of radiotherapy, a therapeutic option for head and neck squamous cell carcinoma (HNSCC). It is responsible for pain, quality of life (QoL) impairment, and increased risk of treatment discontinuation, which may compromise the prognosis for patients. Local therapies to prevent or alleviate ARD have been proposed without providing any high level of evidence to establish recommendations. METHODS We implemented a prospective multicenter randomized study on patients with HNSCC treated with definitive radiotherapy to assess the impact on ear, nose, and throat (ENT) pain of the application of a hydrogel-based skin dressing (HydroTac®) compared with the application of hyaluronic acid (Ialuset®) during radiotherapy. RESULTS Out of 130 enrolled patients, 48 patients per group were assessable for the main endpoint. No difference between groups was found: a worsening of ENT pain of 3 points or more on a visual analog scale from the initiation to 1 month after the end of the radiotherapy was observed for 8 patients (16.7%) who received HydroTac® compared to 13 patients (27%) who received Ialuset® (p = 0.342). The proportion of patients who experienced ARD and grades of ARD (CTCAE v4.0 criteria) were similar between groups. Patient compliance with radiodermatitis treatment was poor, with 56.1% of patients in the HydroTac® group having their treatment temporarily stopped. CONCLUSION The application of a hydrogel dressing to prevent ARD during radiotherapy for HNSCC patients has failed to demonstrate a benefit. These results may be limited by the difficulties of applying the dressing.
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Affiliation(s)
- Marion Perréard
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France.
- INSERM, U 1086 "Cancer Et Prévention", Avenue de La Côte de Nacre, Caen, France.
| | - Natacha Heutte
- Department of Clinical Research, Center François Baclesse, Avenue du Général Harris, Caen, France
- CETAPS EA3832, Rouen University, Rouen, France
| | - Bénédicte Clarisse
- Department of Clinical Research, Center François Baclesse, Avenue du Général Harris, Caen, France
| | - Maxime Humbert
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
- INSERM, U 1086 "Cancer Et Prévention", Avenue de La Côte de Nacre, Caen, France
| | - Alexandra Leconte
- Department of Clinical Research, Center François Baclesse, Avenue du Général Harris, Caen, France
| | - Bernard Géry
- Department of Radiotherapy, Center François Baclesse, Avenue du Général Harris, Caen, France
| | - Thomas Boisserie
- Centre d'Oncologie Et de Radiothérapie CORT37, Chambray-Lès-Tours, France
| | | | | | | | - Emmanuel Babin
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
- INSERM, U 1086 "Cancer Et Prévention", Avenue de La Côte de Nacre, Caen, France
| | - Vianney Bastit
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
- INSERM, U 1086 "Cancer Et Prévention", Avenue de La Côte de Nacre, Caen, France
- Department of Head and Neck Surgery, Center François Baclesse, Avenue du Général Harris, Caen, France
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Behroozian T, Goldshtein D, Ryan Wolf J, van den Hurk C, Finkelstein S, Lam H, Patel P, Kanee L, Lee SF, Chan AW, Wong HCY, Caini S, Mahal S, Kennedy S, Chow E, Bonomo P. MASCC clinical practice guidelines for the prevention and management of acute radiation dermatitis: part 1) systematic review. EClinicalMedicine 2023; 58:101886. [PMID: 37181415 PMCID: PMC10166790 DOI: 10.1016/j.eclinm.2023.101886] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 05/16/2023] Open
Abstract
Acute radiation dermatitis (ARD) commonly develops in cancer patients undergoing radiotherapy and is often characterized by erythema, desquamation, and pain. A systematic review was conducted to summarize the current evidence on interventions for the prevention and management of ARD. Databases were searched from 1946 to September 2020 to identify all original studies that evaluated an intervention for the prevention or management of ARD, with an updated search conducted in January 2023. A total of 235 original studies were included in this review, including 149 randomized controlled trials (RCTs). Most interventions could not be recommended due to a low quality of evidence, lack of supporting evidence, or conflicting findings across multiple trials. Photobiomodulation therapy, Mepitel® film, mometasone furoate, betamethasone, olive oil, and oral enzyme mixtures showed promising results across multiple RCTs. Recommendations could not be made solely based on the published evidence due to limited high-quality evidence. As such, Delphi consensus recommendations will be reported in a separate publication.
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Affiliation(s)
- Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, NY, USA
| | | | | | - Henry Lam
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Partha Patel
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Lauren Kanee
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Henry Chun Yip Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Simran Mahal
- Faculty of Health, University of Waterloo, Ontario, Canada
| | | | - Edward Chow
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Plant and Herbal Extracts as Ingredients of Topical Agents in the Prevention and Treatment Radiodermatitis: A Systematic Literature Review. COSMETICS 2022. [DOI: 10.3390/cosmetics9030063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: The use of herbal extracts as the source of antioxidant substances capable of neutralizing free radicals and providing protection from ionizing radiation appears to be an alternative therapy for radiodermatitis. As concerns the prevention and treatment of side effects, a lot of recommendations are based on proper experience of radiotherapy centers. We summarize recent research aiming at reducing radiation-induced skin injuries by use of proper skin care, using topical preparations with herbal extracts including onco-cosmetics. Methods: This article is limited to a critical analysis of scientific and professional literature. It concerns preparations in different physicochemical forms, e.g., gels, emulsions, ointments. We stress the connection between the type of applied skin care (type of preparation, its composition, the dose), the properties of the herbal extract and the evaluation of its efficiency in preventing and treating radiation reaction on skin. Conclusions: Herbal extracts can be added to recipes because they are part of a category of cosmeceutical supplements and can be introduced into preparations without prescription. The effectiveness evaluation for herbal extracts in radiotherapy is not an easy task since there are no strict guidelines. Studies should be preceded by the analysis of herbal extracts and recipe in terms of physicochemical, dermatological and performance characteristics.
