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Ubeira-Gabellini MG, Mori M, Palazzo G, Cicchetti A, Mangili P, Pavarini M, Rancati T, Fodor A, Del Vecchio A, Di Muzio NG, Fiorino C. Comparing Performances of Predictive Models of Toxicity after Radiotherapy for Breast Cancer Using Different Machine Learning Approaches. Cancers (Basel) 2024; 16:934. [PMID: 38473296 DOI: 10.3390/cancers16050934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE Different ML models were compared to predict toxicity in RT on a large cohort (n = 1314). METHODS The endpoint was RTOG G2/G3 acute toxicity, resulting in 204/1314 patients with the event. The dataset, including 25 clinical, anatomical, and dosimetric features, was split into 984 for training and 330 for internal tests. The dataset was standardized; features with a high p-value at univariate LR and with Spearman ρ>0.8 were excluded; synthesized data of the minority were generated to compensate for class imbalance. Twelve ML methods were considered. Model optimization and sequential backward selection were run to choose the best models with a parsimonious feature number. Finally, feature importance was derived for every model. RESULTS The model's performance was compared on a training-test dataset over different metrics: the best performance model was LightGBM. Logistic regression with three variables (LR3) selected via bootstrapping showed performances similar to the best-performing models. The AUC of test data is slightly above 0.65 for the best models (highest value: 0.662 with LightGBM). CONCLUSIONS No model performed the best for all metrics: more complex ML models had better performances; however, models with just three features showed performances comparable to the best models using many (n = 13-19) features.
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Affiliation(s)
| | - Martina Mori
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gabriele Palazzo
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandro Cicchetti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Paola Mangili
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Maddalena Pavarini
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Andrei Fodor
- Radiotherapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | | | - Nadia Gisella Di Muzio
- Radiotherapy, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Radiotherapy, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Claudio Fiorino
- Medical Physics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Long X, Guo J, Yin Y, Cheng M, Zhang X, Zhang J, Wang P, Zang J, Zhao L. A blinded-endpoint, randomized controlled trial of Sanyrene with natural active ingredient for prophylaxis of radiation dermatitis in patients receiving radiotherapy. Radiat Oncol 2023; 18:174. [PMID: 37891689 PMCID: PMC10604398 DOI: 10.1186/s13014-023-02363-9] [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: 04/19/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Randomized controlled study was conducted to evaluate the efficacy of Sanyrene® vs. control intervention (DaBao®, a complex of hyaluronic acid and Vitamin E) for acute radiation dermatitis in patients receiving radiotherapy. METHODS Patients with breast cancer or head and neck cancer undergoing radiotherapy (≥ 50 Gy) were eligible. Participants were randomly assigned to either Sanyrene arm or control intervention arm in a ratio of 1:1. The primary endpoint was incidence rate of ≥ grade 2 radiation induced dermatitis. (Trial Registration: ChiCTR2100050910, registration date: 9/7/2021) RESULTS: A total of 102 eligible patients were randomly assigned into the study. The rate of ≥ grade 2 radiation dermatitis was 22% in Sanyrene group, as compared with 67.3% in the control intervention group (P<0.001). The incidence of grade 3 radiation dermatitis was 20.4% and 8.0% in control intervention group and Sanyrene group, respectively (P = 0.076). Patients in Sanyrene group had a longer median time to reach ≥ grade 2 radiation dermatitis compared to these in control intervention group, with hazard ratio of 0.231 (95%CI:0.116-0.458, p < 0.001). Mean score of SD-16 were much higher in control intervention group than Sanyrene group at end of radiotherapy (25 vs.8.3), 2 weeks after radiotherapy (22.9 vs. 0.5) and 4 weeks after radiotherapy (4.2 vs.0), with significantly statistical difference between two groups. CONCLUSIONS This trial suggests that Sanyrene is effective on preventing serious radiation dermatitis and improving skin related quality of life in patients with breast cancer or head and neck cancer receiving radiotherapy.
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Affiliation(s)
- Xiaoli Long
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Jing Guo
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yutian Yin
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Ming Cheng
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Xiao Zhang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Jing Zhang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Pengyuan Wang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Jian Zang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
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Helissey C, Cavallero S, Guitard N, Théry H, Chargari C, François S. Revolutionizing Radiotoxicity Management with Mesenchymal Stem Cells and Their Derivatives: A Focus on Radiation-Induced Cystitis. Int J Mol Sci 2023; 24:ijms24109068. [PMID: 37240415 DOI: 10.3390/ijms24109068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Although radiation therapy plays a crucial role in cancer treatment, and techniques have improved continuously, irradiation induces side effects in healthy tissue. Radiation cystitis is a potential complication following the therapeutic irradiation of pelvic cancers and negatively impacts patients' quality of life (QoL). To date, no effective treatment is available, and this toxicity remains a therapeutic challenge. In recent times, stem cell-based therapy, particularly the use of mesenchymal stem cells (MSC), has gained attention in tissue repair and regeneration due to their easy accessibility and their ability to differentiate into several tissue types, modulate the immune system and secrete substances that help nearby cells grow and heal. In this review, we will summarize the pathophysiological mechanisms of radiation-induced injury to normal tissues, including radiation cystitis (RC). We will then discuss the therapeutic potential and limitations of MSCs and their derivatives, including packaged conditioned media and extracellular vesicles, in the management of radiotoxicity and RC.
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Affiliation(s)
- Carole Helissey
- Clinical Unit Research, HIA Bégin, 69 Avenu de Paris, 94160 Saint-Mandé, France
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
| | - Sophie Cavallero
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
| | - Nathalie Guitard
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
| | - Hélène Théry
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
| | - Cyrus Chargari
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
- Department of Radiation Oncology, Pitié Salpêtrière University Hospital, 47-83 Bd de l'Hôpital, 75013 Paris, France
| | - Sabine François
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
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Plaza D, Baic A, Lange B, Brzęk A, Ślosarek K, Stanek A, Cholewka A. Comparison of the Thermal Reaction of Patients after Conserving Procedures and after Mastectomy to the Radiation Dose Obtained during Radiotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16085. [PMID: 36498157 PMCID: PMC9738999 DOI: 10.3390/ijerph192316085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
The main aim of the study was to compare the temperature response of the body to the dose received during breast cancer radiotherapy. The control group consisted of 50 healthy volunteers. They underwent one thermographic examination and compared the temperatures between the left and right breasts. The research group consisted of 50 patients. Based on the treatment plan, the area PTV and isodose was marked on the thermograms. Five thermographs were performed in each patient (before radiotherapy and in each week of treatment). A qualitatively similar increase in mean temperature during treatment was observed in both subgroups in the analyzed areas. The highest increase in temperature was obtained in the third week of treatment. Compared with the value before treatment, the increase in the mean temperature in PTV in patients after partial surgery was 0.78 °C, these values are statistically significant p = 0.000055. In the case of post-mastectomy patients, 0.8 °C was obtained, these values are statistically significant p = 0.00369. In addition, strong correlation was calculated between isodoses read from treatment plans and isotherms obtained from the analysis of thermal images. In post-mastectomy patients for PTV r = 0.77, 30 Gy r = 0.94, 20 Gy r = 0.96, and 10 Gy r = 0.75. For patients after partial surgery for PTV r = 0.74, 30 Gy r = 0.89, 20 Gy r = 0.83, and 10 Gy r = 0.89. Infrared thermography seems to be a useful method of assessing the thermal response of the body to the dose received during radiotherapy of breast cancer and may be a clinically useful method of assessing the early skin response to radiation.
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Affiliation(s)
- Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Agnieszka Baic
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Barbara Lange
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Anna Brzęk
- Department of Physiotherapy, School of Health Sciences, Katowice Medical University of Silesia in Katowice, Poniatowskiego Street 15, 40-055 Katowice, Poland
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Agata Stanek
- Chair and Clinical Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia in Katowice, 41-902 Bytom, Poland
| | - Armand Cholewka
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
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5
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Feng H, Wang H, Xu L, Ren Y, Ni Q, Yang Z, Ma S, Deng Q, Chen X, Xia B, Kuang Y, Li X. Prediction of radiation-induced acute skin toxicity in breast cancer patients using data encapsulation screening and dose-gradient-based multi-region radiomics technique: A multicenter study. Front Oncol 2022; 12:1017435. [PMID: 36439515 PMCID: PMC9686850 DOI: 10.3389/fonc.2022.1017435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Radiation-induced dermatitis is one of the most common side effects for breast cancer patients treated with radiation therapy (RT). Acute complications can have a considerable impact on tumor control and quality of life for breast cancer patients. In this study, we aimed to develop a novel quantitative high-accuracy machine learning tool for prediction of radiation-induced dermatitis (grade ≥ 2) (RD 2+) before RT by using data encapsulation screening and multi-region dose-gradient-based radiomics techniques, based on the pre-treatment planning computed tomography (CT) images, clinical and dosimetric information of breast cancer patients. Methods and Materials 214 patients with breast cancer who underwent RT between 2018 and 2021 were retrospectively collected from 3 cancer centers in China. The CT images, as well as the clinical and dosimetric information of patients were retrieved from the medical records. 3 PTV dose related ROIs, including irradiation volume covered by 100%, 105%, and 108% of prescribed dose, combined with 3 skin dose-related ROIs, including irradiation volume covered by 20-Gy, 30-Gy, 40-Gy isodose lines within skin, were contoured for radiomics feature extraction. A total of 4280 radiomics features were extracted from all 6 ROIs. Meanwhile, 29 clinical and dosimetric characteristics were included in the data analysis. A data encapsulation screening algorithm was applied for data cleaning. Multiple-variable logistic regression and 5-fold-cross-validation gradient boosting decision tree (GBDT) were employed for modeling training and validation, which was evaluated by using receiver operating characteristic analysis. Results The best predictors for symptomatic RD 2+ were the combination of 20 radiomics features, 8 clinical and dosimetric variables, achieving an area under the curve (AUC) of 0.998 [95% CI: 0.996-1.0] and an AUC of 0.911 [95% CI: 0.838-0.983] in the training and validation dataset, respectively, in the 5-fold-cross-validation GBDT model. Meanwhile, the top 12 most important characteristics as well as their corresponding importance measures for RD 2+ prediction in the GBDT machine learning process were identified and calculated. Conclusions A novel multi-region dose-gradient-based GBDT machine learning framework with a random forest based data encapsulation screening method integrated can achieve a high-accuracy prediction of acute RD 2+ in breast cancer patients.
