101
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Kulshrestha S, Chawla R, Singh S, Yadav P, Sharma N, Goel R, Ojha H, Kumar V, Adhikari J. Protection of sildenafil citrate hydrogel against radiation-induced skin wounds. Burns 2020; 46:1157-1169. [DOI: 10.1016/j.burns.2019.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/18/2019] [Accepted: 11/23/2019] [Indexed: 12/23/2022]
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102
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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: 18] [Impact Index Per Article: 4.5] [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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103
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Koukourakis G, Pissakas G, Ganos CG, Sivolapenko G, Kardamakis D. Effectiveness and Tolerability of Natural Herbal Formulations in the Prevention of Radiation-Induced Skin Toxicity in Patients Undergoing Radiotherapy. INT J LOW EXTR WOUND 2020; 21:75-86. [PMID: 32525718 DOI: 10.1177/1534734620923912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study is to investigate the preventive role of 3 herbal formulation products on reducing the incidence of radiation-induced dermatitis in patients undergoing radiotherapy for either breast or head and neck cancer. A total of 59 patients participated in the study. The novel herbal products, a combination of beeswax, olive oil, Calendula and Hypericum oils and Aloe gel, were daily and regularly being used by the patients during radiotherapy and 2 weeks after treatment end. Acute skin toxicity was scored weekly during radiotherapy and after treatment for a further 4-week follow-up period. Demographic data were analyzed by descriptive statistics. Statistical analyses of the study objectives were based on an intent-to-treat principle. Most of the patients presented with grade I (RTOG/EORTC) toxicity in the first weeks of radiotherapy, progressed to grade II but reverted to grade I toxicity up until the study end. A total of 94.9% of the patients had Dermatology Life Quality Index up to 1, and 66.1% remained in this scale. The application of the novel natural product combinations proved to be statistically significantly effective in reducing the intensity of radiation dermatitis, positively affecting the quality of life of the patients.
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104
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Ahn S, Sung K, Kim HJ, Choi YE, Lee YK, Kim JS, Lee SK, Roh JY. Reducing Radiation Dermatitis Using a Film-forming Silicone Gel During Breast Radiotherapy: A Pilot Randomized-controlled Trial. In Vivo 2020; 34:413-422. [PMID: 31882508 DOI: 10.21873/invivo.11790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To evaluate whether topical use of a film-forming silicone gel (StrataXRT®) could reduce radiation dermatitis compared to a moisturizing cream (X-derm®) in patients receiving whole breast radiotherapy. PATIENTS AND METHODS A total of 56 patients with breast cancer were randomized to use StrataXRT or X-derm. The severity of radiation dermatitis was graded using physiological skin parameters, clinician-assessed visual rating scales and patient-reported symptoms. Changes in these parameters from baseline to 4 weeks post-radiotherapy were evaluated every two weeks. RESULTS Two-way repeated-measures ANOVA revealed different patterns of changes in the erythema index (F=3.609, p=0.008) and melanin index (F=3.475, p=0.015). The post hoc analysis demonstrated a significantly lower erythema index and melanin index in the patients allocated to the StrataXRT group. CONCLUSION The use of StrataXRT can reduce radiation dermatitis with respect to objectively measured physiological skin parameters. The results of the present study will support the feasibility of conducting a larger randomized controlled trial.
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Affiliation(s)
- Songmi Ahn
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Kihoon Sung
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Hyun Ju Kim
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Young Eun Choi
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Young Kyu Lee
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Jeong Soo Kim
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Seul Ki Lee
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Joo-Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
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105
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Wang Y, Tu W, Tang Y, Zhang S. Prevention and treatment for radiation-induced skin injury during radiotherapy. RADIATION MEDICINE AND PROTECTION 2020. [DOI: 10.1016/j.radmp.2020.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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106
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Liu X, Liu Z, Wang D, Han Y, Hu S, Xie Y, Liu Y, Zhu M, Guan H, Gu Y, Zhou PK. Effects of low dose radiation on immune cells subsets and cytokines in mice. Toxicol Res (Camb) 2020; 9:249-262. [PMID: 32670556 DOI: 10.1093/toxres/tfaa017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/07/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022] Open
Abstract
Whole-body exposure to low-dose radiation due to diagnostic imaging procedures, occupational hazards and radiation accidents is a source of concern. In this study, we analyzed the effects of single and long-term low-dose irradiation on the immune system. Male Balb/c mice received a single whole-body dose of irradiation (0.01, 0.05, 0.2, 0.5 or 1 Gy). For long-term irradiation, mice were irradiated 10 times (total dose of 0.2, 0.5 or 1 Gy) over a period of 6 weeks. Two days after single or long-term irradiation, the numbers of splenic macrophages, natural killer cells and dendritic cells were reduced, and the spleen organ coefficient was decreased. At 2 Days after long-term low-dose irradiation, the number of white blood cells in the peripheral blood of the mice decreased. Between 7 and 14 Days after long-term low-dose irradiation, the number of immune cells in the thymus and spleen began to increase and then stabilized. Th1/Th2 cytokines and reactive oxygen species-related proteins first decreased and then increased to a plateau. Our results show a significant difference in the effects of single and long-term low-dose irradiation on the immune system.
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Affiliation(s)
- Xiaochang Liu
- School of Public Health, University of South China, Zhengxiang District, Hengyang, Hunan Province 421001, P. R. China.,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Haidian District, Beijing 100850, P. R. China
| | - Zheng Liu
- School of Public Health, University of South China, Zhengxiang District, Hengyang, Hunan Province 421001, P. R. China.,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Haidian District, Beijing 100850, P. R. China
| | - Duo Wang
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Haidian District, Beijing 100850, P. R. China
| | - Yang Han
- School of Public Health, University of South China, Zhengxiang District, Hengyang, Hunan Province 421001, P. R. China.,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Haidian District, Beijing 100850, P. R. China
| | - Sai Hu
- School of Public Health, University of South China, Zhengxiang District, Hengyang, Hunan Province 421001, P. R. China.,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Haidian District, Beijing 100850, P. R. China
| | - Ying Xie
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Yuelu District, Changsha 410013, P. R. China
| | - Yike Liu
- Institute for Chemical Carcinogenesis, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, 195 Dongfeng W Rd, Yuexiu District, Guangzhou 511436, P. R. China
| | - Maoxiang Zhu
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Haidian District, Beijing 100850, P. R. China
| | - Hua Guan
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Haidian District, Beijing 100850, P. R. China
| | - Yongqing Gu
- School of Public Health, University of South China, Zhengxiang District, Hengyang, Hunan Province 421001, P. R. China.,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Haidian District, Beijing 100850, P. R. China
| | - Ping-Kun Zhou
- School of Public Health, University of South China, Zhengxiang District, Hengyang, Hunan Province 421001, P. R. China.,Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Haidian District, Beijing 100850, P. R. China
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107
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Silva M, Freitas B, Andrade R, Espregueira-Mendes J, Silva F, Carvalho Ó, Flores P. Computational Modelling of the Bioheat Transfer Process in Human Skin Subjected to Direct Heating and/or Cooling Sources: A Systematic Review. Ann Biomed Eng 2020; 48:1616-1639. [PMID: 32377981 DOI: 10.1007/s10439-020-02515-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/11/2020] [Indexed: 12/15/2022]
Abstract
The purpose of this systematic review is to analyze characteristics and methodologies utilized in bioheat transfer models of human skin to provide state-of-the-art knowledge on the topic. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, EMBASE and Web of Science databases were searched up to May 30th, 2019 for bioheat transfer models focusing on direct contact between skin and temperature (heat and/or cold) source. Ten studies were included. A 16-item checklist was used to assess their methodological quality. Four studies analyzed healthy skin and six included pathological conditions. All determined skin's thermal behavior, and studies including pathological conditions also analyzed burn damage. Studies did not present a wide variety of mathematical formulation, emphasizing on modelling equations of well-established models from the literature, such as the Pennes' bioheat transfer equation, and the Henriques and Moritz model to quantify skin damage. Reporting of modelling characteristics and formulation of the computational models is not standardized and there is shortage of implementation of validation procedures, hindering representative conclusions. The lack of validation procedures led to low methodological quality. However, all studies provided strategies and parameters as starting points for future developments in this research area.
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Affiliation(s)
- Mariana Silva
- Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Azurém Campus, 4800-058, Guimarães, Portugal.
| | - Bruno Freitas
- Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Azurém Campus, 4800-058, Guimarães, Portugal
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- School of Medicine, University of Minho, Braga, Portugal
| | - Filipe Silva
- Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Azurém Campus, 4800-058, Guimarães, Portugal
| | - Óscar Carvalho
- Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Azurém Campus, 4800-058, Guimarães, Portugal
| | - Paulo Flores
- Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Azurém Campus, 4800-058, Guimarães, Portugal
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108
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Lee J, Jang WH, Shim S, Kim B, Jang WS, Myung JK, Park S, Kim KH. Characterization of early-stage cutaneous radiation injury by using optical coherence tomography angiography. BIOMEDICAL OPTICS EXPRESS 2020; 11:2652-2664. [PMID: 32499950 PMCID: PMC7249837 DOI: 10.1364/boe.387400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 05/09/2023]
Abstract
Cutaneous radiation injury (CRI) is a skin injury caused by exposure to high dose ionizing radiation (IR). Diagnosis and treatment of CRI is difficult due to its initial clinically latent period and the following inflammatory bursts. Early detection of CRI before clinical symptoms will be helpful for effective treatment, and various optical methods have been applied with limitations. Here we show that optical coherence tomography angiography (OCTA) could detect changes in the skin during the latent period in CRI mouse models non-invasively. CRI was induced on the mouse hindlimb with exposure to various IR doses and the injured skin regions were imaged longitudinally by OCTA until the onset of clinical symptoms. OCTA detected several changes in the skin including the skin thickening, the dilation of large blood vessels, and the irregularity in vessel boundaries. Some of OCTA findings were confirmed by histology. The study results showed that OCTA could be used for early CRI detection.
