Management of dermatitis in patients with locally advanced squamous cell carcinoma of the head and neck receiving cetuximab and radiotherapy

Keratin-based topical cream for radiation dermatitis during head and neck radiotherapy: a randomised, open-label pilot study

Introduction

Radiation dermatitis (RD) is a frequent toxicity during radiotherapy (RT) for head and neck cancer (HNC). We report the first use of KeraStat® Cream (KC), a topical, keratin-based wound dressing, in patients with HNC receiving RT.

Methods

This pilot study randomized HNC patients treated with definitive or postoperative RT (≥60 Gy) to KC or standard of care (SOC), applied at least twice daily during and for 1-month after RT. Outcomes of interest included adherence to the assigned regimen (at least 10 applications per week of treatment), clinician- and patient-reported RD, and skin-related quality of life.

Results

24 patients were randomized and completed the study. Most patients had stage III-IV disease and oropharynx cancer. Median RT dose was 68 Gy; the bilateral neck was treated in 19 patients, and 18 patients received concurrent chemotherapy. Complete adherence was observed in 7/12 (SOC) vs. 10/12 (KC, p = 0.65). Adherence by patient-week was 61/68 versus 64/67, respectively (p = 0.20). No differences in RD were observed between groups.

Conclusion

A randomized trial of KC versus SOC in HNC patients treated with RT is feasible with good adherence to study agent. An adequately powered randomized study is warranted to test the efficacy of KC in reducing RD.

Effectiveness of photobiomodulation therapy in radiation dermatitis: A systematic review and meta-analysis

PURPOSE

To evaluate the effectiveness of photobiomodulation therapy (PBMT) in the prevention and treatment of radiation dermatitis (RD).

METHODS

A systematic review was conducted using seven databases and the gray literature. We performed a meta-analysis to summarize the effect sizes of response rates (RRs).

RESULTS

We included seven clinical trials. Breast cancer patients receiving PBMT developed more grade 1 RD than the control group (RR 1.55, 95 % CI 1.14-2.10, I² = 51 %). PBMT appears to prevent RD grade 2 (RR 0.33, 95 % CI 0.09-1.23, I² = 85 %) and RD grade 3 (RR 0.21, 95 % CI 0.05-0.94, I² = 0%) with very low certainty of evidence.

CONCLUSIONS

There is very low certainty of evidence that PBMT was effective in the prevention of RD. However, PBMT showed a significant effect to prevent grade 3 RD in breast cancer patients. Thus, further randomized clinical trials are required to confirm the promising effect of PBMT in RD.

Topical use of Jiawei Simiao Yongan Gao to prevent radiodermatitis in patients with head and neck cancer: A retrospective cohort study

Radiodermatitis is a common side effect of radiotherapy, but currently there is no standard treatment for its prevention. This study aimed to observe the effect of topical application of a paste based on traditional Chinese medicine, Jiawei Simiao Yongan Gao, on radiodermatitis caused by radiotherapy for patients with head and neck cancer.This was a retrospective cohort study of 40 patients with head and neck cancer evaluated during their radiotherapy. Of these, 20 patients were treated with Jiawei Simiao Yongan Gao on the irradiated skin from the beginning of radiotherapy (JSY group). The other 20 patients were given standard nursing (standard group). Acute skin reactions were classified according to the radiation-induced skin reaction assessment scale (RISRAS) and American radiation therapy oncology group (RTOG) acute toxicity grading criteria every 2 weeks, and adverse effects were recorded until the end of the radiotherapy.The two groups showed differences in severity of radiodermatitis. At 0 to 30 Gy, the skin reactions were similar in the two groups, while above 40 Gy the skin reactions were significantly lower grade in the JSY group (P < .05). At 0 to 20 Gy, there was no statistical significance (P > .05); but above 30 Gy they were lower in the JSY group (P < .05).Jiawei Simiao Yongan Gao effectively alleviated acute radiodermatitis caused by radiotherapy of head and neck cancer patients compared with standard nursing.

SEVERE RADIODERMATITIS AND RISK FACTORS ASSOCIATED IN HEAD AND NECK CANCER PATIENTS

ABSTRACT Objective: To evaluate the association between sociodemographic, clinical, and treatment factors in the outcome of severe radiodermatitis in patients with head and neck cancer seen at the nursing consultation; and to analyze the impact of severe radiodermatitis cases on therapeutic follow-up. Method: A quantitative, documentary research conducted with medical records of 167 patients with head and neck cancer submitted to radiotherapy with curative indication followed in the nursing consultation in 2016. A structured form was used for data collection and analytical and descriptive statistics were used for its analysis. Results: Of the 99.4% patients who had radiodermatitis, 11.4% were severe cases. Severe radiodermatitis was associated with the type of equipment, treatment technique and presence of comorbidities. Of the patients who presented grade three, 53% had temporary discontinuation of treatment. Conclusion: Head and neck cancer patients who undergo radiotherapy with curative indication are at risk for severe radiodermatitis. Nursing consultation is important to minimize the severity of this event and the reduction of temporary treatment interruption due to this adverse reaction.