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Modern Dressings in Prevention and Therapy of Acute and Chronic Radiation Dermatitis—A Literature Review. Pharmaceutics 2022; 14:pharmaceutics14061204. [PMID: 35745777 PMCID: PMC9229675 DOI: 10.3390/pharmaceutics14061204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Radiotherapy is an integral part of modern oncology, applied to more than half of all patients diagnosed with cancer. It can be used alone or in combination with surgery or chemotherapy. However, despite the high precision of radiation delivery, irradiation may affect surrounding healthy tissues leading to the development of toxicity. The most common and clinically significant toxicity of radiotherapy is acute and chronic radiation dermatitis, which could result in desquamation, wounds, nonhealing ulcers, and radionecrosis. Moreover, preoperative radiotherapy impairs wound healing after surgery and may lead to severe wound complications. In this review, we comprehensively discuss available types of dressings used in the management of acute and chronic radiation dermatitis and address their efficacy. The most effective ways of preventing acute radiation dermatitis are film dressings, whereas foam dressings were found effective in its treatment. Data regarding dressings in chronic radiation dermatitis are scarce. This manuscript also contains authors’ consensus.
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Goel R, Ojha H, Choudhary V, Sharma D, Nair A, Sharma N, Pathak M, Shivkumar H, Sharma R, Kaushik V, Singhal R. Medical management of ionizing radiation-induced skin injury. RADIATION PROTECTION AND ENVIRONMENT 2022. [DOI: 10.4103/rpe.rpe_4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Comparison of the Effect of Alpha and Hydrocortisone Ointments on Prevention of Acute Skin Complications Due to Radiotherapy in Breast Cancer Patients. J Skin Cancer 2021; 2021:5575688. [PMID: 34221511 PMCID: PMC8221894 DOI: 10.1155/2021/5575688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background Radiotherapy in breast cancer patients is associated with acute and delayed side effects. This study aimed to compare the effect of alpha and hydrocortisone 1% (H1%) ointments on prevention of acute skin complications due to radiotherapy in breast cancer patients. Methods This clinical trial was conducted on 86 patients with breast cancer in the radiotherapy center of Imam Reza Hospital of Kermanshah, Iran. Using the records, the patients were selected and randomly divided into alpha and H1% groups after obtaining informed consent. The severity of dermatitis, complications, and patient complaints during treatment were evaluated weekly for up to 6 weeks by RTOG criteria. Data were analyzed using SPSS-16 software. Results At the end of the third, fourth, fifth, and sixth weeks, 10 (11.7%), 25 (29.1%), 53 (61.6%), and 28 (32.6%) patients had skin complications, respectively. In weeks 5 and 6 in the H1 group, the incidence of complications was higher (P = 0.001). The frequency of pain and burning complaints at the end of the third, fourth, fifth, and sixth weeks was 15 (17.4%), 37 (43.0%), 52 (60.5%), and 1(1.2%), respectively. Pain and burning intensity in the fourth and fifth weeks in the H1 group was lower than alpha (P = 0010). Complaints of skin itching at the end of the third, fourth, and fifth weeks were 16 (18.6%), 25 (29.1%), and 28 (32.6), respectively. This complication was lower in the H1% group during these weeks (P < 0.05). Conclusion Alpha ointment is more effective than H1% in relieving pain and burning, preventing complications except itching. It seems using an alpha ointment or combining it with H1% is an appropriate strategy to reduce the rate of injuries and skin complications of radiotherapy.
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Karri J, Lachman L, Hanania A, Marathe A, Singh M, Zacharias N, Orhurhu V, Gulati A, Abd-Elsayed A. Radiotherapy-Specific Chronic Pain Syndromes in the Cancer Population: An Evidence-Based Narrative Review. Adv Ther 2021; 38:1425-1446. [PMID: 33570737 DOI: 10.1007/s12325-021-01640-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/27/2021] [Indexed: 12/25/2022]
Abstract
While radiation therapy is increasingly utilized in the treatment paradigm of many solid cancers, the chronic effects of radiation therapies are poorly characterized. Notably, understanding radiation-specific chronic pain syndromes is paramount given that the diagnosis and management of these conditions can serve to prevent long-standing functional impairments, optimize quality of life, and even allow for continued radiotherapy candidacy. These radiation-specific chronic pain phenomena include dermatitis, mucositis, enteritis, connective tissue fibrosis, lymphedema, and neuropathic pain syndromes. It is necessary to maintain a low threshold of suspicion for appropriately diagnosing these conditions as there exists a variance in when these symptoms arise after radiation. However, we present key epidemiological data delineating vulnerable cancer populations for each pain syndrome along with the available evidence for the management for each specific condition.
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Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Laura Lachman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alex Hanania
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Anuj Marathe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Mani Singh
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Nicholas Zacharias
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Vwaire Orhurhu
- Division of Pain Medicine, Department of Anesthesia, University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
| | - Amitabh Gulati
- Division of Pain Medicine, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alaa Abd-Elsayed
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
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Management of breast cancer: an overview for therapeutic radiographers. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:The management of breast cancer patients from diagnosis to treatment and beyond can be variable depending on factors including tumour extent and location, histology, genetics, health and wellbeing of the patient as well as personal patient preferences. The therapeutic radiographer’s role is not only vital to ensure safe and accurate radiotherapy delivery but also crucially, as the regular patient interface, they must be fully empowered to engage effectively with all aspects of the patient care pathway. They must be knowledgeable and up to date with evidence-based practices relating to the patient experience including surgery, chemotherapy, endocrine therapy and radiotherapy.Aim:The aim of this paper is to outline the breast cancer management pathway, highlighting the potential side effects that occur as a result of breast radiotherapy treatment and concomitant treatment in order to inform therapeutic radiographers and best practice.Discussion:The treatment pathway for breast cancer patients varies greatly depending on a wide range of factors and is very much individualised for each patient. Each treatment modality has its advantages and disadvantages, and all come with a number of side effects that can affect a patient’s daily living. Toxicities can arise during radiotherapy treatment or months after treatment, and education regarding the management of these is essential for effective patient care. Many technological advances in radiotherapy treatment techniques and regimes have the potential to decrease radiation-induced side effects. Despite attempts to standardise clinical guidelines on the use of topical agents and dressings, historical opinions and ideas are still evident in clinical practice. The use of grading systems in radiotherapy tends to only record patients’ physical symptoms and not their holistic wellbeing and emotional needs.Conclusion:Therapeutic radiographers must ensure that they remain equipped with the skills and knowledge to correctly manage and/or signpost services effectively. This overall outline of the management of patients with breast cancer is designed to help therapeutic radiographers reflect on the current practices and to inspire them, where evidence dictates, to seize opportunities, to explore improvement and to enhance best practice.