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Affiliation(s)
- Jungbin Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, South Korea
| | - Won Hyuk Jang
- Divison of Integrative Biosciences & Biotechnology, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, South Korea
| | - Sehwan Shim
- National Radiation Emergency Medical Centre, Korea Cancer Centre Hospital, Korea Institute of Radiological & Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, South Korea
| | - Bumju Kim
- Divison of Integrative Biosciences & Biotechnology, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, South Korea
| | - Won-Suk Jang
- Laboratory of Experimental Pathology, Korea Cancer Centre Hospital, Korea Institute of Radiological & Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, South Korea
| | - Jae Kyung Myung
- National Radiation Emergency Medical Centre, Korea Cancer Centre Hospital, Korea Institute of Radiological & Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, South Korea
- Laboratory of Experimental Pathology, Korea Cancer Centre Hospital, Korea Institute of Radiological & Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, South Korea
- Department of Pathology, Korea Cancer Centre Hospital, Korea Institute of Radiological & Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, South Korea
| | - Sunhoo Park
- National Radiation Emergency Medical Centre, Korea Cancer Centre Hospital, Korea Institute of Radiological & Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, South Korea
- Laboratory of Experimental Pathology, Korea Cancer Centre Hospital, Korea Institute of Radiological & Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, South Korea
- Department of Pathology, Korea Cancer Centre Hospital, Korea Institute of Radiological & Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, South Korea
| | - Ki Hean Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, South Korea
- Divison of Integrative Biosciences & Biotechnology, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, South Korea
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109
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Byun EB, Song HY, Kim WS. Polysaccharides from Annona muricata leaves protect normal human epidermal keratinocytes and mice skin from radiation-induced injuries. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108672] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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110
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Shah A, Nassri M, Kay J, Simunovic N, Mascarenhas VV, Andrade AJ, Marin-Peña ÓR, Ayeni OR. Intraoperative radiation exposure in hip arthroscopy: a systematic review. Hip Int 2020; 30:267-275. [PMID: 31766894 DOI: 10.1177/1120700019887362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fluoroscopy is used in hip arthroscopy (HA) for portal placement, instrument localisation, and guidance in bony resection. The recent increase in arthroscopic hip procedures may place patients and surgeons at risk for increased radiation exposure and radiation-induced complications. The purpose of the current systematic review was to assess intraoperative radiation exposure in HA. The systematic review was conducted according to PRISMA guidelines; inclusion criteria were studies assessing radiation exposure in HA. 9 studies including 994 patients were included. Mean age was 38.6 years and 48% (436 of 906) were female. Mean time of fluoroscopy exposure was 0.58 minutes. Dose area product was 129.5 cGycm2. Mean intraoperative absorbed radiation dose studies was 12.6 mGy. Mean intraoperative effective dose was 0.48 mSv. The mean occupational exposure to the surgeon per case was 0.0031 mSv. Higher patient body mass index (BMI) correlated to greater patient effective and cumulative dose (p < 0.05, r = 0.404), and greater occupational exposure (p < 0.001, r = 0.460). Increasing surgeon experience decreased fluoroscopy time (p = 0.039) and radiation dose (p = 0.002). Radiation dose and effective dose were well under the thresholds for deterministic effects (2 Gy) and annual radiation exposure for occupational workers (20 mSv). Intraoperative radiation exposure to patients and surgeons is within acceptable annual radiation limits. Ensuring careful selection of perioperative imaging modalities, proper protective shielding, specifically the use of leaded eyeglasses, and optimal C-arm positioning are key strategies to reduce radiation exposure to patients and surgeons alike.
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Affiliation(s)
- Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohammed Nassri
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Department of Radiology, Hospital da Luz, Lisbon, Portugal
| | | | - Óliver R Marin-Peña
- Orthopedic Surgery and Traumatology Department, University Hospital Infanta Leonor, Madrid, Spain
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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111
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Klein LW, Goldstein JA, Haines D, Chambers C, Mehran R, Kort S, Valentine CM, Cox D. SCAI Multi-Society Position Statement on Occupational Health Hazards of the Catheterization Laboratory: Shifting the Paradigm for Healthcare Workers' Protection. J Am Coll Cardiol 2020; 75:1718-1724. [PMID: 32273037 DOI: 10.1016/j.jacc.2020.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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112
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Fallah M, Viklund E, Bäckman A, Brodén J, Lundskog B, Johansson M, Blomquist M, Wilczynska M, Ny T. Plasminogen is a master regulator and a potential drug candidate for the healing of radiation wounds. Cell Death Dis 2020; 11:201. [PMID: 32205839 PMCID: PMC7089956 DOI: 10.1038/s41419-020-2397-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 12/18/2022]
Abstract
Around 95% of cancer patients undergoing radiotherapy experience cutaneous side effects, and some develop radiation wounds or fibrosis. Currently, there is no effective treatment for these indications. We show here that plasminogen administration enhanced the healing of radiation wounds via pleiotropic effects on gene expression. Using RNA sequencing, we found that plasminogen downregulated the expression of genes in the TLR, TNF, WNT, MAPK, and TGF-β signaling pathways, and enhanced the anti-inflammatory effect of arachidonic acid, leading to significantly decreased inflammation and improved remodeling of granulation tissue compared with placebo treatment. In addition, plasminogen induced metabolic changes, including decreased glycolysis. Importantly, many of the factors downregulated by plasminogen are pro-fibrotic. Therefore, in radiation wounds with excessive inflammation, plasminogen is able to enhance and redirect the healing process, such that it more closely resembles physiological healing with significantly reduced risk for developing fibrosis. This makes plasminogen an attractive drug candidate for the treatment of radiation wounds in cancer patients.
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Affiliation(s)
- Mahsa Fallah
- Department of Medical Biochemistry and Biophysics, Umeå University, 901-87, Umeå, Sweden
| | - Emil Viklund
- Department of Medical Biochemistry and Biophysics, Umeå University, 901-87, Umeå, Sweden
| | | | | | - Bertil Lundskog
- Department of Medical Biosciences, Pathology, Umeå University, 901-87, Umeå, Sweden
| | - Michael Johansson
- Department of Radiation Sciences, Umeå University, 901-87, Umeå, Sweden
| | - Michael Blomquist
- Department of Radiation Sciences, Umeå University, 901-87, Umeå, Sweden
| | - Malgorzata Wilczynska
- Department of Medical Biochemistry and Biophysics, Umeå University, 901-87, Umeå, Sweden
- Omnio AB, Tvistevägen 48, 907-36, Umeå, Sweden
| | - Tor Ny
- Department of Medical Biochemistry and Biophysics, Umeå University, 901-87, Umeå, Sweden.
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113
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Therapeutic Interventions to Reduce Radiation Induced Dermal Injury in a Murine Model of Tissue Expander Based Breast Reconstruction. Ann Plast Surg 2020; 85:546-552. [PMID: 32187064 DOI: 10.1097/sap.0000000000002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Radiation therapy (XRT) induced dermal injury disrupts type I collagen architecture. This impairs cutaneous viscoelasticity, which may contribute to the high rate of complications in expander-based breast reconstruction with adjuvant XRT. The objective of this study was to further elucidate the mechanism of radiation-induced dermal injury and to determine if amifostine (AMF) or deferoxamine (DFO) mitigates type I collagen injury in an irradiated murine model of expander-based breast reconstruction. METHODS Female Lewis rats (n = 20) were grouped: expander (control), expander-XRT (XRT), expander-XRT-AMF (AMF), and expander-XRT-DFO (DFO). Expanders were surgically placed. All XRT groups received 28 Gy of XRT. The AMF group received AMF 30 minutes before XRT, and the DFO group used a patch for delivery 5 days post-XRT. After a 20-day recovery period, skin was harvested. Atomic force microscopy and Raman spectroscopy were performed to evaluate type I collagen sheet organization and tissue compositional properties, respectively. RESULTS Type I collagen fibril disorganization was significantly increased in the XRT group compared with the control (83.8% vs 22.4%; P = 0.001). Collagen/matrix ratios were greatly reduced in the XRT group compared with the control group (0.49 ± 0.09 vs 0.66 ± 0.09; P = 0.017). Prophylactic AMF demonstrated a marked reduction in type I collagen fibril disorganization on atomic force microscopy (15.9% vs 83.8%; P = 0.001). In fact, AMF normalized type I collagen organization in irradiated tissues to the level of the nonirradiated control (P = 0.122). Based on Raman spectroscopy, both AMF and DFO demonstrated significant differential protective effects on expanded-irradiated tissues. Collagen/matrix ratios were significantly preserved in the AMF group compared with the XRT group (0.49 ± 0.09 vs 0.69 ± 0.10; P = 0.010). β-Sheet/α-helix ratios were significantly increased in the DFO group compared with the XRT group (1.76 ± 0.03 vs 1.86 ± 0.06; P = 0.038). CONCLUSIONS Amifostine resulted in a significant improvement in type I collagen fibril organization and collagen synthesis, whereas DFO mitigated abnormal changes in collagen secondary structure in an irradiated murine model of expander-based breast reconstruction. These therapeutics offer the ability to retain the native microarchitecture of type I collagen after radiation. Amifostine and DFO may offer clinical utility to reduce radiation induced dermal injury, potentially decreasing the high complication rate of expander-based breast reconstruction with adjuvant XRT and improving surgical outcomes.
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114
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Southworth A, Clough H, Roberts N. An audit of radiation-induced skin reactions in the inframammary fold; does breast size impact on the severity of the reaction? Radiography (Lond) 2020; 26:192-197. [PMID: 32052757 DOI: 10.1016/j.radi.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Skin toxicity is a clinically significant side effect of external beam radiation; moist desquamation is particularly prevalent for breast patients, mainly in the axilla and inframammary fold (IMF). The aim of this audit was to assess if there is a correlation between patient breast size and the presence and extent of radiotherapy skin reaction in the IMF. METHODS Between 22/12/2017 and 31/05/2018 forty patients undergoing standard whole breast radiotherapy using 3D planned medial and lateral tangential fields had their skin reaction recorded weekly, whilst on treatment, using the Radiotherapy Oncology Group (RTOG) scoring system. Skin reactions were also documented at three and eight weeks post radiotherapy. A measurement of the patients IMF length and bra size were also noted. Statistical analysis was carried out using IBMÒ SPSS Statistics 24. RESULTS Six patients presented with grade ≥2 during week three of radiotherapy. The mean IMF length of six patients with adverse reactions 6.1 cm (±3.6 cm). As the length of the IMF increases, severity of skin reactions also increases; a positive correlation was identified between the two at both week three of radiotherapy and three weeks post radiotherapy (r = 0.401, n = 34, p = 0.05 and r = 0.671, n = 29, p = 0.00 respectively). Only one patient displayed grade 2 at eight weeks post radiotherapy (IMF length 7.5 cm). CONCLUSION The findings from this study would suggest that larger breasted patients do present earlier, and with more severe radiation-induced skin reactions. IMPLICATIONS FOR PRACTICE Changes to skin care practice could be considered for patients with larger breasts. This could be in the form of more frequent check-ups during treatment or proactive side effect management rather than reactive management.
