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Golomb BA, Berg BK, Han JH. Susceptibility to radiation adverse effects in veterans with Gulf War illness and healthy civilians. Sci Rep 2024; 14:874. [PMID: 38195674 PMCID: PMC10776672 DOI: 10.1038/s41598-023-50083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024] Open
Abstract
We evaluated whether veterans with Gulf War illness (VGWI) report greater ionizing radiation adverse effects (RadAEs) than controls; whether radiation-sensitivity is tied to reported chemical-sensitivity; and whether environmental exposures are apparent risk factors for reported RadAEs (rRadAEs). 81 participants (41 VGWI, 40 controls) rated exposure to, and rRadAEs from, four radiation types. The relations of RadAE-propensity (defined as the ratio of rRadAEs to summed radiation exposures) to Gulf War illness (GWI) presence and severity, and to reported chemical-sensitivity were assessed. Ordinal logistic regression evaluated exposure prediction of RadAE-propensity in the full sample, in VGWI, and stratified by age and chemical-sensitivity. RadAE-propensity was increased in VGWI (vs. controls) and related to GWI severity (p < 0.01) and chemical-sensitivity (p < 0.01). Past carbon monoxide (CO) exposure emerged as a strong, robust predictor of RadAE-propensity on univariable and multivariable analyses (p < 0.001 on multivariable assessment, without and with adjustment for VGWI case status), retaining significance in age-stratified and chemical-sensitivity-stratified replication analyses. Thus, RadAE-propensity, a newly-described GWI-feature, relates to chemical-sensitivity, and is predicted by CO exposure-both features reported for nonionizing radiation sensitivity, consistent with shared mitochondrial/oxidative toxicity across radiation frequencies. Greater RadAE vulnerability fits an emerging picture of heightened drug/chemical susceptibility in VGWI.
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Affiliation(s)
- Beatrice Alexandra Golomb
- Department of Medicine, UC San Diego School of Medicine, University of California, San Diego, 9500 Gilman Dr. #0995, La Jolla, CA, 92093-0995, USA.
| | - Brinton Keith Berg
- Department of Medicine, UC San Diego School of Medicine, University of California, San Diego, 9500 Gilman Dr. #0995, La Jolla, CA, 92093-0995, USA
| | - Jun Hee Han
- Department of Medicine, UC San Diego School of Medicine, University of California, San Diego, 9500 Gilman Dr. #0995, La Jolla, CA, 92093-0995, USA
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Behroozian T, Goldshtein D, Ryan Wolf J, van den Hurk C, Finkelstein S, Lam H, Patel P, Kanee L, Lee SF, Chan AW, Wong HCY, Caini S, Mahal S, Kennedy S, Chow E, Bonomo P. MASCC clinical practice guidelines for the prevention and management of acute radiation dermatitis: part 1) systematic review. EClinicalMedicine 2023; 58:101886. [PMID: 37181415 PMCID: PMC10166790 DOI: 10.1016/j.eclinm.2023.101886] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 05/16/2023] Open
Abstract
Acute radiation dermatitis (ARD) commonly develops in cancer patients undergoing radiotherapy and is often characterized by erythema, desquamation, and pain. A systematic review was conducted to summarize the current evidence on interventions for the prevention and management of ARD. Databases were searched from 1946 to September 2020 to identify all original studies that evaluated an intervention for the prevention or management of ARD, with an updated search conducted in January 2023. A total of 235 original studies were included in this review, including 149 randomized controlled trials (RCTs). Most interventions could not be recommended due to a low quality of evidence, lack of supporting evidence, or conflicting findings across multiple trials. Photobiomodulation therapy, Mepitel® film, mometasone furoate, betamethasone, olive oil, and oral enzyme mixtures showed promising results across multiple RCTs. Recommendations could not be made solely based on the published evidence due to limited high-quality evidence. As such, Delphi consensus recommendations will be reported in a separate publication.