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Reinders Y, Pohl F, Ahrens N, Prantl L, Kuehlmann B, Haubner F. Impact of platelet-rich plasma on cell migration processes after external radiation. Clin Hemorheol Microcirc 2019; 73:43-51. [PMID: 31561346 DOI: 10.3233/ch-199218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To overcome the compromised wound healing in radiation induced chronic wounds platelet-rich plasma (PRP), as therapeutic agent, is current subject of studies. PRP is associated with pro-angiogenic effects. Nevertheless, effects of platelet-rich plasma in cutaneous wound healing processes are poorly understood so far. METHODS In this study, the migration of endothelial cells, fibroblasts and keratinocytes in conjunction with platelet-rich plasma treatment is investigated in the context of radiation effects. Additionally, cell proliferation and viability after external radiation was analyzed regarding treatment by platelet-rich plasma. RESULTS All cell cultures showed a trend towards decreasing proliferation and viability after irradiation irrespective of PRP. Upon PRP treatment, irradiated fibroblasts as well as endothelial cells showed an enhanced proliferation whereas proliferation and viability of keratinocytes was reduced after PRP treatment. Scratch assays support the positive effect of PRP on fibroblast and endothelial cell migration, whereas a negative effect on keratinocytes was observed after PRP treatment. CONCLUSIONS The present study documents both deleterious effects of external radiation as well as the protective effect of PRP. In summary, increased viability, proliferation and migration are indeed a consequence of the pro-proliferative effect exerted by PRP. Therefore, treatment with PRP products might be useful in the management of chronic radiogenic wounds.
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Affiliation(s)
- Yvonne Reinders
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., Dortmund, Germany
| | - Fabian Pohl
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Ahrens
- Department of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Britta Kuehlmann
- Department of Otorhinolaryngology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, Ludwig-Maximilians-University Munich, Munich, Germany
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Kawamura M, Yoshimura M, Asada H, Nakamura M, Matsuo Y, Mizowaki T. A scoring system predicting acute radiation dermatitis in patients with head and neck cancer treated with intensity-modulated radiotherapy. Radiat Oncol 2019; 14:14. [PMID: 30665451 PMCID: PMC6341605 DOI: 10.1186/s13014-019-1215-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/07/2019] [Indexed: 12/25/2022] Open
Abstract
Background and purpose We created a scoring system incorporating dosimetric and clinical factors to assess the risk of severe, acute skin reactions in patients undergoing intensity-modulated radiation therapy (IMRT) to treat head and neck cancer (HNC). Materials and methods A total of 101 consecutive patients who received definitive IMRT or volumetric modulated arc therapy (VMAT) with a prescription dose of 70 Gy to treat HNC between 2013 and 2017 in our hospital were enrolled. Skin V5Gy, V10Gy, V20Gy, V30Gy, V40Gy, V50Gy, and V60Gy values delivered 5 mm within the body contour were compared between patients with Grades 1–2 and Grade 3 dermatitis. A scoring system was created based on logistic regression analysis (LRA) that identified the most significant dosimetric and clinical factors. Results The V60Gy was significantly associated with radiation dermatitis grade in both LRA and recursive partitioning analysis (RPA). A scoring system incorporating the V60Gy, concurrent chemotherapy status, age, and body mass index was used to divide all patients into three subgroups (0–1, 2–3, and 4–6 points) in the RPA. The incidence of Grade 3 dermatitis significantly differed among the subgroups (0, 20.5, and 58.6%, respectively, P < 0.01). Conclusions A risk analysis model incorporating dose-volume parameters successfully predicted acute skin reactions and will aid in the appropriate management of radiation dermatitis.
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Affiliation(s)
- Mitsue Kawamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
| | - Hiromi Asada
- Nursing Department, Kyoto University Hospital, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.,Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
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Soriano JL, Calpena AC, Souto EB, Clares B. Therapy for prevention and treatment of skin ionizing radiation damage: a review. Int J Radiat Biol 2019; 95:537-553. [DOI: 10.1080/09553002.2019.1562254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- José L. Soriano
- Department of Pharmacy and Pharmaceutical Technology Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Ana C. Calpena
- Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
- Nanoscience and Nanotechnology Institute (IN2UB), University of Barcelona, Barcelona, Spain
| | - Eliana B. Souto
- Department of Pharmaceutical Technology Faculty of Pharmacy, University of Coimbra (FFUC), Pólo das Ciências da Saúde, Azinhaga de Santa Comba, Coimbra, Portugal
- CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
| | - Beatriz Clares
- Department of Pharmacy and Pharmaceutical Technology Faculty of Pharmacy, University of Granada, Granada, Spain
- Nanoscience and Nanotechnology Institute (IN2UB), University of Barcelona, Barcelona, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), SAS-University of Granada, Granada, Spain
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Management of severe bio-radiation dermatitis induced by radiotherapy and cetuximab in patients with head and neck cancer: emphasizing the role of calcium alginate dressings. Support Care Cancer 2018; 27:2957-2967. [DOI: 10.1007/s00520-018-4606-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/10/2018] [Indexed: 12/27/2022]
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Iacovelli NA, Galaverni M, Cavallo A, Naimo S, Facchinetti N, Iotti C, Fallai C, Orlandi E. Prevention and treatment of radiation-induced acute dermatitis in head and neck cancer patients: a systematic review. Future Oncol 2018; 14:291-305. [DOI: 10.2217/fon-2017-0359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Acute dermatitis is the most common radio-induced side effect during treatment for head and neck cancer. The use of a wide variety of agents is reported to handle skin toxicity. Our aim was to review the literature and synthesize current available evidence. A comprehensive search was performed on multiple electronic databases until February 2017 and a systematic approach was carried out according to PRISMA guidelines. A total of 17 papers (950 patients on the whole) met the inclusion/exclusion criteria, with 12 randomized controlled trials and five nonrandomized observational and prospective studies. Generally speaking, there was no strong evidence to support the superiority of any specific intervention neither in prevention nor in therapeutic settings. Well-designed randomized studies including quality of life measurements are needed.