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Affiliation(s)
- Huichun Feng
- Medical Imaging and Translational Medicine Laboratory, Hangzhou Cancer Center, Hangzhou, China
- Patient follow-up center, Hangzhou Cancer Hospital, Hangzhou, China
| | - Hui Wang
- Medical Imaging and Translational Medicine Laboratory, Hangzhou Cancer Center, Hangzhou, China
- Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lixia Xu
- Medical Imaging and Translational Medicine Laboratory, Hangzhou Cancer Center, Hangzhou, China
- Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Ren
- Medical Imaging and Translational Medicine Laboratory, Hangzhou Cancer Center, Hangzhou, China
- Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qianxi Ni
- Department of Radiology, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhen Yang
- Department of Radiotherapy, Xiangya Hospital Central South University, Changsha, China
| | - Shenglin Ma
- Medical Imaging and Translational Medicine Laboratory, Hangzhou Cancer Center, Hangzhou, China
- Medical Oncology, Xiaoshan Hospital Affiliated to Hangzhou Normal University, Hangzhou, China
| | - Qinghua Deng
- Medical Imaging and Translational Medicine Laboratory, Hangzhou Cancer Center, Hangzhou, China
- Patient follow-up center, Hangzhou Cancer Hospital, Hangzhou, China
| | - Xueqin Chen
- Medical Imaging and Translational Medicine Laboratory, Hangzhou Cancer Center, Hangzhou, China
- Patient follow-up center, Hangzhou Cancer Hospital, Hangzhou, China
| | - Bing Xia
- Medical Imaging and Translational Medicine Laboratory, Hangzhou Cancer Center, Hangzhou, China
- Patient follow-up center, Hangzhou Cancer Hospital, Hangzhou, China
| | - Yu Kuang
- Medical Physics Program, University of Nevada, Las Vegas, NV, United States
- *Correspondence: Xiadong Li, ; Yu Kuang,
| | - Xiadong Li
- Medical Imaging and Translational Medicine Laboratory, Hangzhou Cancer Center, Hangzhou, China
- Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Xiadong Li, ; Yu Kuang,
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The Effect of Sanyrene Liquid Dressing in Preventing Radiation Dermatitis: A Systematic Review and Meta-analysis. Adv Skin Wound Care 2022; 35:1-8. [DOI: 10.1097/01.asw.0000889852.91765.ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Plaza D, Baic A, Lange B, Michalecki Ł, Ślosarek K, Stanek A, Cholewka A. The Use of Infrared Thermography in the Assessment of Thermal Reaction of Patients Treated with Radiotherapy after Breast-Conserving Procedures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14187. [PMID: 36361065 PMCID: PMC9657152 DOI: 10.3390/ijerph192114187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The aim of the study was to assess the usefulness of the infrared thermography method in the assessment of the body's thermal reaction in patients during radiotherapy. Studies have shown how the temperature distribution changes with the dose of radiation used in each treatment week. Fifty-four patients participated in the study. The control group consisted of healthy patients, among whom the difference in mean temperatures between the breasts was checked. The study group included patients after conserving procedures qualified for radiotherapy. Measurements were taken and analyzed for each patient during each week of treatment. The target area (marked by a doctor) and the 30 Gy, 20 Gy and 10 Gy isodoses (generated from the treatment plan) were transferred on thermograms and then analyzed. This way of defining the observed areas is the most accurate and individually adjusted to each treated patient. The analysis showed an increase in temperature in the tested body surface areas, whereas the highest average temperature value was achieved during the third week of treatment. The observations may be used to evaluate the skin reaction from radiation; however, they require further studies and new quantitative parameters.
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Affiliation(s)
- Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Agnieszka Baic
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Barbara Lange
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Łukasz Michalecki
- Department of Radiation Oncology, University Clinical Center, Medical University of Silesia, Ceglana Street 35, 40-514 Katowice, Poland
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
| | - Armand Cholewka
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
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Non-Invasive Physical Plasma for Preventing Radiation Dermatitis in Breast Cancer: A First-In-Human Feasibility Study. Pharmaceutics 2022; 14:pharmaceutics14091767. [PMID: 36145515 PMCID: PMC9506560 DOI: 10.3390/pharmaceutics14091767] [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: 07/28/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/20/2022] Open
Abstract
Radiation dermatitis (RD) is the most common acute side effect of breast irradiation. More than a century following the therapeutic utilisation of X-rays, potent preventative and therapeutic options are still lacking. Non-invasive physical plasma (NIPP) is an emerging approach towards treatment of various dermatological disorders. In this study, we sought to determine the safety and feasibility of a NIPP device on RD. Thirty patients undergoing hypofractionated whole-breast irradiation were included. Parallel to radiation treatment, the irradiated breast was treated with NIPP with different application regimens. RD was assessed during and after NIPP/radiation, using clinician- and patient-reported outcomes. Additionally, safety and feasibility features were recorded. None of the patients was prescribed topical corticosteroids and none considered the treatment to be unpleasant. RD was less frequent and milder in comparison with standard skin care. Neither NIPP-related adverse events nor side effects were reported. This proven safety and feasibility profile of a topical NIPP device in the prevention and treatment of RD will be used as the framework for a larger intrapatient-randomised double-blind placebo-controlled trial, using objective and patient-reported outcome measures as an endpoint.
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Deep learning-based automatic assessment of radiation dermatitis in nasopharyngeal carcinoma (NPC) patients. Int J Radiat Oncol Biol Phys 2022; 113:685-694. [PMID: 35304306 DOI: 10.1016/j.ijrobp.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Radiation dermatitis (RD) is a common, unpleasant side-effect of patients receiving radiotherapy. In clinical practice, the severity of RD is graded manually through visual inspection, which is labor-intensive and often leads to large inter-rater variations. To overcome these shortcomings, this study aims to develop an automatic RD assessment based on deep learning (DL) techniques, which could efficiently assist the RD severity classification in clinical application. METHODS A total of 1205 photographs of the head and neck region were collected from nasopharyngeal carcinoma (NPC) patients undergoing radiotherapy. The severity of RD in these photographs was graded by five qualified assessors based on the Radiation Therapy Oncology Group (RTOG) guidance. An end-to-end RD grading framework was developed by combining a DL-based segmentation network and a DL-based RD severity classifier, which are used for segmenting the neck region from the camera-captured photographs and grading, respectively. U-Net was used for segmentation and another convolutional neural network (CNN) classifier (DenseNet-121) was applied to RD severity classification. Dice Similarity Coefficient (DSC) was used to evaluate the performance of segmentation. Severity classification was evaluated by several metrics, including overall accuracy, precision, recall, and F1-score. RESULTS Results of segmentation showed that the averaged DSCs were 91.2% and 90.8% for front and side view, respectively. For RD severity classification, the overall accuracy of test photographs was 83.0%. Our method accurately classified 90.5% of Grade 0, 67.2% of Grade 1, 93.8% of Grade 2, and 100% of Above Grade 2 cases. The overall prediction performance was comparable with human assessors. There was no significant difference in accuracy when using manually or automatically segmented regions (p = 0.683). CONCLUSION We have successfully demonstrated a DL-based method for automatic assessment of RD severity in NPC patients. This method holds great potential for efficient and effective assessing and monitoring of RD in NPC patients.
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Baic A, Plaza D, Lange B, Michalecki Ł, Stanek A, Ślosarek K, Cholewka A. Twelve-Month Evaluation of Temperature Effects of Radiotherapy in Patients after Mastectomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052834. [PMID: 35270526 PMCID: PMC8910534 DOI: 10.3390/ijerph19052834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
The aim of this study was to verify the changes in the temperature distribution within the breast at twelve months after the end of radiotherapy for breast cancer. The study included twenty-four women. The first test group consisted of twelve women who underwent breast mastectomy and qualified for radiotherapy according to standard medical treatment procedures. The second group included twelve healthy women. The tests were conducted before treatment with radiation therapy and two months, six months, nine months, and one year after the end of treatment. The mean temperature values changed depending on the time that had elapsed since the end of treatment. The highest temperature increase in all patients was observed six months after the end of radiotherapy. This research has confirmed that the assessment of temperature changes in the breast area after radiotherapy can evaluate the severity and lesions in the time course of the radiation reaction.
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Affiliation(s)
- Agnieszka Baic
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty Street 1A, 41-500 Chorzow, Poland;
- Correspondence:
| | - Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (K.Ś.)
| | - Barbara Lange
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland;
| | - Łukasz Michalecki
- Department of Radiation Oncology, University Clinical Center, Medical University of Silesia in Katowice, Ceglana Street 35, 40-514 Katowice, Poland;
| | - Agata Stanek
- Chair and Clinical Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego Street 15, 41-902 Bytom, Poland;
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (K.Ś.)
| | - Armand Cholewka
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty Street 1A, 41-500 Chorzow, Poland;
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11
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Baic A, Plaza D, Lange B, Reudelsdorf-Ullmann M, Michalecki Ł, Stanek A, Ślosarek K, Cholewka A. The Use of Thermal Imaging in the Evaluation of Temperature Effects of Radiotherapy in Patients after Mastectomy-First Study. SENSORS 2021; 21:s21217068. [PMID: 34770371 PMCID: PMC8588482 DOI: 10.3390/s21217068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study was to evaluate the temperature parameter of the breast area in patients undergoing radiotherapy at various intervals. The relationship between temperature changes on the patient’s skin and the time after the end of radiotherapy was studied. Measurements with a thermal imaging camera were performed in a group of twelve volunteers. Six of them were healthy women who did not have thermal asymmetry between the breasts, whereas six were diagnosed with breast cancer and underwent mastectomy due to the advanced stage of the disease. The patients were qualified for radiation therapy. Thermographic examinations were performed before treatment, two months later and then six months after the end of the treatment. Temperature differences between the healthy breasts and the treated areas were assessed. Additionally, the correlation between a patient’s skin temperature changes and the time after the end of radiotherapy was analyzed. The highest skin temperature increase (1.47 °C) was observed 6 months after the end of RT compared to the measurement before treatment. It seems that thermovision may bring a new tool for quantitative analyses of the temperature effects of radiotherapy.