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Affiliation(s)
- A Southworth
- Radiotherapy Department, Leeds Cancer Centre, St James's Hospital, Becket Street, Leeds, LS9 7TF, United Kingdom.
| | - H Clough
- Radiotherapy Department, Leeds Cancer Centre, St James's Hospital, Becket Street, Leeds, LS9 7TF, United Kingdom
| | - N Roberts
- Radiotherapy Department, Leeds Cancer Centre, St James's Hospital, Becket Street, Leeds, LS9 7TF, United Kingdom; Sheffield Hallam University, Howard Street, Sheffield, S1 1WB, United Kingdom
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Klein LW, Goldstein JA, Haines D, Chambers C, Mehran R, Kort S, Valentine CM, Cox D. SCAI multi‐society position statement on occupational health hazards of the catheterization laboratory: Shifting the paradigm for Healthcare Workers' Protection. Catheter Cardiovasc Interv 2020; 95:1327-1333. [DOI: 10.1002/ccd.28579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Lloyd W. Klein
- University of California, San Francisco San Francisco California
| | | | - David Haines
- William Beaumont School of Medicine Royal Oak Michigan
| | | | | | | | | | - David Cox
- Brookwood Baptist Health Birmingham Alabama
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Ionizing radiation induces cutaneous lipid remolding and skin adipocytes confer protection against radiation-induced skin injury. J Dermatol Sci 2020; 97:152-160. [PMID: 32001116 DOI: 10.1016/j.jdermsci.2020.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Radiation-induced skin injury is a serious concern during radiotherapy and radiation accidents. Skin fat represents the dominant architectural component of the human skin. However, the interplay between skin fat and the progression of radiation-induced skin injury remains largely unexplored. OBJECTIVE This study aims to elucidate the interplay between skin fat and the progression of radiation-induced skin injury. METHODS SD rats were irradiated with an electron beam. mRNA profiles were determined by RNA-Seq. The skin lipid mass was monitored by magnetic resonance imaging (MRI) and lipid profiles were measured by liquid chromatography-mass spectrometry (LC-MS). Human mature adipocytes isolated from dermal and subcutaneous white adipose tissues (WATs) were co-cultured with human keratinocytes (HaCaT) and skin fibroblasts (WS1) in the transwell culture system. Cell migration ability was measured by migration assay. RESULTS Radiation modulated cutaneous lipid metabolism by downregulating multiple pathways. Moreover, radiation decreased skin fat mass with altered lipid metabolite profiles. The rats fed with a high-fat diet showed resistance to radiogenic skin injury compared with that with a control diet, indicating that skin lipid plays a radioprotective role. Mature adipocytes promoted the migration but not the proliferation of co-cultured skin keratinocytes and fibroblasts. Palmitic acid, the most abundant fatty acid in skin tissues, facilitated the migration of WS1 cells. Moreover, fatty acid-binding protein 4 (FABP4) could be incorporated into skin cells and promote DNA damage repair in irradiated skin fibroblasts. CONCLUSION Radiation induces cutaneous lipid remolding, and skin adipocytes confer a protective role against radiation-induced skin injury.
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Schmidt FMQ, González CVS, Mattar RC, Lopes LB, Santos MFD, de Gouveia Santos VLC. Topical cream containing nanoparticles with vitamin E to prevent radiodermatitis in women with breast cancer: a clinical trial protocol. J Wound Care 2020; 29:18-26. [PMID: 33249985 DOI: 10.12968/jowc.2020.29.latam_sup_1.18.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Little is known about the efficacy of products aiming to prevent radiodermatitis, which affects between 90-95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidenceon their effectiveness. Here, the authors present a clinical trial protocol to evaluate the effects of applying a cream containing nanoparticles with vitamin E to prevent radiodermatitis in patients with breast cancer. METHOD The protocol recommends that 108 women with breast cancer, receiving radiotherapy, are included in this triple-blinded, randomized, controlled study at an oncology hospital. Patients will be divided in three groups of 36 individuals each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will receive a cream without nanoparticles nor vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree, and time of onset of radiodermatitis. The secondary endpoints will focus on the quality of life, symptoms, and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved and registered on an international trials database.
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Affiliation(s)
| | - Carol V Serna González
- Graduate Program in Adult Health Nursing, Universidade de São Paulo, Escola de Enfermagem (EEUSP), Sao Paulo, Brazil
| | | | - Luciana Biagini Lopes
- Pharmacology Department, Universidade de São Paulo, Instituto de Ciências Biomédicas (ICB-USP), Sao Pablo, Brazil
| | - Marinilce Fagundes Dos Santos
- Cell Biology and Development Department, Universidade de São Paulo, Instituto de Ciências Biomédicas (ICB-USP), Sao Pablo, Brazil
| | - Vera L C de Gouveia Santos
- Department of Medial-Surgical Nursing, Universidade de São Paulo, Escola de Enfermagem (EEUSP), Sao Paulo, Brazil
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Schmidt FMQ, González CVS, Mattar RC, Lopes LB, Santos MFD, de Gouveia Santos VLC. Clinical protocol for the topical use of a cream with nanoparticles and vitamin E to prevent radiodermatitis in patients with breast cancer]. J Wound Care 2020; 29:18-26. [PMID: 31859604 DOI: 10.12968/jowc.2020.29.latam_sup_1.18] [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] [Indexed: 03/28/2024]
Abstract
Sinopsis: Objetivo: Poco se conoce sobre la eficacia de productos para la prevención de radiodermatitis, que afecta al 90–95% de las mujeres con cáncer de mama. El uso de antioxidantes es promisorio, sin embargo, poco estudiado. Los autores desarrollaron un protocolo de ensayo clínico para evaluar el efecto potencial de la aplicación de crema con nanopartículas con vitamina E para prevenir radiodermatitis aguda en mujeres con cáncer de mama. Método: El protocolo sugiere que 108 mujeres adultas con cáncer de mama, que estén recibiendo radioterapia, sean incluidas en este ensayo clínico, controlado, aleatorizado y triple ciego, en un hospital oncológico. Se prevé la distribución de pacientes en tres grupos de 36 personas: el grupo A recibirá una crema con nanopartículas lipídicas con vitamina E, el grupo B obtendrá una crema sin nanopartículas ni vitamina E, y el grupo C usará una crema con nanopartículas sin vitamina E. Los resultados primarios evaluarán la incidencia, el grado y el tiempo de surgimiento de la radiodermatitis. Los resultados secundarios se centrarán en la calidad de vida, los síntomas y la temperatura local. Las pacientes serán evaluadas tres veces por semana, desde el inicio de la radioterapia hasta dos semanas después de la última sesión. El presente proyecto fue aprobado por el comité de ética en investigación de las instituciones involucradas.
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Affiliation(s)
- Fernanda Mateus Queiróz Schmidt
- 1Enfermera, estomaterapeuta, MSc, PhD, profesora doctora, Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais (IFSULDEMINAS), Pasos, Minas Gerais, Brasil
| | - Carol V Serna González
- 2Enfermera, estomaterapeuta, MSc, estudiante de PhD, Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA), Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Rodrigo Calixto Mattar
- 3Médico radioterapeuta, Hospital Regional de Câncer, Santa Casa de Misericórdia de Passos, Minas Gerais, Brasil
| | - Luciana Biagini Lopes
- 4Farmaceuta, MSc, PhD, profesora asociada, Departamento de Farmacología, Instituto de Ciências Biomédicas, Universidade de São Paulo, San Pablo, Brasil
| | - Marinilce Fagundes Dos Santos
- 5Odontóloga, MSc, PhD, profesora titular, Departamento de Biología Celular y del desarrollo, Instituto de Ciências Biomédicas, Universidade de São Paulo, San Pablo, Brasil
| | - Vera L C de Gouveia Santos
- 6Enfermera, estomaterapeuta, MSc, PhD, profesora titular, Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
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Chen VE, Greenberger BA, Shi Z, Gajjar S, Shi W, Mourad WF, Yan W. Post-mastectomy and post-breast conservation surgery pain syndrome: a review of etiologies, risk prediction, and trends in management. Transl Cancer Res 2020; 9:S77-S85. [PMID: 33828953 PMCID: PMC8022993 DOI: 10.21037/tcr.2019.06.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Postmastectomy pain syndrome (PMPS) or breast conservation surgery (BCS) pain syndrome could be long-term and lead to disability and impairment on body and social function. The pain syndromes are not uncommon in breast cancer patients. It can affect social, psychological, physical and behavioral aspects of a patient. Surgery, radiation, chemotherapy and psychological factors can all contribute to the development of pain syndromes. Axillary dissection is a strong predictor for pain development. Pain medications, ganglion blocks are typically given to the patient for management. Integrative medicine such as acupuncture and psychological management methods are promising modalities in the management arsenal. In this study, we summarized the up-to-date literature to elucidate the etiology, risk factors and management strategies for PMPS.
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Affiliation(s)
- Victor E Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Zheng Shi
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Shefali Gajjar
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Waleed F Mourad
- Department of Radiation Oncology, University of Kentucky, Lexington, KY, USA
| | - Weisi Yan
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
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Ejaz A, Greenberger JS, Rubin PJ. Understanding the mechanism of radiation induced fibrosis and therapy options. Pharmacol Ther 2019; 204:107399. [DOI: 10.1016/j.pharmthera.2019.107399] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023]
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Liao Y, Feng G, Dai T, Long F, Tang J, Pu Y, Zheng X, Cao S, Xu S, Du X. Randomized, self-controlled, prospective assessment of the efficacy of mometasone furoate local application in reducing acute radiation dermatitis in patients with head and neck squamous cell carcinomas. Medicine (Baltimore) 2019; 98:e18230. [PMID: 31876704 PMCID: PMC6946454 DOI: 10.1097/md.0000000000018230] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute radiation dermatitis (ARD) is a common adverse effect in patients undergoing radiotherapy. Mometasone furoate cream (MMF) was reported to significantly reduce ARD, especially in breast cancer. Clinically, ARD is more critical and more difficult to prevent in patients with head and neck squamous cell carcinoma (HNSCC) than in those with breast cancer, because a higher dose of radiotherapy is required in HNSCC cases. The aim of this study was to evaluate the effect of MMF local application on radiation dermatitis in patients with HNSCC. METHODS HNSCC patients scheduled for bilateral radical radiotherapy to the neck with identical radiation doses were enrolled. One side of the neck skin (test groups) of the patients were randomized to apply a thin layer of MMF once a day from the date of first radiotherapy until either 2 weeks after end of radiotherapy or until the test side skin developed ARD lesions, while the other side of neck (control groups) didn't apply any medication. The severity of ARD was evaluated weekly by using the modified radiation therapy oncology group score, pain intensity, and itch stages. RESULTS Forty-one patients (82 targets) were analyzed. There was a significant difference between the ARD scores on the test side and the control side. MMF reduced the stages of ARD when the radiotherapy dose was <6000 cGY (P = .01) but showed no improvement when the dose was ≥6000 cGY (P = .699). Compared to the control side, local application of MMF significantly reduced the itch and pain scores of the test side skin regardless of the radiotherapy dose and ARD stage (P < .001) during radiotherapy. CONCLUSIONS This study showed that MMF inunction after high-dose radiotherapy (>50 Gy) can prevent ARD, especially when the radiation dose is <6000 cGY.