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Affiliation(s)
| | - Marco Galaverni
- Department of Medicine & Surgery, University of Parma, Italy
| | - Anna Cavallo
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Simona Naimo
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Facchinetti
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, AUSL – IRCCS di Reggio Emilia, Italy
| | - Carlo Fallai
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ester Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ravo V, Calvanese MG, Di Franco R, Crisci V, Murino P, Manzo R, Morra A, Cammarota F, Muto P. Prevention of Cutaneous Damages Induced by Radiotherapy in Breast Cancer: An Institutional Experience. TUMORI JOURNAL 2018; 97:732-6. [DOI: 10.1177/030089161109700609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims A minimal part of patients treated with radiotherapy on the entire breast may present an acute, subacute or chronic cutaneous damage of the healthy tissues involved in the radiation fields. The aim of this retrospective study was to evaluate the most efficient topical hydrating treatment in the prevention of cutaneous radio-induced acute effects in breast cancer. Material and Methods From February 2009 to March 2010, 100 patients affected by breast cancer have been recruited, all of the female sex and with an average age of 47 years. The following topical treatments were compared: Pure vitamin E (Vea lipogel®), Omega-3,6,9 (Quinovit®), Betaglucan, sodium hyaluronate (Neoviderm®), Vitis vinifera A.s-I-M.t-O.dij, (Ixoderm®), natural triglycerides-fitosterols (Xderit®). All enrolled patients were subjected to breast conservative treatment (quadrantectomy with or without homolateral axillary dissection) and without prosthesis positioning, in combination or not with hormonal treatment. Evaluation of the cutaneous acute toxicity was defined according to the RTOG scale either during radiotherapy and during follow-up (3 months after radiation treatment). Results All patients completed the radiotherapy; 62% of patients presented G0-G1 cutaneous toxicity, 28% have developed G2 cutaneous toxicity, 10% have developed G3 toxicity; no patient presented G4 toxicity. Analysis of the data revealed a correlation between the topical treatment used and the incidence of cutaneous toxicity. Conclusions Of the patients who used the cutaneous hydrating creams – betaglucan, sodium hyaluronate (Neoviderm®) and Vitis vinifera A.s-I-M.t-O.dij (Ixoderm®) – during the radiation treatment, 80% developed G0-G1 toxicity and 20% G2 toxicity. The patients who used the other hydrating creams tested in the study manifested not only G1-G2 toxicity but also some G3 toxicity. Chemotherapeutic treatment with taxanes and/or anthracyclines did not result in an increased breast cutaneous toxicity induced by radiotherapy. The hormone therapy given to patients undergoing radiotherapy did not result in increased breast cutaneous toxicity. Further analysis on a larger number of patients is necessary for definitive results.
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Affiliation(s)
| | | | | | | | | | | | - Anna Morra
- UOC Radioterapia Istituto Europeo di Oncologia, Milan
| | | | - Paolo Muto
- UOC Radioterapia INT Pascale Naples, Italy
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Kole AJ, Kole L, Moran MS. Acute radiation dermatitis in breast cancer patients: challenges and solutions. BREAST CANCER (DOVE MEDICAL PRESS) 2017; 9:313-323. [PMID: 28503074 PMCID: PMC5426474 DOI: 10.2147/bctt.s109763] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Nearly all women who receive radiotherapy (RT) for breast cancer experience some degree of radiation dermatitis. However, evidence describing the appropriate management of radiation dermatitis is often lacking or contradictory. Here, we summarize the available literature regarding radiation dermatitis causes, the presentation and timing of symptoms, methods for dermatitis assessment and prevention, and review evidence-based management strategies.
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Affiliation(s)
| | - Lauren Kole
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
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17
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Efficacy of a hydroactive colloid gel versus historical controls for the prevention of radiotherapy-induced moist desquamation in breast cancer patients. Eur J Oncol Nurs 2017; 29:1-7. [PMID: 28720256 DOI: 10.1016/j.ejon.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 03/27/2017] [Accepted: 04/13/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Radiotherapy-induced moist desquamation (RIMD) is a complication that can affect patients' quality of life and jeopardize radiotherapy outcomes. The curative use of a hydroactive colloid gel has previously been shown effective in the management of RIMD in breast cancer patients. This study aimed at investigating the efficacy of this same gel but in the prevention of RIMD. METHODS A group of breast cancer patients who applied the hydroactive gel from start to end of post-lumpectomy radiotherapy (Preventive Hydrogel group) were compared with two groups of matched historical controls: a group applying a dexpanthenol cream throughout their therapy and a group applying first the dexpanthenol cream then, after 11-14 fractions of radiotherapy, the hydroactive gel (Curative Hydrogel group). All patients received identical fractionation regimen. The clinical outcomes were the incidence and time to onset of RIMD. KEY RESULTS After 25 fractions of radiotherapy (50 Gy), patients in the Preventive Hydrogel group (N = 202) developed RIMD significantly less frequently and later than patients in the Dexpanthenol group (N = 131; incidence = 7% vs 35% respectively, odds ratios = 7.27; probability of RIMD-free survival after 50 Gy = 0.88 vs 0.62). There were no significant differences between the Preventive and the Curative Hydrogel group (N = 87). CONCLUSIONS These findings confirm our previous results: applying the hydroactive colloid gel, rather than dexpanthenol, delayed the onset and reduced the incidence of RIMD in breast cancer patients. However, applying the hydrogel preventively offered no statistically significant advantages over applying it curatively.
