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Layer JP, Layer K, Glasmacher AR, Sarria GR, Böhner AMC, Layer YL, Dejonckheere CS, Wiegreffe S, Nour Y, Caglayan L, Grau F, Feyer P, Baumert BG, Baumann R, Krug D, Scafa D, Leitzen C, Landsberg J, Giordano FA, Schmeel LC. Pharmaceutical management of acute radiation dermatitis in the German speaking radiation oncology community. J Dtsch Dermatol Ges 2024; 22:198-207. [PMID: 38092687 DOI: 10.1111/ddg.15279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/20/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Radiation dermatitis (RD) remains the most common side effect in radiation therapy (RT) with various pharmaceutical options available for prevention and treatment. We sought to determine pharmaceutical management patterns of radiation dermatitis among radiation oncology professionals. METHODS We conducted a survey on RD among the German-speaking community of radiation oncologists inquiring for their opinion on preventive and therapeutic pharmaceutical approaches for acute RD. RESULTS 244 health professionals participated. Dexpanthenol lotion is the agent most widely used both for prevention (53.0%) and treatment (76.9%) of RD, followed by urea (29.8%) for prevention and corticosteroids (46.9%) for treatment. A wide range of substances is used by participants, though the overall experience with them is rather limited. 32.5% of participants do generally not recommend any preventative treatment. 53.4% of participants recommend alternative medicine for RD management. While seldomly used, corticosteroids were considered most effective in RD therapy, followed by dexpanthenol and low-level laser therapy. A majority of participants prefers moist over dry treatment of moist desquamation and 43.8% prescribe antiseptics. CONCLUSIONS Pharmaceutical management of RD in the German-speaking radiation oncology community remains controversial, inconsistent, and partially not supported by evidence-based medicine. Stronger evidence level and interdisciplinary consensus is required amongst practitioners to improve these care patterns.
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Affiliation(s)
- Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Andrea R Glasmacher
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Alexander M C Böhner
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Yonah L Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Shari Wiegreffe
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Youness Nour
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Lara Caglayan
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Franziska Grau
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Petra Feyer
- Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - René Baumann
- Department of Radiation Oncology, St. Marien Hospital Siegen, Siegen, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Jennifer Landsberg
- Department of Dermatology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
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Layer JP, Layer K, Glasmacher AR, Sarria GR, Böhner AMC, Layer YL, Dejonckheere CS, Wiegreffe S, Nour Y, Caglayan L, Grau F, Feyer P, Baumert BG, Baumann R, Krug D, Scafa D, Leitzen C, Landsberg J, Giordano FA, Schmeel LC. Pharmazeutische Behandlung der akuten Radiodermatitis in der deutschsprachigen strahlentherapeutischen Gemeinschaft: Pharmaceutical management of acute radiation dermatitis in the German speaking radiation oncology community. J Dtsch Dermatol Ges 2024; 22:198-209. [PMID: 38361198 DOI: 10.1111/ddg.15279_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/20/2023] [Indexed: 02/17/2024]
Abstract
ZusammenfassungHintergrundDie Radiodermatitis (RD) ist die häufigste Nebenwirkung der Strahlentherapie (RT), wobei verschiedene pharmazeutische Optionen zur Vorbeugung/Behandlung zur Verfügung stehen. Unser Ziel war, die pharmazeutischen Behandlungsmuster für die RD unter strahlentherapeutischen Fachleuten zu ermitteln.MethodikWir haben eine Umfrage zum Thema RD in der deutschsprachigen radioonkologischen Gemeinschaft durchgeführt und ihre Meinung zu präventiven und therapeutischen pharmazeutischen Therapieansätzen betreffend die akute RD erfragt.Ergebnisse244 Angehörige zugehöriger Gesundheitsberufe nahmen teil. Dexpanthenol‐Lotion ist das am häufigsten verwendete Mittel sowohl zur Vorbeugung (53%) als auch zur Behandlung (76,9%) der RD, gefolgt von Harnstoff (29,8%) zur Vorbeugung und Kortikosteroiden (46,9%) zur Behandlung. Die Teilnehmer verwenden eine breite Palette an Substanzen, haben aber insgesamt wenig Erfahrung mit diesen. 32,5% der Teilnehmer empfehlen generell keine präventive Behandlung. 53,4% der Teilnehmer empfehlen Alternativmedizin. Obwohl selten eingesetzt, wurden Kortikosteroide als wirksamstes Behandlungsmittel angesehen, gefolgt von Dexpanthenol und Low‐Level‐Lasertherapie. Die Mehrheit der Teilnehmer bevorzugt die feuchte gegenüber der trockenen Behandlung der feuchten Desquamation und 43,8% verschreiben Antiseptika.SchlussfolgerungenDie pharmazeutische Behandlung der RD in der deutschsprachigen strahlentherapeutischen Fachwelt ist nach wie vor umstritten, sowie mitunter inkonsistent und nicht durch evidenzbasierte Medizin gestützt. Ein interdisziplinärer Konsens ist erforderlich, um die bestehenden Behandlungskonzepte zu verbessern.