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Affiliation(s)
- Agnieszka Baic
- Department of Medical Physics, A. Chełkowski Institute of Physics, University of Silesia, 75 Pułku Piechoty 1A St., 41-500 Chorzów, Poland;
- Correspondence:
| | - Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (M.R.-U.); (K.Ś.)
| | - Barbara Lange
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (M.R.-U.); (K.Ś.)
| | - Marta Reudelsdorf-Ullmann
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (M.R.-U.); (K.Ś.)
| | - Łukasz Michalecki
- Department of Radiation Oncology, University Clinical Center of the Medical University of Silesia, Medyków 14 St., 40-572 Katowice, Poland;
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland;
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (M.R.-U.); (K.Ś.)
| | - Armand Cholewka
- Department of Medical Physics, A. Chełkowski Institute of Physics, University of Silesia, 75 Pułku Piechoty 1A St., 41-500 Chorzów, Poland;
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12
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Burnett LR, Hughes RT, Rejeski AF, Moffatt LT, Shupp JW, Christy RJ, Winkfield KM. Review of the Terminology Describing Ionizing Radiation-Induced Skin Injury: A Case for Standardization. Technol Cancer Res Treat 2021; 20:15330338211039681. [PMID: 34613833 PMCID: PMC8504211 DOI: 10.1177/15330338211039681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ionizing radiation causes injury to the skin that produces a complex clinical presentation that is managed by various paradigms without clear standards. The situation is further complicated by the fact that clinicians and researchers often use different terms and billing codes to describe the spectrum of cutaneous injury. There is, however, general agreement between the two most commonly-used diagnostic scales, the Radiation Therapy Oncology Group and the Common Terminology Criteria for Adverse Events, and in their use to describe skin injury following radiation therapy. These scales are typically used by radiation oncologists to quantify radiation dermatitis, a component of the radiation-related disorders of the skin and subcutaneous tissue family of diagnoses. In rare cases, patients with severe injury may require treatment by wound care or burn specialists, in which case the disease is described as a “radiation burn” and coded as a burn or corrosion. Further compounding the issue, most US government agencies use the term Cutaneous Radiation Injury to indicate skin damage resulting from large, whole-body exposures. In contrast, the US Food and Drug Administration approves products for radiation dermatitis or “burns caused by radiation oncology procedures.” A review of the literature and comparison of clinical presentations shows that each of these terms represents a similar injury, and can be used interchangeably. Herein we provide a comparative review of the commonly used terminology for radiation-induced skin injury. Further, we recommend standardization across clinicians, providers, and researchers involved in the diagnosis, care, and investigation of radiation-induced skin injury. This will facilitate collaboration and broader inclusion criteria for grant-research and clinical trials and will assist in assessing therapeutic options particularly relevant to patient skin pigmentation response differences.
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Affiliation(s)
| | - Ryan T Hughes
- 12279Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Lauren T Moffatt
- 121577MedStar Health Research Institute, Washington, DC, USA.,12230Georgetown University School of Medicine, Washington, DC, USA
| | - Jeffrey W Shupp
- 121577MedStar Health Research Institute, Washington, DC, USA.,12230Georgetown University School of Medicine, Washington, DC, USA.,8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Christy
- 110230US Army Institute for Surgical Research, San Antonio Texas, USA
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13
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Mesenchymal Stem Cells for Mitigating Radiotherapy Side Effects. Cells 2021; 10:cells10020294. [PMID: 33535574 PMCID: PMC7912747 DOI: 10.3390/cells10020294] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Radiation therapy for cancers also damages healthy cells and causes side effects. Depending on the dosage and exposure region, radiotherapy may induce severe and irreversible injuries to various tissues or organs, especially the skin, intestine, brain, lung, liver, and heart. Therefore, promising treatment strategies to mitigate radiation injury is in pressing need. Recently, stem cell-based therapy generates great attention in clinical care. Among these, mesenchymal stem cells are extensively applied because it is easy to access and capable of mesodermal differentiation, immunomodulation, and paracrine secretion. Here, we summarize the current attempts and discuss the future perspectives about mesenchymal stem cells (MSCs) for mitigating radiotherapy side effects.
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14
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Chen CH, Hsieh CC, Chang CS, Chen MF. A Retrospective Analysis of Dose Distribution and Toxicity in Patients with Left Breast Cancer Treated with Adjuvant Intensity-Modulated Radiotherapy: Comparison with Three-Dimensional Conformal Radiotherapy. Cancer Manag Res 2020; 12:9173-9182. [PMID: 33061609 PMCID: PMC7532038 DOI: 10.2147/cmar.s269893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background A better understanding of the organs-at-risk (OAR) dose metrics and the related toxicity induced by radiotherapy (RT) for left breast cancer (BC) will improve the quality of life. This study addressed the issue for left-BC patients treated with intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT). Patients and Methods Between 2012 and 2018, 308 left-BC patients underwent adjuvant RT at our hospital. Before June 2015, 134 patients were treated with 3D-CRT. Thereafter, 174 patients underwent IMRT. The patient’s characteristics in the IMRT group did not significantly different compared to those in the 3D-CRT group. Results Among the total study population, the incidence of ≥grade 2 radiation dermatitis (RID) was 17.3%. Higher volumes receiving 105% (≥5.7%) and 107% (≥1%) of prescribed dose and 3D-CRT technique were associated with a higher risk of RID. Regarding lung toxicity, the mean lung dose (≥10.2Gy) and V20 (≥20%) of ipsilateral lung were significantly associated with the incidence of RT-induced pulmonary changes. By dosimetry analysis, IMRT achieved better dose conformity and delivered lower mean doses to heart and ipsilateral lung compared to 3D-CRT. Furthermore, propensity sore and multivariate analysis showed that IMRT technique helped to reduce RT-induced dermatitis and lung toxicity. Conclusion Our data suggest that the volume of OAR exposed to higher doses is a predictor of RT-induced toxicity. Adjuvant RT with IMRT technique offered better dose conformity and spared high-dose levels to OARs to reduce radiation-related morbidity for BC patients.
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Affiliation(s)
- Chia-Hsin Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Chuan Hsieh
- Department of General Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Shen Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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15
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Iacovelli NA, Torrente Y, Ciuffreda A, Guardamagna VA, Gentili M, Giacomelli L, Sacerdote P. Topical treatment of radiation-induced dermatitis: current issues and potential solutions. Drugs Context 2020; 9:dic-2020-4-7. [PMID: 32587626 PMCID: PMC7295106 DOI: 10.7573/dic.2020-4-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
Approximately 95% of patients receiving radiotherapy (RT) will ultimately develop radiation-induced dermatitis (RID) during or after the course of treatment, with major consequences on quality of life and treatment outcomes. This paper reviews the pathophysiology of RID and currently used topical products for the prevention and treatment of RID. Although there is no consensus on the appropriate management, recent evidence suggests that the use of topical products supports to protect and promote tissue repair in patients with RID. Basic recommendations include advice to wear loose clothing, using electric razors if necessary, and avoiding cosmetic products, sun exposure or extreme temperatures. Based on mechanisms involved and on the clinical characteristics of oncological patients, the profile of the ideal topical product for addressing RID can be designed; it should have limited risk of adverse events, systemic adsorption and drug–drug interactions, should be characterized by multiple clinical activities, with a special focus on localized pain, and should have a careful formulation as some vehicles can block the RT beam.
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Affiliation(s)
| | - Yvan Torrente
- Stem Cell Laboratory, Department of Pathophysiology and Transplantation, Universitá degli Studi di Milano, Milan, Italy.,Unit of Neurology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centro Dino Ferrari, Milan, Italy
| | - Adriana Ciuffreda
- Medico Chirurgo, Specialista in Dermatologia e Venereologia, Dermatologia Pediatrica, Milan, Italy
| | - Vittorio A Guardamagna
- Division of Palliative Care and Pain Therapy, IRCCS Istituto Europeo di Oncologia IEO, Milan, Italy.,Director of ESMO, Designated Center of Integrated Oncology and Palliative Care, Milan, Italy
| | | | - Luca Giacomelli
- Polistudium SRL, Milan, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Science, University of Milano, Milan, Italy
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16
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Shariati L, Amouheidari A, Naji Esfahani H, Abed A, Haghjooy Javanmard S, Laher I, Ghasemi A, Vaseghi G. Protective effects of doxepin cream on radiation dermatitis in breast cancer: A single arm double-blind randomized clinical trial. Br J Clin Pharmacol 2020; 86:1875-1881. [PMID: 32040868 DOI: 10.1111/bcp.14238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS Breast cancer is the most frequently occurring cancer in women. Lumpectomy followed by radiotherapy is suggested to be as effective as a total mastectomy. Radiation-induced dermatitis often occurs as a result of breast radiotherapy. Recent studies suggest that doxepin has promising anti-inflammatory properties. This study was undertaken to evaluate the effects of doxepin therapy on radiation dermatitis. METHODS A double-blind randomized clinical trial was launched from 2016 to 2017, with a total of 48 patients who had undergone breast-conserving surgery and received postoperative radiation therapy. Radiotherapy was applied 5 days per week for 5 weeks. Adverse dermatological effects were evaluated by a physician at the beginning of the fifth week of radiotherapy and the patients were then randomly assigned (1:1 ratio) to receive either doxepin (5%) or placebo cream for 7 days. RESULTS There were no significant differences in the dermatitis grade between doxepin and placebo groups at baseline (P > .5). The occurrence of acute dermatitis (grade 2 or higher) was significantly lower with the use of doxepin than with placebo (P ≤ .0001, Zα = 1.96 at 95% confidence interval). CONCLUSION Doxepin cream prevents dermatitis grade 2 or higher during post-operative breast irradiation. Doxepin cream is easy to use, affordable and prevents pain and irritation.
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Affiliation(s)
- Laleh Shariati
- Applied Physiology Research Center, Cardiovascular Research Institute, Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Biomaterials, Nanotechnology and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Hajar Naji Esfahani
- Applied Physiology Research Center, Cardiovascular Research Institute, Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Abed
- Physiology Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ahmad Ghasemi
- Applied Physiology Research Center, Cardiovascular Research Institute, Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Golnaz Vaseghi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Saednia K, Tabbarah S, Lagree A, Wu T, Klein J, Garcia E, Hall M, Chow E, Rakovitch E, Childs C, Sadeghi-Naini A, Tran WT. Quantitative Thermal Imaging Biomarkers to Detect Acute Skin Toxicity From Breast Radiation Therapy Using Supervised Machine Learning. Int J Radiat Oncol Biol Phys 2020; 106:1071-1083. [PMID: 31982495 DOI: 10.1016/j.ijrobp.2019.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/11/2019] [Accepted: 12/24/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Radiation-induced dermatitis is a common side effect of breast radiation therapy (RT). Current methods to evaluate breast skin toxicity include clinical examination, visual inspection, and patient-reported symptoms. Physiological changes associated with radiation-induced dermatitis, such as inflammation, may also increase body-surface temperature, which can be detected by thermal imaging. Quantitative thermal imaging markers were identified and used in supervised machine learning to develop a predictive model for radiation dermatitis. METHODS AND MATERIALS Ninety patients treated for adjuvant whole-breast RT (4250 cGy/fx = 16) were recruited for the study. Thermal images of the treated breast were taken at 4 intervals: before RT, then weekly at fx = 5, fx = 10, and fx = 15. Parametric thermograms were analyzed and yielded 26 thermal-based features that included surface temperature (°C) and texture parameters obtained from (1) gray-level co-occurrence matrix, (2) gray-level run-length matrix, and (3) neighborhood gray-tone difference matrix. Skin toxicity was evaluated at the end of RT using the Common Terminology Criteria for Adverse Events (CTCAE) guidelines (Ver.5). Binary group classes were labeled according to a CTCAE cut-off score of ≥2, and thermal features obtained at fx = 5 were used for supervised machine learning to predict skin toxicity. The data set was partitioned for model training, independent testing, and validation. Fifteen patients (∼17% of the whole data set) were randomly selected as an unseen test data set, and 75 patients (∼83% of the whole data set) were used for training and validation of the model. A random forest classifier with leave-1-patient-out cross-validation was employed for modeling single and hybrid parameters. The model performance was reported using receiver operating characteristic analysis on patients from an independent test set. RESULTS Thirty-seven patients presented with adverse skin effects, denoted by a CTCAE score ≥2, and had significantly higher local increases in skin temperature, reaching 36.06°C at fx = 10 (P = .029). However, machine-learning models demonstrated early thermal signals associated with skin toxicity after the fifth RT fraction. The cross-validated model showed high prediction accuracy on the independent test data (test accuracy = 0.87) at fx = 5 for predicting skin toxicity at the end of RT. CONCLUSIONS Early thermal markers after 5 fractions of RT are predictive of radiation-induced skin toxicity in breast RT.