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Presta G, Puliatti A, Bonetti L, Tolotti A, Sari D, Valcarenghi D. Effectiveness of hyaluronic acid gel (Jalosome soothing gel) for the treatment of radiodermatitis in a patient receiving head and neck radiotherapy associated with cetuximab: A case report and review. Int Wound J 2019; 16:1433-1439. [PMID: 31475472 PMCID: PMC7948705 DOI: 10.1111/iwj.13210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/07/2019] [Accepted: 08/18/2019] [Indexed: 01/17/2023] Open
Abstract
One of the principal side effects in patients that receive radiotherapy is radiodermatitis. Radiodermatitis can be highly invalidating for patients, causing pain, ulceration, swelling, and increased infection risk, with a negative effect on the quality of life, requiring dressings and medications. Therapeutic approaches reported so far in the literature have not proved to be effective in treating radiodermatitis. Therefore, new approaches are needed to deal with these side effects more effectively. The aim of the study was to evaluate the effectiveness of hyaluronic acid gel (HAG) (Jalosome soothing gel) for the treatment of a case of radiodermatitis. This is a case study of a patient affected by squamous cell carcinoma at the tongue base, who was treated with head and neck radiotherapy associated with the administration of cetuximab. About 1 month after this therapy was started the patient developed radiodermatitis, which did not regress with standard treatment. Therefore, HAG was applied once a day for about 20 days. The regression of radiodermatitis was measured using the Radiation Toxicity/Oncology Grading scale, pain relief was measured with a numerical scale, and patient satisfaction was done through a semi-structured interview. The patient presented a dramatic reduction of skin toxicity, which had been resistant to all previous therapeutic approaches. Pain, which was severe at the beginning, gradually disappeared. The patient showed great satisfaction for the reduction of pain and the regression of the radiodermatitis. The effectiveness of HAG appears to be promising for the treatment of radiodermatitis.
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Affiliation(s)
- Giovanni Presta
- Radiotherapy Outpatients UnitOncology Institute of Southern Switzerland (IOSI)BellinzonaCanton TicinoSwitzerland
| | - Andrea Puliatti
- Radiotherapy DepartmentOncology Institute of Southern Switzerland (IOSI)BellinzonaCanton TicinoSwitzerland
| | - Loris Bonetti
- Nursing Development and Research UnitOncology Institute of Southern Switzerland (IOSI)BellinzonaCanton TicinoSwitzerland
| | - Angela Tolotti
- Nursing Development and Research UnitOncology Institute of Southern Switzerland (IOSI)BellinzonaCanton TicinoSwitzerland
| | - Davide Sari
- Nursing DepartmentOncology Institute of Southern Switzerland (IOSI)BellinzonaCanton TicinoSwitzerland
| | - Dario Valcarenghi
- Nursing Development and Research UnitOncology Institute of Southern Switzerland (IOSI)BellinzonaCanton TicinoSwitzerland
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Referral practices to dermatologists for the treatment of radiation dermatitis in the USA: a call for a multidisciplinary approach. Support Care Cancer 2019; 28:967-969. [PMID: 31768733 DOI: 10.1007/s00520-019-05167-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/31/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Acute radiation dermatitis (RD) is a disfiguring and painful rash that occurs in up to 95% of patients receiving radiation therapy (RT) for cancer. Treatment for RD varies among practitioners with no evidence-based gold standard for management. While a multi-disciplinary approach has been utilized to manage other cancer-related toxicities, RD is most often managed by the treating radiation oncologist. METHODS This study evaluated the referral practices of radiation oncologists to dermatologists for management of RD utilizing a survey of radiation oncologists across the USA. The goal was to identify the referral practices of radiation oncologists for RD and any barriers to a multidisciplinary approach. RESULTS Of the 705 respondents, 15% reported ever referring patients to dermatology. Private practitioners referred significantly less than providers in academic or oncology centers (p < 0.01). Practitioners in urban settings were more likely to refer (p < 0.01), and radiation oncologists in the Southeastern USA were less likely to refer (p < 0.01). CONCLUSIONS Lack of timely access to dermatologists in various geographic areas in addition to radiation oncologists' preference to treat RD are barriers to multidisciplinary management of RD. Inclusion of dermatologists and wound care specialists in cancer treatment teams could improve patient care and stimulate needed research into strategies for treatment and prevention of RD.
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Zhu W, Jia L, Chen G, Li X, Meng X, Xing L, Zhao H. Relationships between the changes of skin temperature and radiation skin injury. Int J Hyperthermia 2019; 36:1160-1167. [PMID: 31752541 DOI: 10.1080/02656736.2019.1685685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Radiation skin injury (RSI) causes changes in skin temperature, but detailed information on the thermographic responses is currently lacking. We investigated thermographic patterns after radiotherapy. We hypothesized that skin temperature may be used as a diagnostic and early predictor of RSI severity.Method: All breast cancer patients received radiotherapy after unilateral postmastectomy. The contralateral supraclavicular area served as control, and the frontal thermal image of torso was taken by a thermal infrared imager weekly. We defined areas of interest on bilateral symmetrical supraclavicular area, and analyzed the difference of average and maximum skin temperature (DSTaverage and DSTmax) between them. The extent of the weekly variation in DST (DSTW) was calculated using a mathematical formula to represent a trend of skin temperature change. RSI and symptoms related to RSI were scored from baseline to 2 weeks after the end of radiotherapy.Results: Forty-one patients were enrolled in this study. In comparison to the baseline, the DSTaverage and DSTmax increased significantly over time during radiotherapy (p < .05). The onset of DST increase was accompanied by the onset of radiation dermatitis, and the maximal DST also appeared at the peak of Radiation Therapy Oncology Group (RTOG) and symptom scores. Radiation dose, DSTaverage, burning-feeling and pulling were the independent variables affecting RTOG score according to multivariate analysis (p < .001, p < .034, p < .001, p < .001). Patients with DSTWaverage >1.223 or DSTWmax >1.114 in second week showed a late higher dermatitis score (RTOG score ≥2).Conclusion: This study confirmed that RSI was associated with thermographic response. Our results suggested that the follow-up observations of skin temperature during radiotherapy could provide the objective evaluation criteria and prediction methods for RSI.
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Affiliation(s)
- Wanqi Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Li Jia
- Department of Radiation Oncology, Jinan Fourth People's Hospital, Jinan, China
| | - Guanxuan Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.,Shandong Key Laboratory of Radiation Oncology, Jinan, China
| | - Xiaolin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiangjiao Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Hanxi Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Ryan Wolf J, Gewandter JS, Bautista J, Heckler CE, Strasser J, Dyk P, Anderson T, Gross H, Speer T, Dolohanty L, Bylund K, Pentland AP, Morrow GR. Utility of topical agents for radiation dermatitis and pain: a randomized clinical trial. Support Care Cancer 2019; 28:3303-3311. [PMID: 31758326 DOI: 10.1007/s00520-019-05166-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Although topical agents are often provided during radiation therapy, there is limited consensus and evidence for their use prophylactically to prevent or reduce radiation dermatitis. METHODS This was a multi-site, randomized, placebo-controlled, blinded study of 191 breast cancer patients to compare the prophylactic effectiveness of three topical agents (Curcumin, HPR Plus™, and Placebo) for reducing radiation dermatitis and associated pain. Patients applied the topical agent to their skin in the radiation area site three times daily starting the first day of radiation therapy (RT) until 1 week after RT completion. RESULTS Of the 191 randomized patients, 171 patients were included in the final analyses (87.5% white females, mean age = 58 (range = 36-88)). Mean radiation dermatitis severity (RDS) scores did not significantly differ between study arms (Curcumin = 2.68 [2.49, 2.86]; HPR Plus™ = 2.64 [2.45, 2.82]; Placebo = 2.63 [2.44, 2.83]; p = 0.929). Logistic regression analyses showed that increased breast field separation positively correlated with increased radiation dermatitis severity (p = 0.018). In patients with high breast field separation (≥ 25 cm), RDS scores (Curcumin = 2.70 [2.21, 3.19]; HPR Plus™ = 3.57 [3.16, 4.00]; Placebo = 2.95 [2.60, 3.30]; p = 0.024) and pain scores (Curcumin = 0.52 [- 0.28, 1.33]; HPR Plus™ = 0.55 [- 0.19, 1.30]; Placebo = 1.73 [0.97, 2.50]; p = 0.046) significantly differed at the end of RT. CONCLUSIONS Although there were no significant effects of the treatment groups on the overall population, our exploratory subgroup analysis suggests that prophylactic treatment with topical curcumin may be effective for minimizing skin reactions and pain for patients with high breast separation (≥ 25 cm) who may have the worst skin reactions.
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Affiliation(s)
- Julie Ryan Wolf
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA.
| | - Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Javier Bautista
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Charles E Heckler
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Pawal Dyk
- Heartland Cancer Research NCORP, St. Louis, MO, USA
| | | | - Howard Gross
- Dayton Clinical Oncology Program, Dayton, OH, USA
| | - Tod Speer
- Metro-Minnesota NCORP, St. Louis Park, MN, USA
| | - Lindsey Dolohanty
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA
| | - Kevin Bylund
- Department Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Alice P Pentland
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA
| | - Gary R Morrow
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
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Surface dose and acute skin reactions in external beam breast radiotherapy. Med Dosim 2019; 45:153-158. [PMID: 31718856 DOI: 10.1016/j.meddos.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/02/2019] [Accepted: 09/06/2019] [Indexed: 01/14/2023]
Abstract
The biologically relevant depth for acute skin reactions in radiotherapy is 70 µm. The dose at this depth is difficult to measure or calculate and can be quite different than the dose at a depth of as little as 1 mm. For breast radiotherapy with medial and lateral tangential beams, the skin dose depends on both the contribution from the entrance beam and the exit beam. The skin dose has been estimated in a breast model hemi-ellipse accounting for field size, beam energy, obliquity, lack of backscatter, fractionation, size and shape of the hemi-ellipse. The dose has been held constant along the axis of symmetry of the hemi-ellipse by introducing modulation as in clinical IMRT practice. Dose distributions have been computed as a function of the polar angle from the center of the hemi-ellipse. The exit dose always dominates the entrance dose for all realistic parameters. As a result, the surface dose is higher for 18 MV than 6 MV over the entire surface for all reasonable sizes and shapes of the hemi-ellipse. The results of these calculations suggest that substituting an 18 MV beam for a 6 MV beam to achieve greater skin sparing may have just the opposite effect. The ratio of the surface dose to the mid-depth dose ranges from about 35% at polar angle 0o to up to 70% at polar angle 80o. The dose rises sharply at angles above 30o. The surface dose rises moderately at all angles as the size of the hemi-ellipse increases. The effect of shape is somewhat complex: as the breast becomes flatter, doses at intermediate angles increase, but doses at small and large angles decrease. The biologically effective dose for erythema and moist desquamation is about 2 to 3 Gy higher at all polar angles for conventional fractionation (2.00 Gy × 25 fractions) than for hypofractionation (2.66 Gy × 16).