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Affiliation(s)
- Julian P Layer
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
- Institut für Experimentelle Onkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Katharina Layer
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Andrea R Glasmacher
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Gustavo R Sarria
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Alexander M C Böhner
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Yonah L Layer
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Cas S Dejonckheere
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Shari Wiegreffe
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Youness Nour
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Lara Caglayan
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Franziska Grau
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Petra Feyer
- Abteilung für Strahlenonkologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | | | - René Baumann
- Abteilung für Strahlenonkologie, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - David Krug
- Abteilung für Strahlenonkologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Davide Scafa
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Christina Leitzen
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Jennifer Landsberg
- Abteilung für Dermatologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Frank A Giordano
- Abteilung für Strahlenonkologie, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland
- DKFZ Hector Cancer Institute am Universitätsklinikum Mannheim, Mannheim, Germany
| | - Leonard Christopher Schmeel
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
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Layer K, Layer JP, Glasmacher AR, Sarria GR, Böhner AMC, Layer YL, Dejonckheere CS, Garbe S, Feyer P, Baumert BG, Schendera A, Baumann R, Krug D, Köksal MA, Koch D, Scafa D, Leitzen C, Hölzel M, Giordano FA, Schmeel LC. Risk assessment, surveillance, and nonpharmaceutical prevention of acute radiation dermatitis: results of a multicentric survey among the German-speaking radiation oncology community. Strahlenther Onkol 2023; 199:891-900. [PMID: 37099166 PMCID: PMC10542714 DOI: 10.1007/s00066-023-02074-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/05/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Radiation dermatitis (RD) represents one of the most frequent side effects in radiotherapy (RT). Despite technical progress, mild and moderate RD still affects major subsets of patients and identification and management of patients with a high risk of severe RD is essential. We sought to characterize surveillance and nonpharmaceutical preventive management of RD in German-speaking hospitals and private centers. METHODS We conducted a survey on RD among German-speaking radiation oncologists inquiring for their evaluation of risk factors, assessment methods, and nonpharmaceutical preventive management of RD. RESULTS A total of 244 health professionals from public and private institutions in Germany, Austria, and Switzerland participated in the survey. RT-dependent factors were deemed most relevant for RD onset followed by lifestyle factors, emphasizing the impact of treatment conceptualization and patient education. While a broad majority of 92.8% assess RD at least once during RT, 59.0% of participants report RD at least partially arbitrarily and 17.4% stated to classify RD severity solely arbitrarily. 83.7% of all participants were unaware of patient-reported outcomes (PROs). Consensus exists on some lifestyle recommendations like avoidance of sun exposure (98.7%), hot baths (95.1%), and mechanical irritation (91.8%) under RT, while deodorant use (63.4% not at all, 22.1% with restrictions) or application of skin lotion (15.1% disapproval) remain controversial and are not recommended by guidelines or evidence-based practices. CONCLUSION Identification of patients at an increased risk of RD and subsequent implementation of adequate preventive measures remain relevant and challenging aspects of clinical routines. Consensus exists on several risk factors and nonpharmaceutical prevention recommendations, while RT-dependent risk factors, e.g., the fractionation scheme, or hygienic measures like deodorant use remain controversial. Surveillance is widely lacking methodology and objectivity. Intensifying outreach in the radiation oncology community is needed to improve practice patterns.