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Effectiveness and Acceptability of a Moisturizing Cream and a Barrier Cream During Radiation Therapy for Breast Cancer in the Tropics: A Randomized Controlled Trial. Cancer Nurs 2016; 38:205-14. [PMID: 24945268 DOI: 10.1097/ncc.0000000000000161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inconsistent evidence about product effectiveness to prevent moist desquamation during radiation treatment and minimal research about the acceptability to patients of recommended products prompted this study. OBJECTIVE This randomized controlled trial compared the effectiveness of 2 creams at minimizing the incidence of moist desquamation in a tropical setting and explored which product was most acceptable to patients receiving radiation treatment. METHODS Participants (n = 255) were stratified according to breast or chest wall radiation treatment and randomly allocated to use a moisturizing or barrier cream. Nurses assessed radiation skin reactions weekly with a standardized grading system, and patients were telephoned 1 month after completing treatment for a final skin assessment. Participants completed an Acceptability Survey at similar times. RESULTS At treatment completion, 15% of participants had moist desquamation. An additional 26% self-reported this at follow-up. Risk factors for moist desquamation included increased breast cup size and body mass index. The barrier cream significantly reduced the incidence of moist desquamation during treatment in patients receiving radiation to the chest wall (χ = 3.93, P = .047). Participants preferred the barrier cream over the moisturizer (χ = 5.81, P = .02) during treatment. CONCLUSIONS This study identified a relatively high incidence of moist desquamation in patients receiving radiation therapy for breast cancer. Future patients will have information about product effectiveness in minimizing moist desquamation when choosing skin care products. IMPLICATIONS FOR PRACTICE Structured discharge planning and patient education need to include information about factors that contribute to the likelihood of developing moist desquamation.
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Abstract
Ionizing radiation is an important treatment modality for a variety of malignant conditions. However, development of radiation-induced skin changes is a significant adverse effect of radiation therapy (RT). Cutaneous repercussions of RT vary considerably in severity, course, and prognosis. When they do occur, cutaneous changes to RT are commonly graded as acute, consequential-late, or chronic. Acute reactions can have severe sequelae that impact quality of life as well as cancer treatment. Thus, dermatologists should be informed about these adverse reactions, know how to assess their severity and be able to determine course of management. The majority of measures currently available to prevent these acute reactions are proper skin hygiene and topical steroids, which limit the severity and decrease symptoms. Once acute cutaneous reactions develop, they are treated according to their severity. Treatments are similar to those used in prevention, but incorporate wound care management that maintains a moist environment to hasten recovery. Chronic changes are a unique subset of adverse reactions to RT that may develop months to years following treatment. Chronic radiation dermatitis is often permanent, progressive, and potentially irreversible with substantial impact on quality of life. Here, we also review the etiology, clinical manifestations, pathogenesis, prevention, and management of late-stage cutaneous reactions to radiotherapy, including chronic radiation dermatitis and radiation-induced fibrosis.
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20
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Hydrosorb® versus control (water based spray) in the management of radio-induced skin toxicity: Results of multicentre controlled randomized trial. Radiother Oncol 2015; 117:229-33. [DOI: 10.1016/j.radonc.2015.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/19/2015] [Accepted: 08/22/2015] [Indexed: 12/22/2022]
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21
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Acute skin toxicity management in head and neck cancer patients treated with radiotherapy and chemotherapy or EGFR inhibitors: Literature review and consensus. Crit Rev Oncol Hematol 2015; 96:167-82. [DOI: 10.1016/j.critrevonc.2015.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 04/26/2015] [Accepted: 06/04/2015] [Indexed: 12/27/2022] Open
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22
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Hindley A, Zain Z, Wood L, Whitehead A, Sanneh A, Barber D, Hornsby R. Mometasone Furoate Cream Reduces Acute Radiation Dermatitis in Patients Receiving Breast Radiation Therapy: Results of a Randomized Trial. Int J Radiat Oncol Biol Phys 2014; 90:748-55. [DOI: 10.1016/j.ijrobp.2014.06.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
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23
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Affiliation(s)
- Kàren Morgan
- Macmillan Consultant Radiographer, Taunton and Somerset Foundation Trust
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24
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Dry dressing for epidermal sloughing after subcutaneous azacitidine injection in a myelodysplastic syndrome. Arch Plast Surg 2014; 41:425-6. [PMID: 25075371 PMCID: PMC4113708 DOI: 10.5999/aps.2014.41.4.425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/14/2014] [Accepted: 01/29/2014] [Indexed: 11/08/2022] Open
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Xiaoshan W, Zhixi L, Liang L, Shuchun L, Xia W, Yuyi W, Feng L. Treating breast cancer radiotherapy-induced moist desquamation with a traditional Chinese medicine formula: a case series pilot study. J Altern Complement Med 2014; 20:732-5. [PMID: 25046151 DOI: 10.1089/acm.2013.0419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Abstract Objective: A case series is presented to investigate the efficacy and safety of Erhegao for patients with breast cancer who have radiotherapy-induced moist desquamation. METHODS Eighteen women with breast cancer who received radiotherapy and developed moist desquamation were enrolled. Erhegao cream, a Traditional Chinese Medicine formula consisting of zinc oxide powder, calamine powder, and lithospermum oil, was applied on areas of moist desquamation. Application was repeated once a day until healing. The primary end point for efficacy was the time to healing of the moist desquamation areas. A numerical rating scale was used to measure wound pain relief daily. Incidence of toxicity was also assessed. RESULTS The average time to healing of the moist desquamation area was 13.56 days. The mean pain scores on the first, third, and seventh days were 5.22, 2.94, and 0.83, respectively. Eight-three percent of patients reported pain relief after the first 3 days, and 94%, after the first week. The mean daily reduction in the pain score was 0.40. None of the patients developed clinical infections or reported any toxicity. CONCLUSIONS This formula is effective and safe, especially for pain relief, and may be an alternative treatment for radiotherapy-induced moist desquamation in patients with breast cancer. Future randomized, controlled studies are needed to better evaluate the efficacy of Erhegao cream.