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Pazdrowski J, Polaſska A, Kaźmierska J, Barczak W, Szewczyk M, Adamski Z, Żaba R, Golusiſski P, Golusiſski W, Daſczak-Pazdrowska A. Skin barrier function in patients under radiation therapy due to the head and neck cancers - Preliminary study. Rep Pract Oncol Radiother 2019; 24:563-567. [PMID: 31660049 DOI: 10.1016/j.rpor.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/30/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022] Open
Abstract
Aim To present the possibility of non-invasive monitoring of the skin after radiotherapy in regards of epidermal barrier function. Background Radiodermatitis constitutes 95% of all side effects in patients after radiotherapy. The proper assessment of the severity of radiodermatitis can be determined using semi-quantitative clinical scores [Common Terminology Criteria for Adverse Events v 4.0 (CTCAE)].The most accepted way to analyze the epidermal barrier function is to determine Transepidermal Water Loss (TEWL). Material and methods In prospective study, we included 16 patients diagnosed with head and neck cancer treated with radiotherapy or concomitant chemoradiation in whom we performed non-invasive assessments of the skin barrier function, including TEWL measurement. The final analysis included 6 patients (4 treated with adjuvant radiotherapy, 2 with radical chemoradiation). Clinical assessment of irradiated skin was based on target lesion score (TLS) and CTCAE v 4.0. Results The mean TLS score in the middle of irradiation was 1.6 points, after last irradiation it was 2.3 points; 3 months later the mean TLS score was: 0. CTCAE v 4.0 criteria: 2 patients had grade 0, 3 patients - grade 1; 1 patient - grade 2. There were statistically significant differences in TEWL related to irradiated skin in the following time intervals: before vs. in the middle; before vs. day after; in the middle vs. day after; in the middle vs. 3 months after; day after vs. 3 months after. Conclusions The study showed that radiotherapy causes skin barrier dysfunction in all patients independently of clinical radiodermatitis. The biophysical features of this dysfunction can precede clinical symptoms and they can be assessed by non-invasive and objective methods.
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Affiliation(s)
- Jakub Pazdrowski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Garbary 15, 61-866 Poland
| | - Adriana Polaſska
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Przybyszewskiego 49, Poznan, 60-355, Poland
| | - Joanna Kaźmierska
- Radiotherapy Department II Greater Poland Cancer Center, Garbary 15, Poznan, 61-866 Poland.,Electroradiology Department, University of Medical Sciences, Poznan, Poland
| | - Wojciech Barczak
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Garbary 15, 61-866 Poland.,Radiobiology Lab, The Greater Poland Cancer Centre, Garbary 15, Poznan, 61-866 Poland
| | - Mateusz Szewczyk
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Garbary 15, 61-866 Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Przybyszewskiego 49, Poznan, 60- 355 Poland
| | - Ryszard Żaba
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Przybyszewskiego 49, Poznan, 60-355, Poland
| | - Paweſ Golusiſski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Garbary 15, 61-866 Poland.,Department of Biology and Environmental Studies, Poznan University of Medical Sciences, Poland.,Department of Otolaryngology and Maxillofacial Surgery, University of ZielonaGóra, Poland
| | - Wojciech Golusiſski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Garbary 15, 61-866 Poland
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Soriano-Ruiz JL, Calpena-Campmany AC, Silva-Abreu M, Halbout-Bellowa L, Bozal-de Febrer N, Rodríguez-Lagunas MJ, Clares-Naveros B. Design and evaluation of a multifunctional thermosensitive poloxamer-chitosan-hyaluronic acid gel for the treatment of skin burns. Int J Biol Macromol 2019; 142:412-422. [PMID: 31593719 DOI: 10.1016/j.ijbiomac.2019.09.113] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 08/27/2019] [Accepted: 09/15/2019] [Indexed: 12/14/2022]
Abstract
The main goal of this study was the design, development and characterization of a poloxamer/chitosan/hyaluronic based vehicle including three biological antioxidant molecules such as vitamins A, D and E aimed at improving the treatment of skin burns. The physical characterization of hydrogel, its mechanical and rheological properties as well as internal structure were investigated. Furthermore, biological characteristics such as ex vivo antimicrobial properties and in vivo wound healing were also accomplished and compared with a commercial reference. Results showed optimal physicochemical properties with biocompatible pH value of 4.6 ± 0.1 and zeta potential dependent on pH. The swelling rate was around 350% with optimal wettability, adhesion and leakage properties, as well as thermosensitive gelation processes. The microbiological assay demonstrated similar antimicrobial activity to that of commercial reference. In vivo tolerance study revealed no skin reactions. Finally, the wound healing efficacy of hydrogel in skin burn model showed dermal appendages and similar epidermis, dermis and stratum corneum to the commercial reference. These findings indicated that our hydrogel loading vitamins could be considered an outstanding candidate for further clinical studies.
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Affiliation(s)
- José L Soriano-Ruiz
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, University Campus of Cartuja, 18071 Granada, Spain
| | - Ana C Calpena-Campmany
- Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 27-31 Joan XXIII Ave., 08028 Barcelona, Spain; Nanoscience and Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | - Marcelle Silva-Abreu
- Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 27-31 Joan XXIII Ave., 08028 Barcelona, Spain; Nanoscience and Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | - Lyda Halbout-Bellowa
- Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 27-31 Joan XXIII Ave., 08028 Barcelona, Spain; Nanoscience and Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | - Nuria Bozal-de Febrer
- Department of Biology, Healthcare and the Environment, Faculty of Pharmacy and Food Sciences, University of Barcelona, 27-31 Joan XXIII Ave., 08028 Barcelona, Spain
| | - María J Rodríguez-Lagunas
- Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Sciences, University of Barcelona, 27-31 Joan XXIII Ave., 08028 Barcelona, Spain; Institute of Biomedicine, University of Barcelona, 08028 Barcelona, Spain
| | - Beatriz Clares-Naveros
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, University Campus of Cartuja, 18071 Granada, Spain; Nanoscience and Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain; Biosanitary Institute of Granada (ibs.GRANADA), Andalusian Health Service (SAS)-University of Granada, Granada, Spain.
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Rafati M, Ghasemi A, Saeedi M, Habibi E, Salehifar E, Mosazadeh M, Maham M. Nigella sativa L. for prevention of acute radiation dermatitis in breast cancer: A randomized, double-blind, placebo-controlled, clinical trial. Complement Ther Med 2019; 47:102205. [PMID: 31780017 DOI: 10.1016/j.ctim.2019.102205] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 08/19/2019] [Accepted: 09/30/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The present study aimed to evaluate the effectiveness of Nigella sativa L. (N. sativa) extract on preventing the incidence of acute radiation dermatitis (ARD) in breast cancer patients. METHODS Sixty-two breast cancer patients undergoing radiotherapy (RT) were randomly assigned to receiveN. sativa 5% gel or placebo. Patients were instructed to apply the medications twice daily during RT period. The severity of ARD, the incidence of moist desquamation, worst experienced pain, and skin-related quality of life (SRQOL) scores were assessed weekly during RT. RESULTS Patients who were treated with the N. sativa gel developed ARD significantly less frequently compared to those who used the placebo (p < 0.05 for all weeks except week 2, p = 0.36). The incidence time of grade 2 and 3 of Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) toxicity was prolonged significantly with N. sativa gel as compared to placebo (35 vs. 29 days, p = 0.00 and 42 vs. 40 days, p = 0.01, respectively). Furthermore, the occurrence of moist desquamation was delayed in the N. sativa gel group compared with the placebo group (37 vs. 33 days, p = 0.01). The mean score of the worst pain that patients experienced in the placebo group was significantly higher than that of the N. sativa gel group at week 3 (2.5 ± 0.5 vs. 1.2 ± 0.3, p < 0.05). Nonetheless, the application of N. sativa gel had no significant effect on the SRQOL of patients at any week. CONCLUSION N. sativa extract significantly decreases the severity of ARD and delays the onset of moist desquamation in breast cancer patients.
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Affiliation(s)
- Mohammadreza Rafati
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Arash Ghasemi
- Department of Radiotherapy, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Emran Habibi
- Department of Pharmacognosy and Biotechnology, Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Salehifar
- Department of Clinical Pharmacy, Gastrointestinal Cancer Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Mosazadeh
- Health Sciences Research center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Monireh Maham
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
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Takemoto MM, Garcez AS, Sperandio M. High energy density LED-based photobiomodulation inhibits squamous cell carcinoma progression in co-cultures in vitro. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2019; 199:111592. [DOI: 10.1016/j.jphotobiol.2019.111592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/02/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022]
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Matschke J, Armbruster R, Reeps C, Weitz J, Dragu A. AV loop free flap: an interdisciplinary approach for perineal and sacral defect reconstruction after radical oncological exenteration and radiation in a colorectal cancer patient. World J Surg Oncol 2019; 17:154. [PMID: 31477142 PMCID: PMC6721242 DOI: 10.1186/s12957-019-1698-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background The free flap transfer of a latissimus dorsi flap (LDF) for the closure of sacral wound defects after pelvic exenteration and radiation therapy offers a successful tool of the plastic surgeon. This case report shows the successful coverage using an upstream arterio-venous (AV) loop in combination with an LDF. Case presentation We describe the case of a patient who underwent a pelvic exenteration and radiation therapy due to a local recurrence of rectal cancer. The initially used VRAM flap could not ensure a satisfactorily wound closure. An interdisciplinary approach first yielded an AV loop using both greater saphenous veins and was connected to the arteria and vena femoris followed by a free LDF transfer, which was performed 11 days later. The result was an excellent reconstructive and plastic coverage of the sacral wound defect with a well-perfused LDF. The long-term result showed a perfectly integrated flap in the sacral region. Conclusion We recommend the free LDF for the coverage of large wound defects in irradiated areas after the failure of VRAM flap. If an AV loop is necessary within the flap transfer, we recommend conducting two procedures to guarantee the perfusion of the AV loop.
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Affiliation(s)
- Jan Matschke
- Department of Plastic and Hand Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
| | - Rafael Armbruster
- Department of Plastic and Hand Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Christian Reeps
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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Abstract
Palliative wound care is a philosophy of wound management that prioritizes comfort over healing and attends to the emotional distress these wounds can cause. Intervention strategies focus on management of symptoms such as pain, odor, bleeding, and exudate. Historic treatments such as honey, chlorine, and vinegar have gained renewed interest, and although well suited to the palliative setting, there is an increasing amount of research exploring their efficacy in other contexts. The lived experience of patients and caregivers facing these wounds is often stressful and isolating, and any treatment plan must address these issues along with the physical aspects of care.