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Affiliation(s)
- Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Andrea R Glasmacher
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander M C Böhner
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Yonah L Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Petra Feyer
- Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubünden, Graubünden, Switzerland
| | - Anke Schendera
- Department of Radiation Oncology, Community Hospital Mittelrhein, Koblenz, Germany
| | - René Baumann
- Department of Radiation Oncology, St. Marien Hospital Siegen, Siegen, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Mümtaz A Köksal
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Leonard Christopher Schmeel
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Morbidity in Patients with Nasopharyngeal Carcinoma and Radiation-Induced Skin Lesions: Cause, Risk Factors, and Dermatitis Evolution and Severity. Adv Skin Wound Care 2021; 34:1-8. [PMID: 34807900 DOI: 10.1097/01.asw.0000797952.41753.f4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Radiation-induced skin injuries such as lesions (RSLs) and dermatitis are the most common complication during radiotherapy (RT) for nasopharyngeal carcinoma, but little is known about risk factors unique to oncology. This study sought a greater understanding of these risk factors to stratify patients based on risk and guide clinical decision-making. METHODS Investigators analyzed the data of 864 consecutive patients referred to the RT center of the Southern Theater General Hospital for a new RSL from 2013 to 2019. These patients were followed up for an average of approximately 16 months until their death or March 30, 2020, whichever came first. Multivariate logistic regression analysis and Cox proportional hazards model were used to identify predictors of grade 3 or 4 dermatitis. RESULTS The main causes of treatment interruption included dermatitis and oral mucositis. Significant patient-specific risk factors for RSLs included current smoking, current drinking, and lower Karnofsky Performance Scale score and significant procedure-specific risk factors included receiving intensity-modulated radiation therapy (IMRT), hyperfractionated RT, induction chemotherapy, multicycle chemotherapy, and taxol- and cisplatin-based drugs. The three factors that independently predicted risk of RSL were IMRT, lower Karnofsky Performance Scale score, and multicycle chemotherapy. Comparing predictive factors among patients with severe RSL revealed that patients who received IMRT were more likely to develop grade 3 or 4 dermatitis. CONCLUSIONS Oncology providers should note that IMRT is an aggressive technique with a trend toward increased RSL. Providers should pay special attention to adverse effects to skin in patients with nasopharyngeal carcinoma.
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Gerum S, Iglseder W, Schmid R, Peterka K, Knocke-Abulesz TH, Harl P, Schwaiger S, Reiter I, Salinger J, Venhoda C, Kurzweil G, Poetscher M, Jaeger R, Celedin B, Clemens P, Roeder F. Practice of radiation therapy for anal cancer in Austria-a survey on behalf of the Austrian radiation oncology society gastrointestinal tumor group (ÖGRO-GIT). Strahlenther Onkol 2021; 197:953-961. [PMID: 34591119 PMCID: PMC8547205 DOI: 10.1007/s00066-021-01842-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
Purpose We conducted a patterns-of-care survey on chemoradiation for locoregionally confined anal cancer in Austria to evaluate areas of disagreement and to identify possible targets for further standardization. Methods An anonymous questionnaire comprising 38 questions was sent to all Austrian radiation oncology departments. Results were analyzed descriptively and compared to two international guidelines. Results The response rate was 93%. Work-up generally includes DRE, endoscopy, and cross-sectional imaging of chest/abdomen and pelvis. PET-CT is used by 38%. Screening for HIV and biopsies of suspicious lymph nodes are infrequently used. All centers perform IMRT, mainly with daily IGRT. Median doses to the primary are 54.7 Gy (T1–2) and 59.4 Gy (T3–4). Suspicious nodes receive a boost (median dose 54 Gy), while elective nodal areas are mainly treated with 45–50.4 Gy. Target delineation of elective nodal areas seems generally uniform, although disagreement exists regarding inclusion of the common iliac nodes. No agreement was found for OAR-delineation and dose constraints. Concurrent chemotherapy is mitomycin and 5‑FU/capecitabine. Supportive care beyond skin care is infrequently offered. Intensive follow-up is