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Affiliation(s)
- Wang Xiaoshan
- 1 Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, China
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26
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O'Donovan A, Coleman M, Harris R, Herst P. Prophylaxis and management of acute radiation-induced skin toxicity: a survey of practice across Europe and the USA. Eur J Cancer Care (Engl) 2014; 24:425-35. [DOI: 10.1111/ecc.12213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. O'Donovan
- Applied Radiation Therapy Trinity (ARTT); Trinity College Dublin; Dublin Ireland
| | - M. Coleman
- Applied Radiation Therapy Trinity (ARTT); Trinity College Dublin; Dublin Ireland
| | - R. Harris
- The Society and College of Radiographers; London UK
| | - P. Herst
- Department of Radiation Therapy; University of Otago; Wellington New Zealand
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Trueman E, Taylor L. Using a soft-silicone dressing to treat moist desquamation. ACTA ACUST UNITED AC 2014; 23:S32, S34-7. [DOI: 10.12968/bjon.2014.23.sup10.s32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ellen Trueman
- Senior Radiotherapy Sister, St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust
| | - Lesley Taylor
- Head and Neck and Neuro Oncology Clinical Nurse Specialist and Team Leader, Oncology Support Team, Ninewells Hospital, Dundee
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28
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Glover D, Harmer V. Radiotherapy-induced skin reactions: assessment and management. ACTA ACUST UNITED AC 2014; 23:S28, S30-5. [DOI: 10.12968/bjon.2014.23.sup2.s28] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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29
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Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer 2013; 21:2933-48. [DOI: 10.1007/s00520-013-1896-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/26/2013] [Indexed: 11/26/2022]
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Modesto A, Faivre JC, Granel-Brocard F, Tao YG, Pointreau Y. [Evaluation and management of acute radiation dermatitis]. Cancer Radiother 2012; 16:456-61. [PMID: 22818410 DOI: 10.1016/j.canrad.2012.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 05/22/2012] [Accepted: 05/23/2012] [Indexed: 01/08/2023]
Abstract
Acute radiation dermatitis remains one of the most commonly observed side effect during radiation therapy leading to complication such as superinfection or treatment disruption. Its management is characterized by a great heterogeneity. Few strategies have demonstrated a benefit in preventing radiation dermatitis, which relies mostly on decreasing dose delivered to the skin and skin care practices. Simple emollients and use of topical steroids can be useful in early stages. The singularity of the skin toxicity seen with cetuximab and radiotherapy warrants a specific grading system and distinctive clinical treatment with use of antibiotics.
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Affiliation(s)
- A Modesto
- Département de radiothérapie, institut Claudius-Regaud, Toulouse, France
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31
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Harris R, Probst H, Beardmore C, James S, Dumbleton C, Bolderston A, Faithfull S, Wells M, Southgate E. Radiotherapy skin care: A survey of practice in the UK. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2011.10.040] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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A systematic review of patient-rated measures of radiodermatitis in breast cancer radiotherapy. Am J Clin Oncol 2011; 34:529-36. [PMID: 20838323 DOI: 10.1097/coc.0b013e3181e84b36] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During breast cancer radiotherapy, nearly all patients will experience radiodermatitis. Study objectives were as follows: (1) systematically review the literature on radiodermatitis and breast cancer; (2) summarize and describe patient-rated radiodermatitis measures; (3) determine whether consensus exists regarding subjective radiodermatitis measurement; and (4) provide recommendations for future research. PubMed and CINAHL were searched from their inception through August 2009. Study inclusion and exclusion criteria were: full abstract available, manuscript in English, focused on radiodermatitis resulting from breast cancer radiotherapy, and described a patient-rated empirical assessment of radiodermatitis. Three reviewers examined abstracts, and decisions about inclusion were reached by consensus. Twenty-two of 237 mutually identified studies met selection criteria. Using a standardized abstraction form, 3 authors independently extracted relevant information. Results indicated that (1) only 9% of the studies reviewed included a patient-rated measure; (2) generally, extant scales are very brief and focus almost exclusively on physical reactions, and (3) there is no "gold standard" measure of patient-rated radiodermatitis at this time. We conclude that significantly more research is needed to determine the best (most valid, reliable, sensitive, comprehensive) measure(s) to evaluate the experience of radiodermatitis from the patient's perspective, and that further scale development efforts are needed.