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Affiliation(s)
- Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, NY, USA
| | | | | | - Henry Lam
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Partha Patel
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Lauren Kanee
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Henry Chun Yip Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Simran Mahal
- Faculty of Health, University of Waterloo, Ontario, Canada
| | | | - Edward Chow
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Huth S, Marquardt Y, Huth L, Schmitt L, Prescher K, Winterhalder P, Steiner T, Hölzle F, Eble M, Malte Baron J. Molecular effects of photon irradiation and subsequent aftercare treatment with dexpanthenol-containing ointment or liquid in 3D models of human skin and non-keratinized oral mucosa. Exp Dermatol 2021; 30:745-750. [PMID: 33403711 DOI: 10.1111/exd.14266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/03/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate the molecular effects of radiation and subsequent aftercare treatment with dexpanthenol-containing ointment and liquid on established full-thickness 3D skin models depicting acute radiodermatitis and mucositis. To mimic radiomucositis and radiodermatitis, non-keratinized mucous membrane and normal human skin models were irradiated with 5 Gray. Afterwards, models were treated topically every second day with dexpanthenol-containing ointment or liquid in comparison with placebo and untreated controls. On day 7 after irradiation, histological examination showed impairments in irradiated models. In contrast, models treated with dexpanthenol-containing ointment or liquid showed a completely restored epidermal part. While gene expression profiling revealed an induction of genes related to a pro-inflammatory milieu, oxidative stress and an impaired epidermal differentiation after irradiation of the models, aftercare treatment with dexpanthenol-containing ointment or liquid revealed anti-oxidative and anti-inflammatory effects and had a positive effect on epidermal differentiation and structures important for physical and antimicrobial barrier function. Our findings confirm the potential of our established models as in vitro tools for the replacement of pharmacological in vivo studies regarding radiation-induced skin injuries and give indications of the positive effects of dexpanthenol-containing externals after radiation treatments as part of supportive tumor treatment.
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Affiliation(s)
- Sebastian Huth
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Yvonne Marquardt
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Laura Huth
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Laurenz Schmitt
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Kirsten Prescher
- Department of Radiation Oncology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Philipp Winterhalder
- Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Timm Steiner
- Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Frank Hölzle
- Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Oral and Maxillofacial Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Eble
- Department of Radiation Oncology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jens Malte Baron
- Department of Dermatology and Allergology, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Interdisciplinary Center for Laser Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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O'Donovan A, Coleman M, Harris R, Herst P. Prophylaxis and management of acute radiation-induced skin toxicity: a survey of practice across Europe and the USA. Eur J Cancer Care (Engl) 2014; 24:425-35. [DOI: 10.1111/ecc.12213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. O'Donovan
- Applied Radiation Therapy Trinity (ARTT); Trinity College Dublin; Dublin Ireland
| | - M. Coleman
- Applied Radiation Therapy Trinity (ARTT); Trinity College Dublin; Dublin Ireland
| | - R. Harris
- The Society and College of Radiographers; London UK
| | - P. Herst
- Department of Radiation Therapy; University of Otago; Wellington New Zealand
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Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer 2013; 21:2933-48. [DOI: 10.1007/s00520-013-1896-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/26/2013] [Indexed: 11/26/2022]