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Affiliation(s)
- Khadijeh Saednia
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Electrical Engineering and Computer Science, York University, Toronto, Canada
| | - Sami Tabbarah
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Andrew Lagree
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Tina Wu
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jonathan Klein
- Department of Radiation Oncology, Albert Einstein College of Medicine, New York City, New York
| | - Eduardo Garcia
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Michael Hall
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Eileen Rakovitch
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Charmaine Childs
- Department of Radiotherapy & Oncology, Sheffield Hallam University, Sheffield, United Kingdom
| | - Ali Sadeghi-Naini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Electrical Engineering and Computer Science, York University, Toronto, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - William T Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Radiotherapy & Oncology, Sheffield Hallam University, Sheffield, United Kingdom; Department of Biomedical Physics, Ryerson University, Toronto, Canada.
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18
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Nolan MW, Kelsey KL, Enomoto M, Ru H, Gieger TL, Lascelles BDX. Pet Dogs with Subclinical Acute Radiodermatitis Experience Widespread Somatosensory Sensitization. Radiat Res 2019; 193:241-248. [PMID: 31877255 DOI: 10.1667/rr15468.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Radiation-induced dermatitis (RID) is a common and painful complication of radiotherapy. When severe, radiation-associated pain (RAP) can reduce the efficacy of radiotherapy by limiting the radiation dose given, and/or necessitating breaks in treatment. Current RAP mitigation strategies are of limited efficacy. Our long-term goal is to develop a comparative oncology model, in which novel analgesic interventions for RAP can be evaluated. The aim of this study was to validate quantitative end points indicative of RAP in pet dogs with subclinical and low-grade RID. Extremity soft tissue sarcomas were treated with post-operative irradiation (54 Gy in 18 fractions). Visual toxicity scores, questionnaire-based pain instruments and objective algometry [mechanical quantitative sensory testing (mQST)], were evaluated regularly. Breed-matched control populations were also evaluated to address the effect of potential confounders. Skin biopsies from within the irradiated field were collected at baseline and after 24 Gy irradiation, for analysis of pain-related genes using the nanoString nCounter platform. Relative to control populations, mechanical thresholds decreased in irradiated test subjects as the total radiation dose increased, with the most pronounced effect at the irradiated site. This was accompanied by increased mRNA expression of GFRα3, TNFα, TRPV2 and TRPV4. In a separate set of dogs with moderate-to-severe RID, serum concentrations of artemin (the ligand for GFRα3) were elevated relative to controls (P = 0.015). Progressive reduction in mechanical thresholds, both locally and remotely, indicates widespread somatosensory sensitization during radiation treatment. mQST in pet dogs undergoing radiation treatment represents an innovative tool for preclinical evaluation of novel analgesics.
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Affiliation(s)
- Michael W Nolan
- Departments of Clinical Sciences.,Departments of Comparative Medicine Institute.,Departments of Translational Research in Pain, Comparative Pain Research and Education Centre, North Carolina State University, Raleigh, North Carolina 27607
| | | | | | - Hongyu Ru
- Departments of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27607
| | - Tracy L Gieger
- Departments of Clinical Sciences.,Departments of Comparative Medicine Institute
| | - B Duncan X Lascelles
- Departments of Clinical Sciences.,Departments of Comparative Medicine Institute.,Departments of Translational Research in Pain, Comparative Pain Research and Education Centre, North Carolina State University, Raleigh, North Carolina 27607
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19
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What Can We Learn From Researching in an Overcrowded Research Area? Lessons Learned From the 50 Years of Research on Radiation Dermatitis. Cancer Nurs 2019; 42:343-344. [PMID: 31436600 DOI: 10.1097/ncc.0000000000000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Chan RJ, Blades R, Jones L, Downer TR, Peet SC, Button E, Wyld D, McPhail S, Doolan M, Yates P. A single-blind, randomised controlled trial of StrataXRT® - A silicone-based film-forming gel dressing for prophylaxis and management of radiation dermatitis in patients with head and neck cancer. Radiother Oncol 2019; 139:72-78. [PMID: 31445838 DOI: 10.1016/j.radonc.2019.07.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 01/01/2023]
Abstract
AIM Investigate the effects of StrataXRT® versus 10% Glycerine (Sorbolene cream) for preventing and managing radiation dermatitis in patients with head and neck cancer receiving radical radiotherapy (≥50 Gy) with or without chemotherapy or biotherapy. METHODS A single-blind, randomised controlled, superiority trial was conducted. Patients either received StrataXRT® or Sorbolene (usual care). Skin toxicity, pain, itching and skin-related quality of life scores were collected from baseline, and up to four weeks post-treatment. RESULTS A total of 197 patients were randomised into the study. Skin toxicity was dependent on the treatment group with StrataXRT® patients experiencing lower mean skin toxicity at the end of the radiation treatment (P = 0.002). At the end of treatment, the StrataXRT® arm had a lower percentage of grade 2 (80%) and grade 3 (28%) skin toxicity compared to the sorbolene arm (91% and 45% respectively). After adjustment for Cetuximab, the StrataXRT® arm had a 12% lower risk of experiencing grade 2 skin toxicity (RRR = 0.876, 95% CI: 0.778-0.987, P = 0.031); and a 36% lower risk of experiencing grade 3 skin toxicity (RRR = 0.648, 95% CI: 0.442-0.947, P = 0.025). Cox regression analysis showed that patients receiving StrataXRT® had a 41.0% and 49.4% reduced risks of developing grade 2 and 3 skin toxicity respectively throughout treatment compared to the Sorbolene arm. There were no differences between groups in patient-reported outcomes. No treatment interruptions and study product related adverse events were reported in either arm. CONCLUSION StrataXRT® is effective for preventing, and delaying the development of grade 2 and 3 skin toxicity. TRIAL REGISTRATION ACTRN12616000511437.
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Affiliation(s)
- Raymond J Chan
- Princess Alexandra Hospital, Metro South Health and Hospital Services, Woolloongabba, Q4102, Queensland, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, Q4059, Queensland, Australia.
| | - Rae Blades
- School of Nursing, Queensland University of Technology, Kelvin Grove, Q4059, Queensland, Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Q4029, Queensland, Australia
| | - Lee Jones
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Q4029, Queensland, Australia
| | - Tai-Rae Downer
- School of Nursing, Queensland University of Technology, Kelvin Grove, Q4059, Queensland, Australia
| | - Samuel C Peet
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Q4029, Queensland, Australia
| | - Elise Button
- School of Nursing, Queensland University of Technology, Kelvin Grove, Q4059, Queensland, Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Q4029, Queensland, Australia
| | - David Wyld
- School of Nursing, Queensland University of Technology, Kelvin Grove, Q4059, Queensland, Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Q4029, Queensland, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, Q4029, Queensland, Australia
| | - Melissa Doolan
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Q4029, Queensland, Australia
| | - Patsy Yates
- Princess Alexandra Hospital, Metro South Health and Hospital Services, Woolloongabba, Q4102, Queensland, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, Q4059, Queensland, Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Q4029, Queensland, Australia
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21
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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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22
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Iyama A, Matsuyama T, Matsumoto E, Araki T, Inokuchi S, Yamashita M, Honda N, Miyake T, Saito T, Toya R, Kai Y, Yamashita Y, Oya N. Effect of metal-containing topical agents on surface doses received during external irradiation. JOURNAL OF RADIATION RESEARCH 2018; 59:794-799. [PMID: 30247674 PMCID: PMC6251421 DOI: 10.1093/jrr/rry078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/24/2018] [Indexed: 06/08/2023]
Abstract
The ability of topical metal-containing agents (MCAs) to enhance radiation dermatitis remains controversial. In the present study, we evaluated increases in surface doses associated with topical agents at different application thicknesses and with MCAs versus non-metal containing agents (NMCAs). We assessed two clinically available MCAs, zinc oxide ointment (ZOO) and silver sulfadiazine cream (SSDC), and eight NMCAs. Surface doses were measured using a Markus chamber placed on a polystyrene phantom. To evaluate the role of application thickness, each agent was applied to the chamber in oil-slick (<0.1-mm), 1-mm and 5-mm layers prior to irradiation of a 10 × 10 cm field with 4-, 6- and 10-MV X-ray beams. The surface dose enhancement ratio (SDER) was calculated as the ratio of the surface dose with an agent to the dose without an agent. The SDER values for the eight NMCAs, ZOO and SSDC at an oil-slick thickness were 101.6-104.6% (mean: 103.3%), 104.5% and 105.0%, respectively, using a 6-MV X-ray beam. The corresponding values at a 1-mm thickness were 196.8-237.8% (mean: 215.7%), 229.3% and 201.4%, respectively, and those at a 5-mm thickness were 342.2-382.4% (mean: 357.9%), 357.1% and 352.6%, respectively. A similar tendency was found using 4- and 10-MV X-ray beams. The lack of a significant difference in surface dose enhancement between MCAs and NMCAs, particularly when applied in oil-slick layers, suggests that MCAs do not need to be avoided or applied in a restricted manner during radiotherapy for dosimetric reasons.