performed for at least 5 years. Treatment of T1N0 shows considerable disagreement. Conclusion We found a high rate of agreement between the centers and concordance with major guidelines. PET-CT, routine HIV testing, and biopsies of suspicious LN seem underrepresented. The largest controversy regarding target volumes concerns inclusion of the common iliac nodes. Prescribed doses are generally in line with the recommendations or higher. OAR delineation, dose constraints, supportive care, and treatment of early anal cancer represent areas for further standardization. Supplementary Information The online version of this article (10.1007/s00066-021-01842-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Gerum
- Universitätsklinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Uniklinikum der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - W Iglseder
- Universitätsklinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Uniklinikum der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Schmid
- Universitätsklinik für Radioonkologie, Medizinische Universität Wien, Universitätsklinikum AKH Wien, Comprehensive Cancer Center Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - K Peterka
- Institut für Radioonkologie, Kaiser-Franz-Josef-Spital/SMZ Süd-Klinik Favoriten, Kundratstraße 3, 1100, Wien, Austria
| | - T H Knocke-Abulesz
- Sonderabteilung Strahlentherapie, Wiener Gesundheitsverbund Klinik Hietzing, Wolkersbergenstraße 1, 1130, Wien, Austria
| | - P Harl
- Institut für Radioonkologie, SMZ - Ost Donauspital der Stadt Wien, Langobardenstraße 122, 1220, Wien, Austria
| | - S Schwaiger
- Institut für Radioonkologie, Klinik Ottakring, Wilhelminenspital der Stadt Wien, Montleartstraße 37, 1160, Wien, Austria
| | - I Reiter
- Institut für Radioonkologie und Strahlentherapie, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Germany
| | - J Salinger
- Klinische Abteilung für Strahlentherapie - Radioonkologie, Universitätsklinikum Krems, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Mitterweg 10, 3500, Krems an der Donau, Austria
| | - C Venhoda
- Klinik für Radioonkologie, Klinikum der Barmherzigen Schwestern, Ordensklinikum Linz, Seilerstätte 4, 4010, Linz, Austria
| | - G Kurzweil
- Klinik für Radioonkologie/Strahlentherapie, Salzkammergutklinikum Vöcklabruck, Dr.-Wilhelm-Boch-Straße 1, 4840, Vöcklabruck, Austria
| | - M Poetscher
- Universitätsklinik für Strahlentherapie - Radioonkologie, Comprehensive Cancer Center Graz, Medizinische Universität Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - R Jaeger
- Universitätsklinik für Strahlentherapie - Radioonkologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - B Celedin
- Institut für Strahlentherapie/Radioonkologie, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Austria
| | - P Clemens
- Institut für Radioonkologie und Strahlentherapie, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
| | - F Roeder
- Universitätsklinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Uniklinikum der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Giunta EF, Bregni G, Hendlisz A, Sclafani F. Anal squamous cell carcinoma: standards of care, new data and ongoing clinical trials. Curr Opin Oncol 2021; 33:372-377. [PMID: 33882526 DOI: 10.1097/cco.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize current standards of care, discuss results of recent studies and present ongoing clinical trials for anal squamous cell carcinoma (ASCC). RECENT FINDINGS Over the last year, no practice changing studies have been reported in the setting of localised ASCC. A number of retrospective analyses, however, have provided practice-informing data, such as those confirming the negative impact of low compliance to chemoradiotherapy (CRT) on patient outcomes. In contrast, and for the first time, randomized evidence has become available to inform the management of advanced tumours. The InterAACT trial represents a key milestone in the evidence-building process for this disease, establishing carboplatin plus paclitaxel as a new standard of care for treatment-naïve advanced ASCC patients. Furthermore, more data have accumulated about the value of triplet chemotherapy in the first-line setting and of immune checkpoint inhibitors (either as single agents or in combination with other agents) in the refractory setting. SUMMARY Recent findings have the potential to improve the treatment quality standards and overall outcome of patients with either localised or advanced ASCC. Results from ongoing clinical trials will hopefully provide useful insights into the management of this disease and further shape current treatment paradigms.