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133
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Pazdrowski J, Dańczak‐Pazdrowska A, Polańska A, Kaźmierska J, Barczak W, Szewczyk M, Golusiński P, Adamski Z, Żaba R, Golusiński W. An ultrasonographic monitoring of skin condition in patients receiving radiotherapy for head and neck cancers. Skin Res Technol 2019; 25:857-861. [DOI: 10.1111/srt.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/27/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Jakub Pazdrowski
- Department of Head and Neck Surgery Poznan University of Medical Sciences Poznan Poland
- Department of Head and Neck Surgery The Greater Poland Cancer Centre Poznan Poland
| | | | - Adriana Polańska
- Department of Dermatology and Venereology Poznan University of Medical Sciences Poznan Poland
| | - Joanna Kaźmierska
- Radiotherapy Department II Greater Poland Cancer Center Poznan Poland
- Electroradiology Department University of Medical Sciences Poznan Poland
| | - Wojciech Barczak
- Department of Head and Neck Surgery Poznan University of Medical Sciences Poznan Poland
- Radiobiology Lab The Greater Poland Cancer Centre Poznan Poland
| | - Mateusz Szewczyk
- Department of Head and Neck Surgery Poznan University of Medical Sciences Poznan Poland
- Department of Head and Neck Surgery The Greater Poland Cancer Centre Poznan Poland
| | - Paweł Golusiński
- Department of Head and Neck Surgery Poznan University of Medical Sciences Poznan Poland
- Department of Head and Neck Surgery The Greater Poland Cancer Centre Poznan Poland
| | - Zygmunt Adamski
- Department of Dermatology Poznan University of Medical Sciences Poznan Poland
| | - Ryszard Żaba
- Department of Dermatology and Venereology Poznan University of Medical Sciences Poznan Poland
| | - Wojciech Golusiński
- Department of Head and Neck Surgery Poznan University of Medical Sciences Poznan Poland
- Department of Head and Neck Surgery The Greater Poland Cancer Centre Poznan Poland
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Musa AE, Omyan G, Esmaely F, Shabeeb D. Radioprotective Effect of Hesperidin: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E370. [PMID: 31336963 PMCID: PMC6681345 DOI: 10.3390/medicina55070370] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 01/23/2023]
Abstract
Background and objectives: Ionizing radiation (IR) has been of immense benefit to man, especially for medical purposes (diagnostic imaging and radiotherapy). However, the risks of toxicity in healthy normal cells, leading to cellular damage as well as early and late side effects, have been major drawbacks. The aim of this study was to evaluate the radioprotective effect of hesperidin against IR-induced damage. Materials and Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) were applied in reporting this study. A search was conducted using the electronic databases PubMed, Scopus, Embase, Google Scholar, and www.ClinicalTrials.gov for information about completed or ongoing clinical trials. Results: From our search results, 24 studies involving rats, mice, and cultured human and animal cells were included. An experimental case-control design was used in all studies. The studies showed that the administration of hesperidin reduced oxidative stress and inflammation in all investigated tissues. Furthermore, it increased 30-day and 60-day survival rates and protected against DNA damage. The best radioprotection was obtained when hesperidin was administered before irradiation. Conclusions: The results of the included studies support the antioxidant, anti-inflammatory, and antiapoptotic abilities of hesperidin as a potential radioprotective agent against IR-induced damage. We recommend future clinical trials for more insights.
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Affiliation(s)
- Ahmed Eleojo Musa
- Department of Medical Physics, Tehran University of Medical Sciences (TUMS), Tehran 1416753955, Iran.
| | - Gilnaz Omyan
- Department of Physics, University of Guilan, Guilan 43714, Iran
- Radiotherapy and Oncology Research Center, Cancer Institute, TUMS, Tehran 1416753955, Iran
| | - Farid Esmaely
- Department of Medical Physics, Tehran University of Medical Sciences (TUMS), Tehran 1416753955, Iran
| | - Dheyauldeen Shabeeb
- Misan Radiotherapy Center, Misan Health Directorate, Ministry of Health/Environment, Misan 62010, Iraq
- Department of Physiology, College of Medicine, University of Misan, Misan 62010, Iraq
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Burnett LR, Gabard AR, Robinson M, Bourland JD, Dorand JE, Dozier S, Xiao R, Roy DC, Tytell M. Biomolecular Analysis of Beta Dose-Dependent Cutaneous Radiation Injury in a Porcine Model. Radiat Res 2019; 192:145-158. [PMID: 31166846 DOI: 10.1667/rr14283.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
While cutaneous radiation injury (CRI) is generally referenced as a consequence of a nuclear attack, it can also be caused by less dangerous events such as the use of dirty bombs, industrial radiological accidents, or accidental overexposure of beta (β) particle or gamma (γ) radiation sources in medical procedures. Although the gross clinical consequences of these injuries have been well documented, relatively little is known about the molecular changes underlying the progression of pathology. Here we describe a porcine model of cutaneous radiation injury after skin was exposed to strontium-90 b particle at doses of 16-42 Gy and characterize the anatomical and molecular changes over 70 days. The results show that irradiated sites displayed dosedependent increases in erythema and moist desquamation that peaked between days 35 and 42. Dose-dependent histopathological changes were observed, with higher doses exhibiting increased inflammation and epidermal hyperplasia beyond day 35. Furthermore, immunohistochemistry showed that exposure to 37 Gy β-particle radiation decreased epidermal cell proliferation and desmosomal junction proteins at day 70, suggesting compromised epidermal integrity. Metabolomic analysis of biopsies revealed dose- and time-dependent changes as high as 252-fold in several metabolites not previously linked to CRI. These alterations were seen in pathways reflecting protein degradation, oxidative stress, eicosanoid production, collagen matrix remodeling, mitochondrial stress, cell membrane composition and vascular disruption. Taken together, these data show that exposure to high doses of β particle damaged the molecular processes underlying skin integrity to a greater extent and for a longer period of time than has been shown previously. These findings further understanding of radiation-induced skin injury and serve as a foundation for the development and testing of potential therapeutics to treat CRI.
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Affiliation(s)
| | | | - Mac Robinson
- Department of b Neurobiology and Anatomy, Wake Forest University School of Medicine and Graduate School, Winston-Salem, North Carolina
| | - J Daniel Bourland
- c Department of Radiation Oncology and Physics, Wake Forest University School of Medicine and Graduate School, Winston-Salem, North Carolina
| | - Jennifer E Dorand
- c Department of Radiation Oncology and Physics, Wake Forest University School of Medicine and Graduate School, Winston-Salem, North Carolina
| | - Stephen Dozier
- Department of b Neurobiology and Anatomy, Wake Forest University School of Medicine and Graduate School, Winston-Salem, North Carolina
| | - Roy Xiao
- Department of b Neurobiology and Anatomy, Wake Forest University School of Medicine and Graduate School, Winston-Salem, North Carolina
| | - Daniel C Roy
- a KeraNetics, LLC, Winston-Salem, North Carolina
| | - Michael Tytell
- Department of b Neurobiology and Anatomy, Wake Forest University School of Medicine and Graduate School, Winston-Salem, North Carolina
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Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review. ACTA ACUST UNITED AC 2019; 55:medicina55060226. [PMID: 31146506 PMCID: PMC6630203 DOI: 10.3390/medicina55060226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/26/2019] [Accepted: 05/21/2019] [Indexed: 01/12/2023]
Abstract
Background: In those undergoing treatment for breast cancer, evidence has demonstrated a significant improvement in survival, and a reduction in the risk of local recurrence in patients who undergo postmastectomy radiation therapy (PMRT). There is uncertainty about the optimal timing of PMRT, whether it should be before or after tissue expander or permanent implant placement. This study aimed to summarize the data reported in the literature on the effect of the timing of PMRT, both preceding and following 2-stage expander-implant breast reconstruction (IBR), and to statistically analyze the impact of timing on infection rates and the need for explantation. Methods: A comprehensive systematic review of the literature was conducted using the PubMed/Medline, Ovid, and Cochrane databases without timeframe limitations. Articles included in the analysis were those reporting outcomes data of PMRT in IBR published from 2009 to 2017. Chi-square statistical analysis was performed to compare infection and explantation rates between the two subgroups at p < 0.05. Results: A total of 11 studies met the inclusion criteria for this study. These studies reported outcomes data for 1565 total 2-stage expander-IBR procedures, where PMRT was used (1145 before, and 420 after, implant placement). There was a statistically significant higher likelihood of infection following pre-implant placement PMRT (21.03%, p = 0.000079), compared to PMRT after implant placement (9.69%). There was no difference in the rate of explantation between pre-implant placement PMRT (12.93%) and postimplant placement PMRT (11.43%). Conclusion: This study suggests that patients receiving PMRT before implant placement in 2-stage expander–implant based reconstruction may have a higher risk of developing an infection.
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Acute Skin Damage and Late Radiation-Induced Fibrosis and Inflammation in Murine Ears after High-Dose Irradiation. Cancers (Basel) 2019; 11:cancers11050727. [PMID: 31130616 PMCID: PMC6562452 DOI: 10.3390/cancers11050727] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 01/04/2023] Open
Abstract
The use of different scoring systems for radiation-induced toxicity limits comparability between studies. We examined dose-dependent tissue alterations following hypofractionated X-ray irradiation and evaluated their use as scoring criteria. Four dose fractions (0, 5, 10, 20, 30 Gy/fraction) were applied daily to ear pinnae. Acute effects (ear thickness, erythema, desquamation) were monitored for 92 days after fraction 1. Late effects (chronic inflammation, fibrosis) and the presence of transforming growth factor beta 1 (TGFβ1)-expressing cells were quantified on day 92. The maximum ear thickness displayed a significant positive correlation with fractional dose. Increased ear thickness and erythema occurred simultaneously, followed by desquamation from day 10 onwards. A significant dose-dependency was observed for the severity of erythema, but not for desquamation. After 4 × 20 and 4 × 30 Gy, inflammation was significantly increased on day 92, whereas fibrosis and the abundance of TGFβ1-expressing cells were only marginally increased after 4 × 30 Gy. Ear thickness significantly correlated with the severity of inflammation and fibrosis on day 92, but not with the number of TGFβ1-expressing cells. Fibrosis correlated significantly with inflammation and fractional dose. In conclusion, the parameter of ear thickness can be used as an objective, numerical and dose-dependent quantification criterion to characterize the severity of acute toxicity and allow for the prediction of late effects.