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Affiliation(s)
- Ayumi Iyama
- Department of Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Kumamoto, Kumamoto, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1, Honjo, Kumamoto, Kumamoto, Japan
| | - Eriko Matsumoto
- Department of Radiology, Amakusa Central General Hospital, Kumamoto, Japan
| | - Takafumi Araki
- Department of Radiology, Amakusa Central General Hospital, Kumamoto, Japan
| | - Satoshi Inokuchi
- Department of Radiology, Amakusa Central General Hospital, Kumamoto, Japan
| | - Mizuki Yamashita
- Department of Radiology, Amakusa Central General Hospital, Kumamoto, Japan
| | - Noritoshi Honda
- Department of Dermatology, Amakusa Central General Hospital, Kumamoto, Japan
| | - Taiga Miyake
- Department of Dermatology, Amakusa Central General Hospital, Kumamoto, Japan
| | - Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1, Honjo, Kumamoto, Kumamoto, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1, Honjo, Kumamoto, Kumamoto, Japan
| | - Yudai Kai
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1, Honjo, Kumamoto, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Kumamoto, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1, Honjo, Kumamoto, Kumamoto, Japan
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Yee C, Wang K, Asthana R, Drost L, Lam H, Lee J, Vesprini D, Leung E, DeAngelis C, Chow E. Radiation-induced Skin Toxicity in Breast Cancer Patients: A Systematic Review of Randomized Trials. Clin Breast Cancer 2018; 18:e825-e840. [DOI: 10.1016/j.clbc.2018.06.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/05/2018] [Accepted: 06/29/2018] [Indexed: 11/25/2022]
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Sekiguchi K, Akahane K, Ogita M, Haga C, Ito R, Arai S, Ishida Y, Tsukada Y, Kawamori J. Efficacy of heparinoid moisturizer as a prophylactic agent for radiation dermatitis following radiotherapy after breast-conserving surgery: a randomized controlled trial. Jpn J Clin Oncol 2018; 48:450-457. [PMID: 29635534 PMCID: PMC5926546 DOI: 10.1093/jjco/hyy045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/28/2018] [Indexed: 11/14/2022] Open
Abstract
Background The application of heparinoid moisturizer for 2 weeks following whole-breast radiotherapy (WBRT) was previously reported to significantly increase skin water content (WC) and help improve skin dryness and desquamation. The prospective open-label, randomized trial included an exploratory arm to investigate the preventive efficacy of heparinoid moisturizer for acute radiation dermatitis (ARD). Methods Between April 2011 and April 2013, patients receiving WBRT were assigned (1:2:2) to receive either: moisturizer for prophylaxis (group P), moisturizer starting 2 weeks after WBRT for treatment (group M), and no moisturizer (group C). This paper presents the results of comparison between the exploratory arm and no moisturizer group. Skin WC was measured prior to WBRT, on the last day of WBRT, and 2 weeks, 4 weeks and 3 months following WBRT. Signs and symptoms were also assessed. Results Comparing two groups, WC values were significantly higher in group P until 4 weeks following WBRT. At 2 weeks following WBRT, mean WC values in group P and C were 38.5 ± 6.1 arbitrary units (a.u.) and 30.2 ± 7.8 a.u., respectively (P < 0.001). In group C, dryness was more severe at 2 and 4 weeks following WBRT and desquamation more severe until 3 months following WBRT. However, the erythema score showed no difference between the two groups. Regarding symptoms, group C pain scores on the last day of WBRT were significantly higher than in group P (P < 0.030). Conclusions The preventive application of heparinoid moisturizer has the potential of reducing skin desquamation and dryness in patients receiving WBRT.
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Affiliation(s)
- Kenji Sekiguchi
- Department of Radiation Oncology, St. Luke's International Hospital.,Department of Radiation Oncology, Sonoda-kai Radiation Oncology Clinic, Tokyo
| | - Keiko Akahane
- Department of Radiology, Saitama Medical Center Jichi Medical University, Saitama
| | - Mami Ogita
- Department of Radiation Oncology, St. Luke's International Hospital.,Department of Radiology, The University of Tokyo Hospital
| | - Chiori Haga
- Department of Radiation Oncology, St. Luke's International Hospital
| | - Ryoko Ito
- Department of Radiation Oncology, St. Luke's International Hospital
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital
| | - Yasushi Ishida
- Center for Clinical Epidemiology, St. Luke's International Hospital
| | - Yoichiro Tsukada
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital
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Zhu W, Jia L, Chen G, Zhao H, Sun X, Meng X, Zhao X, Xing L, Yu J, Zheng M. Epigallocatechin-3-gallate ameliorates radiation-induced acute skin damage in breast cancer patients undergoing adjuvant radiotherapy. Oncotarget 2018; 7:48607-48613. [PMID: 27224910 PMCID: PMC5217042 DOI: 10.18632/oncotarget.9495] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/04/2016] [Indexed: 11/25/2022] Open
Abstract
There are few effective treatment options for radiation-induced dermatitis in breast cancer patients. We conducted a single-arm trial to tested the hypothesis that topical epigallocatechin-3-gallate (EGCG) is effective against radiation-induced dermatitis in breast cancer patients undergoing radiotherapy. Forty-nine patients participated in this study. The patients underwent mastectomy followed by adjuvant radiotherapy. Topical EGCG was applied daily, starting when grade I dermatitis appeared and ending two weeks after radiotherapy. The maximum dermatitis observed during the EGCG treatment was as follows: Grade 1 toxicity, 71.4% (35 patients); grade 2 toxicity, 28.6% (14 patients); there were no patients with grade 3 or 4 toxicity. The majority of the radiation-induced dermatitis was observed 1 week after the end of radiotherapy. EGCG reduced the pain in 85.7% of patients, burning-feeling in 89.8%, itching in 87.8%, pulling in 71.4%, and tenderness in 79.6%. These findings suggest topical EGCG may be an effective treatment for radiation-induced dermatitis and has acceptable toxicity.
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Affiliation(s)
- Wanqi Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Li Jia
- Department of Radiation Oncology, Jinan Fourth People's Hospital, Jinan, Shandong, China
| | - Guanxuan Chen
- Shandong Key Laboratory of Radiation Oncology, Jinan, Shandong, China
| | - Hanxi Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Xiaorong Sun
- Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Xiangjiao Meng
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Xianguang Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Key Laboratory of Radiation Oncology, Jinan, Shandong, China
| | - Meizhu Zheng
- Shandong Key Laboratory of Radiation Oncology, Jinan, Shandong, China
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Cleary JF, Anderson BM, Eickhoff JC, Khuntia D, Fahl WE. Significant suppression of radiation dermatitis in breast cancer patients using a topically applied adrenergic vasoconstrictor. Radiat Oncol 2017; 12:201. [PMID: 29273054 PMCID: PMC5741935 DOI: 10.1186/s13014-017-0940-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/04/2017] [Indexed: 11/30/2022] Open
Abstract
Background Our previous studies showed that vasoconstrictor applied topically to rat skin minutes before irradiation completely prevented radiodermatitis. Here we report on a Phase IIa study of topically applied NG12-1 vasoconstrictor to prevent radiodermatitis in post-lumpectomy breast cancer patients who received at least 40 Gray to the whole breast using standard regimens. Methods Patients had undergone surgery for Stage Ia, Ib, or IIa infiltrating ductal or lobular carcinoma of the breast or ductal carcinoma in situ. NG12-1 formulation was applied topically to the same 50-cm2 treatment site within the radiation field 20 min before each daily radiotherapy fraction. Results Scores indicated significant reductions in radiodermatitis at the NG12-1 treatment site versus control areas in the same radiotherapy field. The mean dermatitis score for all subjects was 0.47 (SD 0.24) in the NG12-1-treated area versus 0.72 (SD 0.22) in the control area (P = 0.022). Analysis by two independent investigators indicated radiodermatitis reductions in 9 of the 9 patients with scorable radiodermatitis severity, and one patient with insufficient radiodermatitis to enable scoring. There were no serious adverse events from NG12-1 treatment. Conclusions Thirty, daily, NG12-1 treatments, topically applied minutes before radiotherapy, were well tolerated and conferred statistically significant reductions in radiodermatitis severity (P = 0.022). Trial registration NCT01263366; clinicaltrials.gov
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Affiliation(s)
- James F Cleary
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | | | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Deepak Khuntia
- Varian Medical Systems, Palo Alto, CA, USA.,Valley Medical Oncology, Pleasanton, CA, USA
| | - William E Fahl
- Department of Oncology, Wisconsin Institutes of Medical Research, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI, USA.
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Seité S, Bensadoun RJ, Mazer JM. Prevention and treatment of acute and chronic radiodermatitis. BREAST CANCER-TARGETS AND THERAPY 2017; 9:551-557. [PMID: 29138594 PMCID: PMC5677297 DOI: 10.2147/bctt.s149752] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
More than half the number of patients with cancer, who are treated with radiotherapy, will have radiodermatitis at some point during their treatment. Radiodermatitis either occurs early on in the treatment period or appears months or up to several years later. Acute radiodermatitis is a burn injury that varies in severity according to both treatment and inherent patient factors. Most acute radiodermatitis reactions resolve after several weeks but some reactions persist and can cause complications. Late-onset radiodermatitis is characterized by telangiectasia that forms on atrophic and fragile skin. These radiodermatitis reactions can have a significant negative impact on concomitant and subsequent therapeutic protocols and most particularly on the patient’s quality of life. Today, treatment of radiodermatitis reactions is in its infancy. Although there is insufficient evidence available to form recommendations that would prevent or reduce radiodermatitis, some advances have been made using low level light therapy (LLLT) or vascular lasers to control the symptoms. Some recent preclinical and clinical research suggests that LLLT has biostimulating properties which allow the tissues to regenerate and heal faster, reduce inflammation, and prevent fibrosis. Also, in late-onset radiodermatitis pulsed dye laser treatment has been shown to be beneficial in clearing radiation-induced telangiectasia. In the absence of evidence-based recommendations, the objective of this paper is to review how to prevent or manage the symptoms of radiodermatitis reactions.
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Affiliation(s)
- Sophie Seité
- La Roche-Posay Laboratoire Dermatologique, Levallois-Perret
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28
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Hasan H, Muhammed T, Yu J, Taguchi K, Samargandi OA, Howard AF, Lo AC, Olson R, Goddard K. "Assessing the methodological quality of systematic reviews in radiation oncology: A systematic review". Cancer Epidemiol 2017; 50:141-149. [PMID: 28915472 DOI: 10.1016/j.canep.2017.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/22/2017] [Accepted: 08/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the methodological quality of systematic reviews and meta-analyses in Radiation Oncology. METHODS A systematic literature search was conducted for all eligible systematic reviews and meta-analyses in Radiation Oncology from 1966 to 2015. Methodological characteristics were abstracted from all works that satisfied the inclusion criteria and quality was assessed using the critical appraisal tool, AMSTAR. Regression analyses were performed to determine factors associated with a higher score of quality. RESULTS Following exclusion based on a priori criteria, 410 studies (157 systematic reviews and 253 meta-analyses) satisfied the inclusion criteria. Meta-analyses were found to be of fair to good quality while systematic reviews were found to be of less than fair quality. Factors associated with higher scores of quality in the multivariable analysis were including primary studies consisting of randomized control trials, performing a meta-analysis, and applying a recommended guideline related to establishing a systematic review protocol and/or reporting. CONCLUSIONS Systematic reviews and meta-analyses may introduce a high risk of bias if applied to inform decision-making based on AMSTAR. We recommend that decision-makers in Radiation Oncology scrutinize the methodological quality of systematic reviews and meta-analyses prior to assessing their utility to inform evidence-based medicine and researchers adhere to methodological standards outlined in validated guidelines when embarking on a systematic review.