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Harris R, Probst H, Beardmore C, James S, Dumbleton C, Bolderston A, Faithfull S, Wells M, Southgate E. Radiotherapy skin care: A survey of practice in the UK. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2011.10.040] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Salvo N, Barnes E, van Draanen J, Stacey E, Mitera G, Breen D, Giotis A, Czarnota G, Pang J, De Angelis C. Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. ACTA ACUST UNITED AC 2011; 17:94-112. [PMID: 20697521 DOI: 10.3747/co.v17i4.493] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radiation therapy is a common treatment for cancer patients. One of the most common side effects of radiation is acute skin reaction (radiation dermatitis) that ranges from a mild rash to severe ulceration. Approximately 85% of patients treated with radiation therapy will experience a moderate-to-severe skin reaction. Acute radiation-induced skin reactions often lead to itching and pain, delays in treatment, and diminished aesthetic appearance-and subsequently to a decrease in quality of life. Surveys have demonstrated that a wide variety of topical, oral, and intravenous agents are used to prevent or to treat radiation-induced skin reactions. We conducted a literature review to identify trials that investigated products for the prophylaxis and management of acute radiation dermatitis. Thirty-nine studies met the pre-defined criteria, with thirty-three being categorized as prophylactic trials and six as management trials.For objective evaluation of skin reactions, the Radiation Therapy Oncology Group criteria and the U.S. National Cancer Institute Common Toxicity Criteria were the most commonly used tools (65% of the studies). Topical corticosteroid agents were found to significantly reduce the severity of skin reactions; however, the trials of corticosteroids evaluated various agents, and no clear indication about a preferred corticosteroid has emerged. Amifostine and oral enzymes were somewhat effective in preventing radiation-induced skin reactions in phase II and phase III trials respectively; further large randomized controlled trials should be undertaken to better investigate those products. Biafine cream (Ortho-McNeil Pharmaceuticals, Titusville, NJ, U.S.A.) was found not to be superior to standard regimes in the prevention of radiation-induced skin reactions (n = 6).In conclusion, the evidence is insufficient to support the use of a particular agent for the prevention and management of acute radiation-induced skin reactions. Future trials should focus on comparing agents and approaches that, in phase I and II trials, suggest efficacy. These future phase III randomized controlled trials must clearly distinguish between preventive and management strategies for radiation-induced dermatitis. Only then can evidence-based guidelines be developed, with the hope of standardizing the approach across centres and of improving the prevention and management of radiation-induced dermatitis.
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Affiliation(s)
- N Salvo
- Department of Pharmacy, Edmond Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
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Jensen JM, Gau T, Schultze J, Lemmnitz G, Fölster-Holst R, May T, Abels C, Proksch E. Treatment of acute radiodermatitis with an oil-in-water emulsion following radiation therapy for breast cancer: a controlled, randomized trial. Strahlenther Onkol 2011; 187:378-84. [PMID: 21603988 DOI: 10.1007/s00066-011-2224-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 02/23/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND A side effect of radiotherapy for breast cancer is acute radiodermatitis. It is a common practice to keep irradiated skin dry on account of data from the 1950s that suggested this regimen limits dermatitis. However, severe dryness of the skin induced by irradiation results in itching and discomfort. Dry skin is characterized by scaliness, epidermal barrier dysfunction, and reduced stratum corneum hydration, and these signs and symptoms are reduced by treatment with an emulsion. PATIENTS AND METHODS We performed a randomized, controlled, open-label study with 66 patients (ITT population), treating the irradiated skin in one group (n = 34) with an oil-in-water emulsion (WO1932), while leaving the other group untreated (n = 32). Clinical scoring (ONS radiation skin reaction scoring, pruritus) and biophysical measurements (stratum corneum hydration and transepidermal water loss (TEWL), as a marker of skin barrier function) were determined at day 1 (directly after termination of the radiation therapy), day 8, and day 47 (± 7). RESULTS Irradiation increased the ONS score and pruritus, whereas skin hydration and TEWL were reduced. The primary hypothesis that the increase in skin hydration was significantly greater in the emulsion-treated compared to the untreated group as early as after 8 days of treatment could not be confirmed. At the end of the study (day 47 ± 7), however, normalization of stratum corneum hydration was more advanced in the treatment group compared to the untreated group and nearly reached the values of the contralateral healthy breast skin. ONS score and pruritus also revealed an advantage for the emulsion-treated group. TEWL did not show significant changes during emulsion treatment. No adverse events were caused by the treatment regimens CONCLUSION Treatment of radiodermatitis with an oil-in-water emulsion was well tolerated, enhanced stratum corneum hydration, improved clinical indicators, and provided relief from itching.