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34
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Salvo N, Barnes E, van Draanen J, Stacey E, Mitera G, Breen D, Giotis A, Czarnota G, Pang J, De Angelis C. Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. ACTA ACUST UNITED AC 2011; 17:94-112. [PMID: 20697521 DOI: 10.3747/co.v17i4.493] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radiation therapy is a common treatment for cancer patients. One of the most common side effects of radiation is acute skin reaction (radiation dermatitis) that ranges from a mild rash to severe ulceration. Approximately 85% of patients treated with radiation therapy will experience a moderate-to-severe skin reaction. Acute radiation-induced skin reactions often lead to itching and pain, delays in treatment, and diminished aesthetic appearance-and subsequently to a decrease in quality of life. Surveys have demonstrated that a wide variety of topical, oral, and intravenous agents are used to prevent or to treat radiation-induced skin reactions. We conducted a literature review to identify trials that investigated products for the prophylaxis and management of acute radiation dermatitis. Thirty-nine studies met the pre-defined criteria, with thirty-three being categorized as prophylactic trials and six as management trials.For objective evaluation of skin reactions, the Radiation Therapy Oncology Group criteria and the U.S. National Cancer Institute Common Toxicity Criteria were the most commonly used tools (65% of the studies). Topical corticosteroid agents were found to significantly reduce the severity of skin reactions; however, the trials of corticosteroids evaluated various agents, and no clear indication about a preferred corticosteroid has emerged. Amifostine and oral enzymes were somewhat effective in preventing radiation-induced skin reactions in phase II and phase III trials respectively; further large randomized controlled trials should be undertaken to better investigate those products. Biafine cream (Ortho-McNeil Pharmaceuticals, Titusville, NJ, U.S.A.) was found not to be superior to standard regimes in the prevention of radiation-induced skin reactions (n = 6).In conclusion, the evidence is insufficient to support the use of a particular agent for the prevention and management of acute radiation-induced skin reactions. Future trials should focus on comparing agents and approaches that, in phase I and II trials, suggest efficacy. These future phase III randomized controlled trials must clearly distinguish between preventive and management strategies for radiation-induced dermatitis. Only then can evidence-based guidelines be developed, with the hope of standardizing the approach across centres and of improving the prevention and management of radiation-induced dermatitis.
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Affiliation(s)
- N Salvo
- Department of Pharmacy, Edmond Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
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35
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Kumar S, Juresic E, Barton M, Shafiq J. Management of skin toxicity during radiation therapy: a review of the evidence. J Med Imaging Radiat Oncol 2010; 54:264-79. [PMID: 20598015 DOI: 10.1111/j.1754-9485.2010.02170.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Acute skin toxicity occurs in the majority of the patients undergoing radical radiotherapy. While a variety of topical agents and dressing are used to ameliorate side effects, there is minimal evidence to support their use. The aims of this study were to systematically review evidence on acute skin toxicity management and to assess the current practices in ANZ. A systematic review of the literature was conducted on studies published between 1980 and 2008. A meta-analysis was performed on articles on clinical trials reporting grade II or greater toxicity. Analyses were divided into breast (the most common site) and other sites. A survey of Radiation Oncology departments across ANZ was conducted to identify patterns of practices and compare these with the published evidence. Twenty-nine articles were reviewed. Only seven articles demonstrated statistically significant results for management of side-effects. These were for topical corticosteroids, hyaluronic acid, sucralfate, calendula, Cavilon cream (3M, St Paul, Minnesota, USA) and silver leaf dressing. Meta-analysis demonstrated statistical significance for the prophylactic use of topical agents in the management acute toxicity. The survey of departments had a low response rate but demonstrated variation in skin care practices across ANZ. A considerable number of these practices were based only on anecdotal evidence. Lack of evidence in the literature for the care of radiation skin reactions was associated with variation in practice. Only a limited number of studies have demonstrated a significant benefit of specific topical agents. There is a need for objective and prospective recording of skin toxicity to collect meaningful comparative data on which to base recommendations for practice.
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Affiliation(s)
- S Kumar
- Radiation Oncology, Liverpool Cancer Therapy Centre, Sydney, Australia.
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36
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[Treatment and prevention of acute radiation dermatitis]. Cancer Radiother 2010; 14:213-6. [PMID: 20427219 DOI: 10.1016/j.canrad.2010.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 02/07/2010] [Accepted: 02/11/2010] [Indexed: 11/22/2022]
Abstract
Acute radiation dermatitis is a common side-effect of radiotherapy which often necessitates interruption of the therapy. Currently, there is no general consensus about its prevention or about the treatment of choice. The goal of this work was to focus on optimal methods to prevent and manage acute skin reactions related to radiation therapy and to determine if there are specific topical or oral agents for the prevention of this acute skin reaction. The prevention and the early treatment are the two focus points of the management of the acute radiation dermatitis.
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37
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Kedge EM. A systematic review to investigate the effectiveness and acceptability of interventions for moist desquamation in radiotherapy patients. Radiography (Lond) 2009. [DOI: 10.1016/j.radi.2008.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chargari C, Fromantin I, Kirova Y. Intérêt des applications cutanées en cours de radiothérapie pour la prévention et le traitement des épithéliites radio-induites. Cancer Radiother 2009; 13:259-66. [DOI: 10.1016/j.canrad.2009.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 03/28/2009] [Accepted: 04/13/2009] [Indexed: 11/29/2022]
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Are improvements needed in the management of severe acute skin reactions following completion of breast radiotherapy? A discussion of some possible service options. JOURNAL OF RADIOTHERAPY IN PRACTICE 2009. [DOI: 10.1017/s146039690800650x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractRadiotherapy is a critical component for many patients undergoing treatment for breast cancer. Most patients develop some degree of acute radiation skin reaction as a result of the treatment. Acute skin reactions range from faint erythema to moist desquamation and often peak within 1 month after completion of treatment.The emphasis of radiotherapy skincare advice is often during treatment with less attention paid to post-radiotherapy skincare. This article highlights this gap in service provision at one radiotherapy centre and demonstrates the difficulties encountered when there is an inadequate support system. Possible options are discussed for the management of skin reactions after radiotherapy and the potential implications of adopting these strategies. The pragmatic solution introduced to Addenbrookes’ Hospital was to amend patient information providing a supplementary section for health-care professionals overseeing patient care after completion of treatment. This has gone some way to addressing this issue but still has limitations.Provision of timely and consistent skincare advice and support is vital to provide high-quality patient care. This article emphasises the importance of standardisation of radiotherapy skincare and providing an effective support network for patients after completion of radiotherapy.