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Affiliation(s)
- Haroon Hasan
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada.
| | - Taaha Muhammed
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Jennifer Yu
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada
| | - Kelsi Taguchi
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada
| | - Osama A Samargandi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah, Saudi Arabia; Division of Plastic and Reconstructive Surgery, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, B3H 4R2, Canada
| | - A Fuchsia Howard
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Andrea C Lo
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada; Department of Surgery, Faculty of Medicine, 950 West 10th. Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Robert Olson
- British Columbia Cancer Agency - Centre for the North, 1215 Lethbridge Street, Prince George, British Columbia, V2M 7E9, Canada; Department of Surgery, Faculty of Medicine, 950 West 10th. Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Karen Goddard
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada; Department of Surgery, Faculty of Medicine, 950 West 10th. Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
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Abstract
Radiation therapy (RT) is an essential component for management of many cancers. Veterinary health care professionals must counsel owners about the potential side effects of RT, the anticipated management plan, and associated costs. For most veterinary patients treated with RT, acute radiation side effects are mild; however, careful radiation treatment planning and appropriate management of acute side effects are essential to try to prevent chronic sequelae and the need for ongoing wound care. This article reviews acute and late side effects to the skin and their management.
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Affiliation(s)
- Tracy Gieger
- Department of Clinical Sciences, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA.
| | - Michael Nolan
- Department of Clinical Sciences, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
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30
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Lucey P, Zouzias C, Franco L, Chennupati SK, Kalnicki S, McLellan BN. Practice patterns for the prophylaxis and treatment of acute radiation dermatitis in the United States. Support Care Cancer 2017; 25:2857-2862. [DOI: 10.1007/s00520-017-3701-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/31/2017] [Indexed: 01/22/2023]
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Abstract
Radiation dermatitis occurs frequently during adjuvant radiation therapy for breast cancer. Prevention of radiation dermatitis by applying various creams and ointments has a limited success, and Aqua cream which has urea as one of its active ingredients is used in many institutions as a preventive treatment. The primary goal of this study is to assess the effect of vitamin D (calcipotriol) ointment in prevention of radiodermatitis in breast cancer patients compared to Aqua cream. Twenty-three women with localized breast cancer who underwent breast-conserving surgery and opted to receive adjuvant radiotherapy to breast only were enrolled in this study. A cream containing an active vitamin D analog, calcipotriol (Daivonex), was randomly applied either to the medial or to the lateral half of the irradiated breast, while Aqua cream was applied to the complimentary half of the same breast along the whole treatment days, each day, after the delivery of radiation. Skin reaction was recorded and compared between the two halves of the breast. Vitamin D was well tolerated by patients with no local or systemic allergic reactions. Radiation dermatitis was not significantly different between both treatment arms. Topical vitamin D ointment is not superior to Aqua cream for prevention of radiation-induced dermatitis in women treated with adjuvant radiation for breast cancer. Vitamin D ointment is no better than urea cream at preventing radiation-induced skin damage in breast cancer patients. Researchers in Israel led by Eyal Fenig from the Rabin Medical Center in Petah Tikva studied 23 women with localized breast cancer who underwent breast-conserving surgery and received adjuvant radiation to destroy any tumor cells left behind. Each day after their radiation therapy, the women applied an active vitamin D analog called calcipotriol (Daivonex) to half of their irradiated breast and a skin-hydrating, urea-containing ointment called Aqua cream to the other half of the same breast. The topical vitamin D ointment was well tolerated by the study participants. However, there was no noticeable difference in the effect of calcipotriol or Aqua cream for the vast majority of the women.
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32
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Organizational Strategies for Building Capacity in Evidence-Based Oncology Nursing Practice. Nurs Clin North Am 2017; 52:149-158. [DOI: 10.1016/j.cnur.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nolan MW, Long CT, Marcus KL, Sarmadi S, Roback DM, Fukuyama T, Baeumer W, Lascelles BDX. Nocifensive Behaviors in Mice with Radiation-Induced Oral Mucositis. Radiat Res 2017; 187:397-403. [PMID: 28186468 DOI: 10.1667/rr14669.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Oral mucositis can result in significant dysphagia, and is the most common dose-limiting acute toxicity in head and neck cancer patients receiving chemoradiotherapy. There is a critical need to determine the cellular and molecular mechanisms that underlie radiotherapy-associated discomfort in patients with mucositis. The objective was to induce oral mucositis in mice, using a clinical linear accelerator, and to quantify resultant discomfort, and characterize peripheral sensitization. A clinical linear accelerator was used to deliver ionizing radiation to the oral cavity of mice. Mucositis severity scoring, and various behavioral assays were performed to quantify bouts of orofacial wiping and scratching, bite force, gnawing behavior and burrowing activity. Calcium imaging was performed on neurons of the trigeminal ganglia. Glossitis was induced with a single fraction of at least 27 Gy. Body weight decreased and subsequently returned to baseline, in concert with development and resolution of mucositis, which was worst at day 10 and 11 postirradiation, however was resolved within another 10 days. Neither bite force, nor gnawing behavior were measurably affected. However, burrowing activity was decreased, and both facial wiping and scratching were increased while mice had visible mucositis lesions. Sensory nerves of irradiated mice were more responsive to histamine, tumor necrosis factor alpha and capsaicin. Radiation-induced glossitis is associated with hyper-reactivity of sensory neurons in the trigeminal ganglia of mice, and is accompanied by several behaviors indicative of both itch and pain. These data validate an appropriate model for cancer treatment related discomfort in humans.
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Affiliation(s)
- Michael W Nolan
- North Carolina State University, College of Veterinary Medicine, a Department of Clinical Sciences, Raleigh, North Carolina 27607.,b Department of Comparative Medicine Institute, Raleigh, North Carolina 27607
| | - C Tyler Long
- c Molecular and Biomedical Sciences, Raleigh, North Carolina 27607
| | - Karen L Marcus
- North Carolina State University, College of Veterinary Medicine, a Department of Clinical Sciences, Raleigh, North Carolina 27607
| | - Shayan Sarmadi
- North Carolina State University, College of Veterinary Medicine, a Department of Clinical Sciences, Raleigh, North Carolina 27607
| | - Donald M Roback
- d Rex Cancer Center, Department of Radiation Oncology, Raleigh, North Carolina
| | - Tomoki Fukuyama
- d Rex Cancer Center, Department of Radiation Oncology, Raleigh, North Carolina
| | - Wolfgang Baeumer
- b Department of Comparative Medicine Institute, Raleigh, North Carolina 27607.,c Molecular and Biomedical Sciences, Raleigh, North Carolina 27607
| | - B Duncan X Lascelles
- North Carolina State University, College of Veterinary Medicine, a Department of Clinical Sciences, Raleigh, North Carolina 27607.,b Department of Comparative Medicine Institute, Raleigh, North Carolina 27607
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Thomas SEJ, Reimer-Kirkham S, Kohr R. Wound Dressings During Radiotherapy for Cancer: A Survey of Practice. Clin J Oncol Nurs 2017. [PMID: 26207722 DOI: 10.1188/15.cjon.e87-e91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients undergoing radiotherapy may experience changes to the skin that require dressings. Recommendations regarding radiating through wound dressings have been variable and relate to the concern regarding surface dose increase or bolus effect. OBJECTIVES The purpose of this article is to identify current evidence and practice through literature review and a national environmental scan. METHODS Nurses from 18 radiation oncology centers in Canada were surveyed about current practice. In-depth telephone interviews were conducted with four nurse participants to further understand the context of this issue within the nursing practice environment. FINDINGS The integrated results of the study were reviewed with five clinical experts to make recommendations for research, practice, leadership, and policy. Implications for clinical practice included the involvement of radiation oncology nurses in the treatment planning team, development of clinical practice tools, and the relevance of the Person-Centered Nursing framework for wound management during radiotherapy.
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35
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Topical interventions to prevent acute radiation dermatitis in head and neck cancer patients: a systematic review. Support Care Cancer 2016; 25:1001-1011. [DOI: 10.1007/s00520-016-3521-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 12/05/2016] [Indexed: 12/21/2022]
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36
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Singh M, Alavi A, Wong R, Akita S. Radiodermatitis: A Review of Our Current Understanding. Am J Clin Dermatol 2016; 17:277-92. [PMID: 27021652 DOI: 10.1007/s40257-016-0186-4] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Radiodermatitis (radiation dermatitis, radiation-induced skin reactions, or radiation injury) is a significant side effect of ionizing radiation delivered to the skin during cancer treatment as well as a result of nuclear attacks and disasters, such as that which occurred in Fukushima in 2011. More specifically, 95 % of cancer patients receiving radiation therapy will develop some form of radiodermatitis, including erythema, dry desquamation, and moist desquamation. These radiation skin reactions result in a myriad of complications, including delays in treatment, diminished aesthetic appeal, and reduced quality of life. Recent technological advancements and novel treatment regimens have only been successful in partly ameliorating these adverse side effects. This article examines the current knowledge surrounding the pathogenesis, clinical manifestations, differential diagnoses, prevention, and management of radiodermatitis. Future research should examine therapies that incorporate the current understanding of the pathophysiology of radiodermatitis while measuring effectiveness using objective and universal outcome measures.
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The Efficacy and Safety of Jaungo, a Traditional Medicinal Ointment, in Preventing Radiation Dermatitis in Patients with Breast Cancer: A Prospective, Single-Blinded, Randomized Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:9481413. [PMID: 27066103 PMCID: PMC4811089 DOI: 10.1155/2016/9481413] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/23/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Abstract
Purpose. This study was performed to evaluate the efficacy and safety of Jaungo in preventing radiation dermatitis in patients with breast cancer. Methods. Thirty patients were prospectively enrolled and randomly assigned to receive Jaungo or general supportive skin care. Radiation dermatitis and pain were examined at daily intervals from the start of radiotherapy until 4 weeks after its completion. The primary endpoint of this study was the incidence of radiation dermatitis. The secondary endpoints were time to onset of radiation dermatitis, duration of radiation dermatitis, and maximum pain score. Results. Jaungo reduced the incidence of grade ≥2 (46.7% versus 78.6%) and grade 3 radiation dermatitis (20.0% versus 50.0%) in comparison with general supportive skin care. Jaungo also delayed the onset of grade 2 dermatitis (35 days versus 30 days). In terms of time to onset of grade 3 dermatitis, duration of dermatitis, and maximum pain score, Jaungo showed results comparable to those achieved with general supportive skin care. No patients experienced adverse effects caused by Jaungo administration. Conclusions. Jaungo minimized radiation dermatitis in patients with breast cancer without causing adverse effects. Further randomized studies with a larger sample size are required to assess clinical use of Jaungo.