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Affiliation(s)
- Jens-Michael Jensen
- Department of Dermatology, University Hospitals of Schleswig-Holstein, University of Kiel, Germany.
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D'haese S, Van Roy M, Bate T, Bijdekerke P, Vinh-Hung V. Management of skin reactions during radiotherapy in Flanders (Belgium): A study of nursing practice before and after the introduction of a skin care protocol. Eur J Oncol Nurs 2010; 14:367-72. [DOI: 10.1016/j.ejon.2009.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 10/21/2009] [Accepted: 10/23/2009] [Indexed: 11/28/2022]
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Bolderston A, Lloyd NS, Wong RKS, Holden L, Robb-Blenderman L. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer 2006; 14:802-17. [PMID: 16758176 DOI: 10.1007/s00520-006-0063-4] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 03/09/2006] [Indexed: 10/24/2022]
Abstract
GOALS OF WORK To develop a practice guideline report on the questions: What are the optimal methods to prevent acute skin reactions (occurring within the first 6 months of irradiation) related to radiation therapy? What are the optimal methods to manage acute skin reactions related to radiation therapy? MATERIALS AND METHODS Cancer Care Ontario's Supportive Care Guidelines Group (SCGG) conducted a systematic review of literature on this topic. Evidence-based recommendations were formulated to guide clinical decision making, and a formal external review process was conducted to validate the relevance of these opinions for Ontario practitioners. MAIN RESULTS Twenty-eight trials meeting the inclusion criteria were identified. Of the twenty-three trials that evaluated preventative methods, washing was the only practice which significantly prevented skin reaction. Some evidence suggested topical steroid creams and calendula ointment might be effective. None of the five trials evaluating skin reaction management detected a positive effect using steroid cream, sucralfate cream, or dressings. CONCLUSIONS Skin washing, including gentle washing with water alone with or without mild soap, should be permitted in patients receiving radiation therapy to prevent acute skin reaction. There is insufficient evidence to support or refute specific topical or oral agents for the prevention or management of acute skin reaction. In the expert opinion from the SCGG, the use of a plain, non-scented, lanolin-free hydrophilic cream may be helpful in preventing radiation skin reactions. In addition, a low dose (i.e., 1%) corticosteroid cream may be beneficial in the reduction of itching and irritation.
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Affiliation(s)
- Amanda Bolderston
- Department of Radiation Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
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D'haese S, Bate T, Claes S, Boone A, Vanvoorden V, Efficace F. Management of skin reactions during radiotherapy: a study of nursing practice. Eur J Cancer Care (Engl) 2005; 14:28-42. [PMID: 15698384 DOI: 10.1111/j.1365-2354.2005.00510.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the consensus of skin care advice given by nurses during radiotherapy. Sixty-seven nurses, identified through nine Belgian radiotherapy departments, responded to a questionnaire survey consisting of 58 items regarding prevention and management of erythema, dry desquamation and moist desquamation. Consensus for a given advice was categorized as small if less than 50% of the nurses gave the same answer, as moderate if between 50% and 75% and as large when more than 75%. Overall, 33% of the items showed small consensus, 29% showed moderate consensus and 38% showed large consensus. The highest consensus was seen for advice in cases of moist and dry desquamation. There was less agreement in the case of erythema and it decreased further for preventive advice. Some skin care techniques that were frequently used by the nurses cannot be supported by the literature. Also, some techniques recommended by the literature are not frequently used. Further, few differences (P < 0.05) between nurses working in a university hospital and the ones working in a non-university hospital were found in terms of advice given to patients. To increase consensus on skin care issues more conclusive research is needed. Of equal importance is the translation of existing research results into daily clinical practice.
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Affiliation(s)
- S D'haese
- Department of Radiotherapy, Oncology Centre, Academic Hospital - Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
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