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Affiliation(s)
- Emilio Francesco Giunta
- Medical Oncology Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giacomo Bregni
- Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Hendlisz
- Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francesco Sclafani
- Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
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Dröge LH, von Sivers FF, Schirmer MA, Wolff HA. Conventional 3D conformal radiotherapy and volumetric modulated arc therapy for cervical cancer: Comparison of clinical results with special consideration of the influence of patient- and treatment-related parameters. Strahlenther Onkol 2021; 197:520-527. [PMID: 33938967 PMCID: PMC8154751 DOI: 10.1007/s00066-021-01782-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/30/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Intensity-modulated radiotherapy (IMRT) for cervical cancer yields favorable results in terms of oncological outcomes, acute toxicity, and late toxicity. Limited data are available on clinical results with volumetric modulated arc therapy (VMAT). This study's purpose is to compare outcome and toxicity with VMAT to conventional 3D conformal radiotherapy (3DCRT), giving special consideration to the influence of patient- and treatment-related parameters on side effects. MATERIALS AND METHODS Patients with cervical cancer stage I-IVA underwent radiotherapy alone or chemoradiotherapy using 3DCRT (n = 75) or VMAT (n = 30). Survival endpoints were overall survival, progression-free survival, and locoregional control. The National Cancer Institute Common Terminology Criteria for Adverse Events and the Late Effects of Normal Tissues criteria were used for toxicity assessment. Toxicity and patient- and treatment-related parameters were included in a multivariable model. RESULTS There were no differences in survival rates between treatment groups. VMAT significantly reduced late small bowel toxicity (OR = 0.10, p = 0.03). Additionally, VMAT was associated with an increased risk of acute urinary toxicity (OR = 2.94, p = 0.01). A low body mass index (BMI; OR = 2.46, p = 0.03) and overall acute toxicity ≥grade 2 (OR = 4.17, p < 0.01) were associated with increased overall late toxicity. CONCLUSION We demonstrated significant reduction of late small bowel toxicity with VMAT treatment, an improvement in long-term morbidity is conceivable. VMAT-treated patients experienced acute urinary toxicity more frequently. Further analysis of patient- and treatment-related parameters indicates that the close monitoring of patients with low BMI and of patients who experienced relevant acute toxicity during follow-up care could improve late toxicity profiles.
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Affiliation(s)
- Leif Hendrik Dröge
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Franziska-Felicitas von Sivers
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Markus Anton Schirmer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Hendrik Andreas Wolff
- University Medical Center Göttingen, Göttingen, Germany
- Department of Radiology, Nuclear Medicine and Radiotherapy, Radiologie München, 80333, Munich, Germany
- Department of Radiotherapy and Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
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Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a prospective cohort study. Sci Rep 2021; 11:7693. [PMID: 33833301 PMCID: PMC8032760 DOI: 10.1038/s41598-021-87170-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/22/2021] [Indexed: 11/26/2022] Open
Abstract
To address whether the addition of intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT) aggravate radiation-induced acute injury of locoregionally advanced nasopharyngeal carcinoma (LANPC) patients with induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT). We conducted a prospective study of 182 patients in the stage III to IVb with biopsy-proven nonmetastatic LANPC who newly underwent radiotherapy and sequentially received IC, followed by CCRT at our institution. Occurring time of radiation-induced toxicities were estimated and compared using the Kaplan–Meier method and Log-rank test. The most severe acute toxicities included oral mucositis in 97.25% and dermatitis in 90.11%. Subset analysis revealed that Grade 3–4 acute dermatitis were significantly higher in the IMRT than 3D-CRT. Oral mucositis and dermatitis were the earliest occurrence of acute injuries (2 years: 60.44% and 17.58%). Patients in IMRT group achieved significantly lower risk of bone marrow toxicity, but higher risk of leukopenia and gastrointestinal injury. Multivariate analyses also demonstrated that IMRT, female gender and hepatitis were the independent prognostic factors for bone marrow toxicity. In a combined regimen of IC followed by CCRT for the treatment of LANPC, IMRT seems to be an aggressive technique with a trend towards increased gastrointestinal and hematological toxicities, but decreased bone marrow toxicity than those treated with 3D-CRT. This study provides a comprehensive summary of prospective evidence reporting the side effects in the management of LANPC patients. We quantify the occurrence risks of chemoradiotherapy-induced acute injuries through analysis of time-to-event.
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