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Clinical Manifestation, Diagnosis, and Surgical Treatment of Chronic Radiation Ulcers Related to Percutaneous Coronary Intervention. Ann Plast Surg 2016; 76 Suppl 1:S68-73. [DOI: 10.1097/sap.0000000000000688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhao H, Zhu W, Jia L, Sun X, Chen G, Zhao X, Li X, Meng X, Kong L, Xing L, Yu J. Phase I study of topical epigallocatechin-3-gallate (EGCG) in patients with breast cancer receiving adjuvant radiotherapy. Br J Radiol 2015; 89:20150665. [PMID: 26607642 DOI: 10.1259/bjr.20150665] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the safety, tolerability and preliminary effectiveness of topical epigallocatechin-3-gallate (EGCG) for radiation dermatitis in patients with breast cancer receiving adjuvant radiotherapy. METHODS Patients with breast cancer who received radiotherapy to the chest wall after mastectomy were enrolled. EGCG solution was sprayed to the radiation field from the initiation of Grade 1 radiation dermatitis until 2 weeks after completion of radiotherapy. EGCG concentration escalated from 40 to 660 μmol l(-1) in 7 levels with 3-6 patients in each level. EGCG toxicity was graded using the NCI (National Cancer Institute Common Terminology Criteria for Adverse Events) v. 3.0. Any adverse event >Grade 1 attributed to EGCG was considered dose-limiting toxicity. The maximum tolerated dose was defined as the dose level that induced dose-limiting toxicity in more than one-third of patients at a given cohort. Radiation dermatitis was recorded weekly by the Radiation Therapy Oncology Group scoring and patient-reported symptoms. RESULTS From March 2012 to August 2013, 24 patients were enrolled. Acute skin redness was observed in 1 patient and considered to be associated with the EGCG treatment at 140 μmol l(-1) level. Three more patients were enrolled at this level and did not experience toxicity to EGCG. The dose escalation stopped at 660 μmol l(-1). No other reported acute toxicity was associated with EGCG. Grade 2 radiation dermatitis was observed in eight patients during or after radiotherapy, but all decreased to Grade 1 after EGCG treatments. Patient-reported symptom scores were significantly decreased at 2 weeks after the end of radiotherapy in pain, burning, itching and tenderness, p < 0.05. CONCLUSION The topical administration of EGCG was well tolerated and the maximum tolerated dose was not found. EGCG may be effective in treating radiation dermatitis with preliminary investigation. ADVANCES IN KNOWLEDGE EGCG solution seemed to be feasible for treating radiation dermatitis in patients with breast cancer after mastectomy. It should be tested as a way to reduce radiation-induced normal tissue toxicity and complications in future years.
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Affiliation(s)
- Hanxi Zhao
- 1 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong
| | - Wanqi Zhu
- 1 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong
| | - Li Jia
- 2 Department of Radiation Oncology, Jinan Fourth People's Hospital, Jinan, Shandong
| | - Xiaorong Sun
- 3 Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong.,4 Shandong Key Laboratory of Radiation Oncology, Jinan, Shandong, China
| | - Guanxuan Chen
- 4 Shandong Key Laboratory of Radiation Oncology, Jinan, Shandong, China
| | - Xianguang Zhao
- 1 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong
| | - Xiaolin Li
- 1 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong
| | - Xiangjiao Meng
- 1 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong
| | - Lingling Kong
- 1 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong
| | - Ligang Xing
- 1 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong.,4 Shandong Key Laboratory of Radiation Oncology, Jinan, Shandong, China
| | - Jinming Yu
- 1 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong.,4 Shandong Key Laboratory of Radiation Oncology, Jinan, Shandong, China
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Sekiguchi K, Ogita M, Akahane K, Haga C, Ito R, Arai S, Ishida Y, Tsukada Y, Kawamori J. Randomized, prospective assessment of moisturizer efficacy for the treatment of radiation dermatitis following radiotherapy after breast-conserving surgery. Jpn J Clin Oncol 2015; 45:1146-53. [PMID: 26491204 PMCID: PMC4653048 DOI: 10.1093/jjco/hyv155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
Abstract
Objective The effect of heparinoid moisturizer use after acute skin damage for patients receiving whole-breast radiotherapy after lumpectomy is understudied. Methods A total of 30 patients were randomly assigned to receive heparinoid moisturizer (Group M), and 32 patients comprised the control group (Group C). Patients in Group M were instructed to apply heparinoid moisturizer from 2 weeks following whole-breast radiotherapy, and to continue to use the moisturizer until 3 months after completion of whole-breast radiotherapy. Group C patients were instructed to not apply any topical moisturizer during the study period. The relative ratio of skin water content ratio (RWCR(t)= (It /Nt)/(I0/N0)) between irradiated and non-irradiated field was calculated. Signs and symptoms were also assessed. The primary endpoint was the difference in relative ratio of skin water content ratio between 2 and 4 weeks following whole-breast radiotherapy. Results In Group C, relative ratio of skin water content ratio dropped to 0.80 ± 0.15 at 2 weeks and maintained the low level at 4 weeks following whole-breast radiotherapy. Similarly, in Group M, relative ratio of skin water content ratio dropped to 0.81 ± 0.19 at 2 weeks (prior to application), however, it returned to baseline level (1.05 ± 0.23) at 4 weeks (2 weeks after application). The arithmetic difference of relative ratio of skin water content ratio in Group M was 0.24 ± 0.23 and was significantly larger than in Group C (0.06 ± 0.15; P < 0.01). Skin dryness and desquamation were less severe in Group M. Conclusions The application of heparinoid moisturizer for 2 weeks following whole-breast radiotherapy significantly increased water content and helped improve skin dryness and desquamation compared with no use of moisturizer.
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Affiliation(s)
- Kenji Sekiguchi
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo
| | - Mami Ogita
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo
| | - Keiko Akahane
- Department of Radiology, Saitama Medical Center Jichi Medical University, Saitama
| | - Chiori Haga
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo
| | - Ryoko Ito
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital, Tokyo
| | - Yasushi Ishida
- Center for Clinical Epidemiology, St. Luke's International Hospital, Tokyo
| | - Yoichiro Tsukada
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo
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Prophylactic Treatment with Adlay Bran Extract Reduces the Risk of Severe Acute Radiation Dermatitis: A Prospective, Randomized, Double-Blind Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:312072. [PMID: 26495009 PMCID: PMC4606150 DOI: 10.1155/2015/312072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/02/2015] [Indexed: 11/17/2022]
Abstract
Acute radiation dermatitis is a frequent adverse effect in patients with breast cancer undergoing radiotherapy, but there are only a small number of studies providing evidence-based interventions for this clinical condition. Adlay is a cereal crop that has been previously shown to have anti-inflammatory and antioxidant properties. In this study, we seek to evaluate the effectiveness of oral prophylactic treatment with adlay bran extract in reducing the risk of severe acute radiation dermatitis. A total of 110 patients with breast cancer undergoing radiotherapy were analyzed. Using a prospective, randomized, double-blind design, 73 patients received oral treatment with adlay bran extract and 37 patients received olive oil (placebo). Treatment was started at the beginning of radiation therapy and continued until the termination of radiation treatment. Our results showed that the occurrence of severe acute radiation dermatitis (RTOG grade 2 or higher) was significantly lower in patients treated with oral adlay bran extract compared to placebo (45.2% versus 75.7%, adjusted odds ratio 0.24). No serious adverse effects from adlay bran treatment were noted. In conclusion, prophylactic oral treatment with adlay bran extract reduces the risk of severe acute radiation dermatitis and may have potential use in patients with breast cancer undergoing radiotherapy.
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Kang HC, Ahn SD, Choi DH, Kang MK, Chung WK, Wu HG. The safety and efficacy of EGF-based cream for the prevention of radiotherapy-induced skin injury: results from a multicenter observational study. Radiat Oncol J 2014; 32:156-62. [PMID: 25324987 PMCID: PMC4194298 DOI: 10.3857/roj.2014.32.3.156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/24/2014] [Accepted: 08/11/2014] [Indexed: 12/24/2022] Open
Abstract
Purpose This study was designed to evaluate the efficacy and safety of topically applied recombinant human epidermal growth factor (rhEGF) for the prevention of radiation-induced dermatitis in cancer patients. Materials and Methods From December 2010 to April 2012, a total of 1,172 cancer patients who received radiotherapy (RT) of more than 50 Gy were prospectively enrolled and treated with EGF-based cream. An acute skin reaction classified according to the Radiation Therapy Oncology Group 6-point rating scale was the primary end point and we also assessed the occurrence of edema, dry skin, or pruritus. Results The percentage of radiation dermatitis with maximum grade 0 and grade 1 was 19% and 58% at the time of 50 Gy, and it became 29% and 47% after completion of planned RT. This increment was observed only in breast cancer patients (from 18%/62% to 32%/49%). Adverse events related to the EGF-based cream developed in 49 patients (4%) with mild erythema the most common. Skin toxicity grade >2 was observed in 5% of the patients. Edema, dry skin, and pruritus grade ≥3 developed in 9%, 9%, and 1% of the patients, respectively. Conclusion Prophylactic use of an EGF-based cream is effective in preventing radiation dermatitis with tolerable toxicity. Further studies comparing EGF cream with other topical agents may be necessary.