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Gollins S, Gaffney C, Slade S, Swindell R. RCT on gentian violet versus a hydrogel dressing for radiotherapy-induced moist skin desquamation. J Wound Care 2008; 17:268-70, 272, 274-5. [PMID: 18666721 DOI: 10.12968/jowc.2008.17.6.29589] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Radiotherapy-induced moist desquamation is a significant problem but there is a paucity of randomised data on which to base treatment decisions. The current prospective randomised trial compared gentian violet (GV) to a hydrogel dressing in this context. METHOD Thirty patients undergoing radiotherapy to the head and neck region or breast who had developed moist desquamation in the radiotherapy field were randomised to treatment with 0.5% aqueous gentian violet (GV) (n=16) or a hydrogel dressing (n=14). The area of desquamation was regularly measured until healing or withdrawal from the study. RESULTS The likelihood of healing with the hydrogel was greater than GV with a hazard ratio for healing of 7.95 (95% CI 2.20-28.68; p=0.002). The median time to healing for hydrogel was 12 days but had not been reached for GV by 30 days. Over the first 14 days the median'area under curve' of moist desquamation for GV was 82.6 cm2 (range 31.8-320.7 cm2) and that for hydrogel 20.0 cm2 (range 3.8-301.0 cm2) (difference significant at p=0.003). Ten of 16 patients treated with GV withdrew from the study (due to stinging in five and failure to heal in five) compared with two of the 14 treated with hydrogel (difference significant at p=0.021). CONCLUSION Hydrogel dressings are more likely to heal radiotherapy-induced moist desquamation and are better tolerated than GV.
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Affiliation(s)
- S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK.
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A case study to evaluate a new soft silicone dressing, Mepilex Lite, for patients with radiation skin reactions. Cancer Nurs 2008; 31:E8-14. [PMID: 18176123 DOI: 10.1097/01.ncc.0000305680.06143.39] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radiation skin reactions are a known side effect of radiation therapy. Moist desquamation reactions are not only painful but also may be a focus for infection and can be dose limiting. There is a challenge to find a dressing which is protective, comfortable, and a traumatic to delicate irradiated skin. The primary aim of this study was to evaluate patient comfort when using Mepilex Lite in the management of dry and moist desquamation. Secondary objectives included safety, tolerance, and influence on healing. Sixteen patients were recruited at 2 centers in the United Kingdom and in Sweden when they had a RTOG score of 3 and 1 symptom measured by the Radiation-Induced Skin Reaction Assessment tool. Digital photography was used at each weekly visit. Patients completed the Radiation-Induced Skin Reaction Assessment, daily diary cards, and open diaries for quantitative and qualitative evaluation. Some patients found that the dressing minimized pain during dressing changes and was easily lifted and adjusted without loss of adherent properties. A new dressing had a soothing or cooling effect on the skin, and some reported a more normal sleep pattern. The dressing had no negative effect on wound healing. The researchers conclude that the dressing provides a promising alternative to existing dressings and is worthy of further research.
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42
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A multidisciplinary approach to squamous cell carcinomas of the head and neck: an update. Curr Opin Oncol 2008; 20:249-55. [DOI: 10.1097/cco.0b013e3282faa0b1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Merchant TE, Bosley C, Smith J, Baratti P, Pritchard D, Davis T, Li C, Xiong X. A phase III trial comparing an anionic phospholipid-based cream and aloe vera-based gel in the prevention of radiation dermatitis in pediatric patients. Radiat Oncol 2007; 2:45. [PMID: 18093332 PMCID: PMC2238757 DOI: 10.1186/1748-717x-2-45] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 12/19/2007] [Indexed: 11/26/2022] Open
Abstract
Purpose Radiation dermatitis is a common side effect of radiation therapy (RT). In severe cases, RT must be interrupted until the skin heals, which can compromise treatment. The purpose of the study was to compare an anionic polar phospholipid (APP)-based cream and an aloe vera-based gel to determine their effectiveness in preventing and treating radiation dermatitis. Patients and methods Forty-five pediatric patients (median age, 11 years) with various diagnoses who received at least 23.4 Gy participated. APP cream and aloe vera gel were symmetrically applied within the irradiated field after each treatment. Three measures were collected before, during and after completion of treatment: subject's skin comfort, dermatologic assessment, and common toxicity criteria (CTC). Results Significant differences in specific variables favoring APP cream use were noted in some patients including skin comfort variables, dry (p = 0.002), soft (p = 0.057), feels good (p = 0.002), rough (p = 0.065), smooth (p = 0.012) and dermatologic variables, dryness (p = 0.013), erythema (p = 0.002) and peely (p = 0.008). Grouped CTC scores were supportive of APP cream (p = 0.004). In comparing the first and last assessments, two dermatologic variables, dryness (p = 0.035) and peely (p = 0.016), favored APP cream. Conclusion APP cream is more effective than aloe vera-based gel for prevention and treatment of radiation dermatitis.
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Affiliation(s)
- Thomas E Merchant
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Munro AJ. Hidden danger, obvious opportunity: error and risk in the management of cancer. Br J Radiol 2007; 80:955-66. [DOI: 10.1259/bjr/12777683] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Russi EG, Merlano MC, Comino A, Numico G. Ultrathin Hydrocolloid Dressing in Skin Damaged From Alternating Radiotherapy and Chemotherapy Plus Cetuximab in Advanced Head and Neck Cancer (G.O.N.O. AlteRCC Italian Trial): In Regard to Macmillan et al. (Int J Radiat Oncol Biol Phys 2007;68:864–872). Int J Radiat Oncol Biol Phys 2007; 69:638-9. [PMID: 17869678 DOI: 10.1016/j.ijrobp.2007.05.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 05/23/2007] [Indexed: 11/16/2022]
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