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138
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Gou S, Del Rio-Sancho S, Singhal M, Laubach HJ, Kalia YN. Er:YAG fractional laser ablation for cutaneous co-delivery of pentoxifylline and d-α-tocopherol succinate: A new approach for topical treatment of radiation-induced skin fibrosis. Eur J Pharm Sci 2019; 135:22-31. [PMID: 31078643 DOI: 10.1016/j.ejps.2019.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/30/2022]
Abstract
Radiation induced fibrosis is a common side-effect after radiotherapy. Pentoxifylline is reported to reverse radiation injuries when used in conjunction with D-α-tocopherol. However, pentoxifylline has a short half-life, limited oral bioavailability, and induces several systemic adverse effects. The objective of this study was to investigate the feasibility of using Er:YAG fractional laser ablation to enable simultaneous cutaneous delivery of pentoxifylline and D- α -tocopherol succinate from poly(lactide-co-glycolide) microparticles prepared using the freeze-fracture technique. In vitro release experiments demonstrated the different release profiles of the two molecules, which were influenced by their very different lipophilicities and aqueous solubilities. Experiments were then performed to investigate the effect of laser fluence on pore depth and so determine the pore volume available to host the topically applied microparticles. Application of the pentoxifylline and D-α-tocopherol succinate containing microparticles, prepared with RESOMER® RG 502H, to laser porated skin for 48 h, resulted in simultaneous delivery of pentoxifylline (69.63 ± 6.41 μg/cm2; delivery efficiency 46.4%) and D-α-tocopherol succinate (33.25 ± 8.91 μg/cm2; delivery efficiency 22.2%). After deposition into the micropores, the poly(lactide-co-glycolide) microparticles containing pentoxifylline and D-α-tocopherol succinate could serve as an intraepidermal depot to enable sustained drug delivery after micropore closure and thereby reduce the need for repeated microporation.
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Affiliation(s)
- Si Gou
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, 1211 Geneva, Switzerland
| | - Sergio Del Rio-Sancho
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, 1211 Geneva, Switzerland
| | - Mayank Singhal
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, 1211 Geneva, Switzerland
| | - Hans-Joachim Laubach
- Division of Dermatology, Geneva University Hospital, 1205 Geneva, Switzerland; Centre Laser MD, 8 Rue de Londres, 67000 Strasbourg, France
| | - Yogeshvar N Kalia
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, 1211 Geneva, Switzerland.
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139
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Sokolenko VL, Sokolenko SV. Interdependence of oxidative/antioxidant system indicators and thyroid status under conditions of prolonged exposure to small doses of radiation. REGULATORY MECHANISMS IN BIOSYSTEMS 2019. [DOI: 10.15421/021933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We have studied the interdependence of the intensity of oxidative processes/antioxidant level and the thyroid status parameters in a group of students aged 18–24 who lived for a long time in the territory of enhanced radioecological control (density of soil contamination by isotopes (137Cs 3.7 ∙ 104 – 18.5 ∙ 104 Bq/m2). We examined 50 people from relatively environmentally friendly areas (control group) and 50 people from IV radiation zone (experimental group). In the experimental group, there were no individuals with clinical manifestations of thyroid pathology. However, subgroups with signs of hyperthyroidism and hypothyroidism were identified. We evaluated the level of cortisol, thyrotrophic hormone (TSH), triiodothyronine (T3), thyroxine (T4), malonic dialdehyde (MDA), ceruloplasmin (CP), transferrin (Tf), sulfhydryl groups (SH); we calculated the oxidative stress index (OSI). The research was conducted one month before the examination time and also during the exams as a factor in increased emotional stress. A lowered CP level was found in the subgroup with signs of hypothyroidism; SH groups – in all subgroups, separated by thyroid status. The oxidative stress index was higher in all students examined of the experimental group, compared with the control. The growth of MDA level is marked in the experimental group – it is the most strongly pronounced in conditions of additional emotional load in people with signs of hyperthyroidism and hypothyroidism. CP level significantly decreased in the subgroup of hyperthyroidism on the background of T3 decrease. OSI increased in all students examined from the experimental group. In the subgroup of hypothyroidism it became significantly higher than in the subgroup of euthyroidism. A positive correlation between the levels of CP and T3 was found. The highest values of the correlation coefficients were noted for subgroups with signs of hyperthyroidism and hypothyroidism, with the coefficient significance increasing under conditions of emotional stress. The index of oxidative stress in the experimental group positively correlated with the level of TSH – in terms of emotional stress, the statistical significance of the coefficients disappeared. In the subgroups divided by thyroid status, variability of interactions between OSI and T3 was observed but it was not statistically significant. It was found that the participation of thyroid status in supporting redox homeostasis in people aged 18–24 who suffered from chronic small-doze radiation exposure was realized mainly by the influence on the antioxidant system. The ability of thyroid hormones to maintain a proper antioxidant state was suppressed in this group. The unbalanced relationship between thyroid hormones and oxidative stress indicators is strongly manifested under conditions of additional emotional stress.
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140
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Hegedus F, Schwartz RA. Cutaneous radiation damage: updating a clinically challenging concern. GIORN ITAL DERMAT V 2019; 154:550-556. [PMID: 31042858 DOI: 10.23736/s0392-0488.19.06338-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cutaneous radiation damage, commonly referred to as radiation dermatitis, is a finding of considerable concern. The exposure is often from radiation therapy, a double-edged sword, removing malignant cancer cells and improving the lives of countless patients, yet being locally destructive and potentially premalignant. Among its negative consequences and complications, radiation dermatitis, a potentially severe skin reaction that occurs after the receipt of radiation therapy, presents a clinical challenge today. There are two types of cutaneous radiation dermatitis: acute and chronic. Acute radiation dermatitis manifests within 90 days after the induction of radiation therapy while chronic radiation dermatitis develops beyond 90 days of radiation. There are many risk factors associated with radiation dermatitis which can be characterized as intrinsic, extrinsic, or both. Intrinsic risk factors include concurrent chemotherapy and targeted therapy, connective tissue and skin disorders, genetic and personal factors such as age, sex, smoking habits, and nutritional status. Extrinsic factors are mainly related to the type and dose of the radiation received. Treatment options have been enhanced in the last decade, providing patients with better outcomes and improved quality of life. Such treatments include topical ointments and therapies, oral enzymes, wound dressings and surgical treatments. This article aims to review the current medical understanding of radiation dermatitis, its risk factors, pathophysiology, and treatment options.
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Affiliation(s)
- Fanni Hegedus
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
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141
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Farrugia CJE, Burke ES, Haley ME, Bedi KT, Gandhi MA. The use of aloe vera in cancer radiation: An updated comprehensive review. Complement Ther Clin Pract 2019; 35:126-130. [DOI: 10.1016/j.ctcp.2019.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/24/2018] [Accepted: 01/22/2019] [Indexed: 12/21/2022]
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142
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Beamer LC, Grant M. Using the Dermatology Life Quality Index to Assess How Breast Radiodermatitis Affects Patients' Quality of Life. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2019; 13:1178223419835547. [PMID: 31019366 PMCID: PMC6463233 DOI: 10.1177/1178223419835547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study is to report the initial validation process for using the Dermatology Life Quality Index (DLQI) for radiodermatitis of the breast. Methods This is an additional analysis of a study designed to report a longitudinal study in skin-related and global quality of life in women with breast radiodermatitis. A total of 40 participants completed the DLQI instrument weekly while receiving external radiotherapy of the female breast. At week 5 on treatment, 31 (78%) participants provided narrative feedback on how each DLQI item affected her life. Agreement between participant DLQI numerical ratings and narrative feedback on items was assessed. Construct validity was estimated using principal component analysis (PCA). Internal consistency of the DLQI was assessed using Cronbach alpha. Results Percentage of agreement between participant DLQI ratings and narratives ranged from 71% to 98%. Each participant responded "no" to the work and study item leading to zero variance and removal from our analyses. Principal component analysis supported the inclusion of all of the remaining items. The DLQI with nine remaining items demonstrated moderately good internal consistency (α = .69). Conclusions The results of our examination of the DLQI when used for breast radiodermatitis are promising. Next steps include additional larger studies among more diverse populations.
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Affiliation(s)
- Laura Curr Beamer
- School of Nursing & Health Studies, Northern Illinois University, DeKalb, IL, USA.,College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Marcia Grant
- Division of Nursing Research and Education, City of Hope National Medical Center/Beckman Research Institute, Duarte, CA, USA
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143
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Deptuła M, Zieliński J, Wardowska A, Pikuła M. Wound healing complications in oncological patients: perspectives for cellular therapy. Postepy Dermatol Alergol 2019; 36:139-146. [PMID: 31320845 PMCID: PMC6627262 DOI: 10.5114/ada.2018.72585] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/23/2017] [Indexed: 12/16/2022] Open
Abstract
Various types of cancer are nowadays a serious medical and social problem and a great challenge for modern medicine. The majority of anticancer therapy is based on traditional chemotherapy and radiotherapy. Both of these highly non-specific types of treatment have a number of serious side effects including wound healing complications. Radiotherapy and chemotherapy mostly affect rapidly dividing skin cells (e.g. keratinocytes), as well as fibroblasts, melanocytes, endothelial and immune cells. Currently, there are many strategies to improve wound healing in oncological patients, including various types of dressings, biomaterials, growth factors, and cell therapies.
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Affiliation(s)
- Milena Deptuła
- Department of Embryology, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Zieliński
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Anna Wardowska
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Michał Pikuła
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
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144
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Perraud AL, Rao DM, Kosmacek EA, Dagunts A, Oberley-Deegan RE, Gally F. The ion channel, TRPM2, contributes to the pathogenesis of radiodermatitis. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2019; 58:89-98. [PMID: 30483886 PMCID: PMC6394656 DOI: 10.1007/s00411-018-0769-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Abstract
Radiodermatitis is a painful side effect for cancer patients undergoing radiotherapy. Irradiation of the skin causes inflammation and breakdown of the epidermis and can lead to significant morbidity and mortality in severe cases, as seen in exposure from accidents or weapons such as "dirty bombs" and ultimately leads to tissue fibrosis. However, the pathogenesis of radiodermatitis is not fully understood. Using a mouse model of radiodermatitis, we showed that the Transient Receptor Potential Melastatin 2 (TRPM2) ion channel plays a significant role in the development of dermatitis following exposure to ionizing radiation. Irradiated TRPM2-deficient mice developed less inflammation, fewer severe skin lesions and decreased fibrosis when compared to wild type mice. The TRPM2-deficient mice also showed a faster recovery period as seen by their increased weight gain post irradiation. Finally, TRPM2-deficient mice exhibited lower systemic inflammation with a reduction in inflammatory cytokines present in the serum. These findings suggest that TRPM2 may be a potential therapeutic target for reducing the severity of radiodermatitis.