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Affiliation(s)
- Hyun-Cheol Kang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Seung-Do Ahn
- Department of Radiation Oncology, Asan Medical Center, Seoul, Korea
| | - Doo-Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Woong-Ki Chung
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Huasun, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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Natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer: a phase 3, double-blind, randomized, controlled trial. Int J Radiat Oncol Biol Phys 2014; 90:756-64. [PMID: 25151541 DOI: 10.1016/j.ijrobp.2014.06.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/21/2014] [Accepted: 06/11/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the effects of a natural oil-based emulsion containing allantoin versus aqueous cream for preventing and managing radiation-induced skin reactions. METHODS AND MATERIALS A total of 174 patients were randomized and participated in the study. Patients received either cream 1 (the natural oil-based emulsion containing allantoin) or cream 2 (aqueous cream). Skin toxicity, pain, itching, and skin-related quality of life scores were collected for up to 4 weeks after radiation treatment. RESULTS Patients who received cream 1 had a significantly lower average level of Common Terminology Criteria for Adverse Events at week 3 (P<.05) but had statistically higher average levels of skin toxicity at weeks 7, 8, and 9 (all P<.001). Similar results were observed when skin toxicity was analyzed by grades. With regards to pain, patients in the cream 2 group had a significantly higher average level of worst pain (P<.05) and itching (P=.046) compared with the cream 1 group at week 3; however, these differences were not observed at other weeks. In addition, there was a strong trend for cream 2 to reduce the incidence of grade 2 or more skin toxicity in comparison with cream 1 (P=.056). Overall, more participants in the cream 1 group were required to use another topical treatment at weeks 8 (P=.049) and 9 (P=.01). CONCLUSION The natural oil-based emulsion containing allantoin seems to have similar effects for managing skin toxicity compared with aqueous cream up to week 5; however, it becomes significantly less effective at later weeks into the radiation treatment and beyond treatment completion (week 6 and beyond). There were no major differences in pain, itching, and skin-related quality of life. In light of these results, clinicians and patients can base their decision on costs and preferences. Overall, aqueous cream seems to be a more preferred option.
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Mancini ML, Sonis ST. Mechanisms of cellular fibrosis associated with cancer regimen-related toxicities. Front Pharmacol 2014; 5:51. [PMID: 24734020 PMCID: PMC3973915 DOI: 10.3389/fphar.2014.00051] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/09/2014] [Indexed: 11/26/2022] Open
Abstract
Fibrosis is a common, persistent and potentially debilitating complication of chemotherapy and radiation regimens used for the treatment of cancer. The molecular mechanisms underlying fibrosis have been well studied and reveal overall processes that are largely ubiquitous. However, it is important to note that although the processes are similar, they result in cellular phenotypes that are highly tissue specific. These tissue specific differences may present opportunities for therapeutic interventions to prevent or treat this often irreversible condition. Data generated from animal models of cancer therapy-related tissue toxicities have revealed that the signaling pathways involved in fibrosis are the same as those involved in the normal injury response and include the transforming growth factor β superfamily and a range of pro-inflammatory cytokines. The critical difference between normal wound healing and fibrosis development appears to be, that in fibrosis, these signaling pathways escape normal cellular regulation. As a result, an injury state is maintained and processes involved in normal healing are usurped. There are a few, if any, therapeutics that effectively prevent or treat fibrosis in patients. Consequently, cancer survivors may be chronically plagued with a variety of life-altering fibrosis-related symptoms. Uncovering the signaling pathways that drive cellular fibrosis is paramount to the development of specific therapeutics that will mitigate this potentially devastating condition.
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Chan RJ, Webster J, Chung B, Marquart L, Ahmed M, Garantziotis S. Prevention and treatment of acute radiation-induced skin reactions: a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 2014; 14:53. [PMID: 24484999 PMCID: PMC3909507 DOI: 10.1186/1471-2407-14-53] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Radiation-induced skin reaction (RISR) is a common side effect that affects the majority of cancer patients receiving radiation treatment. RISR is often characterised by swelling, redness, pigmentation, fibrosis, and ulceration, pain, warmth, burning, and itching of the skin. The aim of this systematic review was to assess the effects of interventions which aim to prevent or manage RISR in people with cancer. METHODS We searched the following databases up to November 2012: Cochrane Skin Group Specialised Register, CENTRAL (2012, Issue 11), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), CINAHL (from 1981) and LILACS (from 1982). Randomized controlled trials evaluating interventions for preventing or managing RISR in cancer patients were included. The primary outcomes were development of RISR, and levels of RISR and symptom severity. Secondary outcomes were time taken to develop erythema or dry desquamation; quality of life; time taken to heal, a number of skin reaction and symptom severity measures; cost, participant satisfaction; ease of use and adverse effects. Where appropriate, we pooled results of randomized controlled trials using mean differences (MD) or odd ratios (OR) with 95% confidence intervals (CI). RESULTS Forty-seven studies were included in this review. These evaluated six types of interventions (oral systemic medications; skin care practices; steroidal topical therapies; non-steroidal topical therapies; dressings and other). Findings from two meta-analyses demonstrated significant benefits of oral Wobe-Mugos E for preventing RISR (OR 0.13 (95% CI 0.05 to 0.38)) and limiting the maximal level of RISR (MD -0.92 (95% CI -1.36 to -0.48)). Another meta-analysis reported that wearing deodorant does not influence the development of RISR (OR 0.80 (95% CI 0.47 to 1.37)). CONCLUSIONS Despite the high number of trials in this area, there is limited good, comparative research that provides definitive results suggesting the effectiveness of any single intervention for reducing RISR. More research is required to demonstrate the usefulness of a wide range of products that are being used for reducing RISR. Future efforts for reducing RISR severity should focus on promising interventions, such as Wobe-Mugos E and oral zinc.
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Affiliation(s)
- Raymond Javan Chan
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston Q4029, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove Q4059, Australia
- Centre for Health Practice Innovation, Griffith University, Nathan Q4111, Australia
| | - Joan Webster
- School of Nursing, Queensland University of Technology, Kelvin Grove Q4059, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston Q4029, Australia
- Centre for Health Practice Innovation, Griffith University, Nathan Q4111, Australia
| | - Bryan Chung
- Division of Plastic Surgery, QEII Health Science Centre, Halifax, Canada
| | - Louise Marquart
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Brisbane Q4029, Australia
| | - Muhtashimuddin Ahmed
- Safety and Quality Unit, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston Q4029, Australia
| | - Stuart Garantziotis
- Centre for Health Practice Innovation, Griffith University, Nathan Q4111, Australia
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Leung TH, Zhang LF, Wang J, Ning S, Knox SJ, Kim SK. Topical hypochlorite ameliorates NF-κB-mediated skin diseases in mice. J Clin Invest 2013; 123:5361-70. [PMID: 24231355 DOI: 10.1172/jci70895] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 09/12/2013] [Indexed: 11/17/2022] Open
Abstract
Nuclear factor-κB (NF-κB) regulates cellular responses to inflammation and aging, and alterations in NF-κB signaling underlie the pathogenesis of multiple human diseases. Effective clinical therapeutics targeting this pathway remain unavailable. In primary human keratinocytes, we found that hypochlorite (HOCl) reversibly inhibited the expression of CCL2 and SOD2, two NF-κB-dependent genes. In cultured cells, HOCl inhibited the activity of inhibitor of NF-κB kinase (IKK), a key regulator of NF-κB activation, by oxidizing cysteine residues Cys114 and Cys115. In NF-κB reporter mice, topical HOCl reduced LPS-induced NF-κB signaling in skin. We further evaluated topical HOCl use in two mouse models of NF-κB-driven epidermal disease. For mice with acute radiation dermatitis, topical HOCl inhibited the expression of NF-κB-dependent genes, decreased disease severity, and prevented skin ulceration. In aged mice, topical HOCl attenuated age-dependent production of p16INK4a and expression of the DNA repair gene Rad50. Additionally, skin of aged HOCl-treated mice acquired enhanced epidermal thickness and proliferation, comparable to skin in juvenile animals. These data suggest that topical HOCl reduces NF-κB-mediated epidermal pathology in radiation dermatitis and skin aging through IKK modulation and motivate the exploration of HOCl use for clinical aims.
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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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Evaluating the relevance of dosimetric considerations to patient instructions regarding skin care during radiation therapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013. [DOI: 10.1017/s1460396913000241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractIntroductionPatient teaching in radiation therapy may include restrictions on applying skin products owing to concerns that the presence of such materials may increase skin dose. These restrictions may create unnecessarily complicated and conflicting self-care instructions.PurposeTo determine what thickness of skin product is necessary to produce a clinically meaningful dose increase to the skin, and provide recommendations for evidence-based patient instructions.MethodsDosimetric measurements and Monte Carlo simulations were used to calculate skin dose under 0–1·5 mm thicknesses of two common classes of skin product for a variety of treatment geometries. The thickness of product required to produce a clinically significant dose increase to the skin was determined.ResultsThe thickness of product required to create a clinically meaningful dose increase was >0·7 mm for 10 × 10 cm2 fields and >1·5 mm for 1 × 1 cm2 fields. A typical application of product would be only 0·3 mm.ConclusionIt seems unrealistic to anticipate patients using sufficiently large quantities of skin product to be of clinical concern. We therefore recommend that there are no dosimetric reasons to restrict the use of these types of skin products during radiation therapy for common treatment scenarios.
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Chan RJ. Response to "Topical agent therapy for prevention and treatment of radiodermatitis: a meta-analysis". Support Care Cancer 2013; 21:1801-2. [PMID: 23393004 DOI: 10.1007/s00520-013-1737-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/28/2013] [Indexed: 11/28/2022]
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Chan RJ, Keller J, Cheuk R, Blades R, Tripcony L, Keogh S. A double-blind randomised controlled trial of a natural oil-based emulsion (Moogoo Udder Cream®) containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer. Radiat Oncol 2012; 7:121. [PMID: 22849762 PMCID: PMC3419129 DOI: 10.1186/1748-717x-7-121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/19/2012] [Indexed: 11/10/2022] Open
Abstract
Background Radiation-induced skin reaction (RISR) is one of the most common and distressing side effects of radiotherapy in patients with cancer. It is featured with swelling, redness, itching, pain, breaks in skin, discomfort, and a burning sensation. There is a lack of convincing evidence supporting any single practice in the prevention or management of RISR. Methods/Designs This double-blinded randomised controlled trial aims to investigate the effects of a natural oil-based emulsion containing allantoin (as known as Moogoo Udder Cream®) versus aqueous cream in reducing RISR, improving pain, itching and quality of life in this patient group. One group will receive Moogoo Udder Cream®. Another group will receive aqueous cream. Outcome measures will be collected using patient self-administered questionnaire, interviewer administered questionnaire and clinician assessment at commencement of radiotherapy, weekly during radiotherapy, and four weeks after the completion of radiotherapy. Discussion Despite advances of radiologic advances and supportive care, RISR are still not well managed. There is a lack of efficacious interventions in managing RISR. While anecdotal evidence suggests that Moogoo Udder Cream® may be effective in managing RISR, research is needed to substantiate this claim. This paper presents the design of a double blind randomised controlled trial that will evaluate the effects of Moogoo Udder Cream® versus aqueous cream for managing in RISR in patients with cancer. Trial registration ACTRN 12612000568819
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Affiliation(s)
- Raymond Javan Chan
- Cancer Care Services, Royal Brisbane & Women's Hospital, Butterfield Street, Herston, QLD Q4029, Australia.
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