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Affiliation(s)
- Anne-Laure Perraud
- Department of Biomedical Research, National Jewish Health, 1400 Jackson St., Room K827, Denver, CO, 80206, USA
- Department of Immunology and Microbiology, University of Colorado Denver, Denver, USA
| | - Deviyani M Rao
- Department of Biomedical Research, National Jewish Health, 1400 Jackson St., Room K827, Denver, CO, 80206, USA
| | - Elizabeth A Kosmacek
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, USA
| | - Aleksandra Dagunts
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, USA
| | - Rebecca E Oberley-Deegan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, USA
| | - Fabienne Gally
- Department of Biomedical Research, National Jewish Health, 1400 Jackson St., Room K827, Denver, CO, 80206, USA.
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145
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Radiodermatitis - review of treatment options. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.2478/sjdv-2018-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Radiation dermatitis is one of the commonest side effects of ionizing radiation which is applied in radiotherapy of carcinoma of all localizations, most frequently of tumors of breast, head and neck region, lungs and soft tissue sarcomas. It usually occurs as a complication of breast radiotherapy and thus it is more often recorded in female patients on the skin in the region of breast subjected to radiation. Clinical manifestations of radiation dermatitis can be divided into four phases: acute phase (erythema, dry desquamation, moist desquamation, ulceration and necrosis with resulting re-epithelialization, residual post-inflammatory hyperpigmentation, reduction and suppression of sebaceous and sweat glands and epilation); subacute phase (hyperpigmentation and hypopigmentation, telangiectasia, skin atrophy, even ulceration); chronic phase (skin atrophy, dermal fibrosis and permanent skin epilation) and late phase (increased risk of skin cancer). In order to prevent radiation dermatitis, skin care products should be applied throughout radiotherapy that will decrease the frequency of skin reactions or block them and thus improve life quality. Although the therapy includes not only topical corticosteroids but numerous other products with active ingredients such as aloe vera, calendula, hyaluronic acid, sucralfat, sorbolene, mineral and olive oil, honey, vitamin C, zinc, antimicrobials and silver, common therapeutic consensus has not been reached on their application in radiation dermatitis. Therefore, the treatment should be conducted according to the basic guidelines but tailor-made for each individual patient.
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146
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Zhou Y, Zhang Y. Single- versus 2-stage reconstruction for chronic post-radiation chest wall ulcer: A 10-year retrospective study of chronic radiation-induced ulcers. Medicine (Baltimore) 2019; 98:e14567. [PMID: 30813173 PMCID: PMC6408038 DOI: 10.1097/md.0000000000014567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Radiation therapy can have adverse effects on normal tissue and cause chronic ulcers. The purpose of this study was to compare breast cancer patients who underwent single-stage reconstruction with patients who underwent 2-stage reconstruction for chronic radiation-induced necrotic ulcers of the chest wall.This retrospective study comprised of 50 patients with chronic radiation-induced chest wall ulcers who underwent chest wall reconstruction in our hospital between January 2002 and January 2016. All patients developed ulcers after undergoing breast cancer surgery, followed by radiation therapy. These patients were divided into 2 groups: group A, patients who underwent debridement and reconstruction with tissue flaps simultaneously in a single-stage procedure; group B, patients who underwent debridement and omentum majus tamping in the 1st stage, followed by surgical reconstruction with skin grafting or flap transfer 2 weeks later. The postoperative complications and outcomes were evaluated and compared.These patients were followed up for 48 to 55 months (mean: 50 months), and overall survival was 98%. One patient in group A died of septicemia 5 days after the operation. Six patients in group A developed flap infection, among which 4 patients progressed to flap necrosis (group A: 6/25 vs group B: 0/25; P = .000).Compared to single-stage reconstruction, surgical reconstruction in 2 stages was safer and more effective in treating chronic radiation-induced ulcers of the chest wall, and is associated with fewer postoperative complications. The omentum majus flap was the most ideal tissue for the repair of these defects.
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Affiliation(s)
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
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147
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Kawamura M, Yoshimura M, Asada H, Nakamura M, Matsuo Y, Mizowaki T. A scoring system predicting acute radiation dermatitis in patients with head and neck cancer treated with intensity-modulated radiotherapy. Radiat Oncol 2019; 14:14. [PMID: 30665451 PMCID: PMC6341605 DOI: 10.1186/s13014-019-1215-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/07/2019] [Indexed: 12/25/2022] Open
Abstract
Background and purpose We created a scoring system incorporating dosimetric and clinical factors to assess the risk of severe, acute skin reactions in patients undergoing intensity-modulated radiation therapy (IMRT) to treat head and neck cancer (HNC). Materials and methods A total of 101 consecutive patients who received definitive IMRT or volumetric modulated arc therapy (VMAT) with a prescription dose of 70 Gy to treat HNC between 2013 and 2017 in our hospital were enrolled. Skin V5Gy, V10Gy, V20Gy, V30Gy, V40Gy, V50Gy, and V60Gy values delivered 5 mm within the body contour were compared between patients with Grades 1–2 and Grade 3 dermatitis. A scoring system was created based on logistic regression analysis (LRA) that identified the most significant dosimetric and clinical factors. Results The V60Gy was significantly associated with radiation dermatitis grade in both LRA and recursive partitioning analysis (RPA). A scoring system incorporating the V60Gy, concurrent chemotherapy status, age, and body mass index was used to divide all patients into three subgroups (0–1, 2–3, and 4–6 points) in the RPA. The incidence of Grade 3 dermatitis significantly differed among the subgroups (0, 20.5, and 58.6%, respectively, P < 0.01). Conclusions A risk analysis model incorporating dose-volume parameters successfully predicted acute skin reactions and will aid in the appropriate management of radiation dermatitis.
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Affiliation(s)
- Mitsue Kawamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
| | - Hiromi Asada
- Nursing Department, Kyoto University Hospital, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.,Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
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148
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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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Shabeeb D, Najafi M, Musa AE, Keshavarz M, Shirazi A, Hassanzadeh G, Hadian MR, Samandari H. Biochemical and Histopathological Evaluation of the Radioprotective Effects of Melatonin Against Gamma Ray-Induced Skin Damage. Curr Radiopharm 2019; 12:72-81. [PMID: 30465519 DOI: 10.2174/1874471012666181120163250] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/25/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Radiotherapy is one of the treatment methods for cancers using ionizing radiations. About 70% of cancer patients undergo radiotherapy. Radiation effect on the skin is one of the main complications of radiotherapy and dose limiting factor. To ameliorate this complication, we used melatonin as a radioprotective agent due to its antioxidant and anti-inflammatory effects, free radical scavenging, improving overall survival after irradiation as well as minimizing the degree of DNA damage and frequency of chromosomal abrasions. METHODS Sixty male Wistar rats were randomly assigned to 4 groups: control (C), melatonin (M), radiation (R) and melatonin + radiation (MR). A single dose of 30 Gy gamma radiation was exposed to the right hind legs of the rats while 40 mg/ml of melatonin was administered 30 minutes before irradiation and 2 mg/ml once daily in the afternoon for one month till the date of rat's sacrifice. Five rats from each group were sacrificed 4, 12 and 20 weeks after irradiation. Afterwards, their exposed skin tissues were examined histologically and biochemically. RESULTS In biochemical analysis, we found that malondialdehyde (MDA) levels significantly increased in R group and decreased significantly in M and MR groups after 4, 12, and 20 weeks, whereas catalase (CAT) and superoxide dismutase (SOD) activities decreased in the R group and increased in M and MR groups during the same time periods compared with the C group (p<0.05). Histopathological examination found there were statistically significant differences between R group compared with the C and M groups for the three different time periods (p<0.005, p<0.004 and p<0.004) respectively, while R group differed significantly with MR group (p<0.013). No significant differences were observed between C and M compared with MR group (p>0.05) at 4 and 20 weeks except for inflammation and hair follicle atrophy, while there were significant effects at 12 weeks (p<0.05). CONCLUSION Melatonin can be successfully used for the prevention and treatment of radiation-induced skin injury. We recommend the use of melatonin in optimal and safe doses. These doses should be administered over a long period of time for effective radioprotection and amelioration of skin damages as well as improving the therapeutic ratio of radiotherapy.
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Affiliation(s)
- Dheyauldeen Shabeeb
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science, International Campus, Tehran, Iran
- Department of Physiology, College of Medicine, University of Misan, Iraq
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Najafi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahmed Eleojo Musa
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science, International Campus, Tehran, Iran
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoor Keshavarz
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Shirazi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science, International Campus, Tehran, Iran
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Hassanzadeh
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammed Reza Hadian
- Brain and Spinal Cord Injury, Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
| | - Hedayat Samandari
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Cun-Jin S, Jian-Hao X, Xu L, Feng-Lun Z, Jie P, Ai-Ming S, Duan-Min H, Yun-Li Y, Tong L, Yu-Song Z. X-ray induces mechanical and heat allodynia in mouse via TRPA1 and TRPV1 activation. Mol Pain 2019; 15:1744806919849201. [PMID: 31012378 PMCID: PMC6509987 DOI: 10.1177/1744806919849201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022] Open
Abstract
Radiotherapy-related pain is a common adverse reaction with a high incidence among cancer patients undergoing radiotherapy and remarkably reduces the quality of life. However, the mechanisms of ionizing radiation-induced pain are largely unknown. In this study, mice were treated with 20 Gy X-ray to establish ionizing radiation-induced pain model. X-ray evoked a prolonged mechanical, heat, and cold allodynia in mice. Transient receptor potential vanilloid 1 and transient receptor potential ankyrin 1 were significantly upregulated in lumbar dorsal root ganglion. The mechanical and heat allodynia could be transiently reverted by intrathecal injection of transient receptor potential vanilloid 1 antagonist capsazepine and transient receptor potential ankyrin 1 antagonist HC-030031. Additionally, the phosphorylated extracellular regulated protein kinases (ERK) and Jun NH2-terminal Kinase (JNK) in pain neural pathway were induced by X-ray treatment. Our findings indicated that activation of transient receptor potential ankyrin 1 and transient receptor potential vanilloid 1 is essential for the development of X-ray-induced allodynia. Furthermore, our findings suggest that targeting on transient receptor potential vanilloid 1 and transient receptor potential ankyrin 1 may be promising prevention strategies for X-ray-induced allodynia in clinical practice.
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Affiliation(s)
- Su Cun-Jin
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Neuroscience, Soochow University, Suzhou, China
| | - Xu Jian-Hao
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Liu Xu
- Institute of Neuroscience, Soochow University, Suzhou, China
| | - Zhao Feng-Lun
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Pan Jie
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shi Ai-Ming
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hu Duan-Min
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Yun-Li
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Liu Tong
- Institute of Neuroscience, Soochow University, Suzhou, China
- College of Life Sciences, Yanan University, Yanan, China
| | - Zhang Yu-Song
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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