Implementing web-based ping-pong-type e-communication to enhance staff satisfaction, multidisciplinary cooperation, and clinical effectiveness: A SQUIRE-compliant quality-improving study

BACKGROUND

Frequent multidisciplinary communication is essential in conducting daily radiotherapy (RT) practice. However, traditional oral or paper-based communication has limitations. E-communication has been suggested, but its effects are still not well demarcated in the field of radiation oncology.

OBJECTS

In our web-based integrated information platform, we constructed a ping-pong-type e-communication function to transfer specific notations among multidisciplinary RT staffs. The purpose was to test whether applying this e-communication can increase effectiveness of multidisciplinary cooperation when compared with oral or paper-based practice. Staff satisfaction and clinical benefits were also demonstrated.

DESIGN AND SETTING

A real-world quality-improving study was conducted in a large center of radiation oncology.

PARTICIPANTS AND DATASET USED

Before and after applying multidisciplinary e-communication (from 2014 to 2015), clinical RT staffs were surveyed for their user experience and satisfaction (n = 23). For measuring clinical effectiveness, a secondary database of irradiated head and neck cancer patients was re-analyzed for comparing RT toxicities (n = 402).

INTERVENTIONS

Applying ping-pong-type multidisciplinary reflective e-communication was the main intervention.

OUTCOME MEASURES

For measuring staff satisfaction, eight domains were surveyed, such as timeliness, convenience, and completeness. For measuring clinical effectiveness of multidisciplinary cooperation, event rates of severe (i.e., grade 3-4) RT mucositis and dermatitis were recorded.

RESULTS

Overall, when compared with oral communication only, e-communication demonstrated multiple benefits, particularly on notation-review convenience (2.00 ± 1.76 vs 9.19 ± 0.81; P < 0.0001).When compared with paper-based practice, e-communication showed statistically significant benefits on all eight domains, especially on notation-review convenience (5.05 ± 2.11 vs 9.19 ± 0.81; P < 0.0001) and convenience of feedback notation (4.81 ± 1.72 vs 8.76 ± 1.09; P < 0.0001).Moreover, staff satisfaction was gradually increased from oral (3.57 ± 1.94), paper-based (5.57 ± 2.06), to e-communication (8.76 ± 0.70; P < 0.0001). Secondary measurement confirmed these observations.Before and after facilitating multidisciplinary cooperation by using e-communication, severe (i.e., grade 3-4) mucositis and dermatitis were decreased from 21.7% to 10% then to 5.1%.

CONCLUSIONS

Replacing oral or paper-based practice with e-communication is useful in facilitating RT multidisciplinary teamwork. Staff satisfaction and clinical effectiveness can be increased.

Management of radiotherapy-induced skin reactions

Radiotherapy is a highly effective cancer treatment that not only offers cure but also excellent palliation of disease related symptoms and complications. Although radiotherapy is primarily an outpatient treatment, delivered within specialist centres, a diverse range of health professionals may be involved in the treatment pathway before, during and after treatment. Radiotherapy can, and does, make a significant contribution to improving a patient's wellbeing through effective symptom management. However, treatment-related side-effects do occur, with an acute skin reaction being one of the most common. It is imperative that radiotherapy-induced skin reactions are correctly assessed and appropriately managed in promoting patient comfort, treatment compliance and enhanced quality of life. This article describes how the use of a recognised assessment tool and evidence-based guidelines can facilitate consistent, high-quality care in the management of radiotherapy-induced skin reactions.

Initial experience of radiotherapy plus cetuximab for Japanese head and neck cancer patients

In Japan, cetuximab with concurrent bioradiotherapy (BRT) for squamous cell carcinoma of head and neck (SCCHN) was approved in December 2012. We herein report our initial experience of BRT, with special emphasis on acute toxicities of this combination therapy. Thirty-one non-metastatic SCCHN patients who underwent BRT using cetuximab between July 2013 and June 2014 were retrospectively evaluated. All patients received cetuximab with a loading dose of 400 mg/m(2) one week before the start of radiotherapy, followed by 250 mg/m(2) per week during radiotherapy. The median cycle of cetuximab was seven cycles and the median dose of radiotherapy was 70 Gy. Twenty-five patients (80.6%) accomplished planned radiotherapy and six cycles or more cetuximab administration. Six patients (19.4%) discontinued cetuximab. Grade 3 dermatitis, mucositis and infusion reaction occurred in 19.4%, 48.3% and 3.2%, respectively. One patient experienced Grade 3 gastrointestinal bleeding caused by diverticular hemorrhage during BRT. Grade 3 drug-induced pneumonitis occurred in two patients. The response rate was 74%, including 55% with a complete response. BRT using cetuximab for Japanese patients with SCCHN was feasible as an alternative for cisplatin-based concurrent chemoradiation, although longer follow-up is necessary to evaluate late toxicities.

Treating breast cancer radiotherapy-induced moist desquamation with a traditional Chinese medicine formula: a case series pilot study

Abstract Objective: A case series is presented to investigate the efficacy and safety of Erhegao for patients with breast cancer who have radiotherapy-induced moist desquamation.

METHODS

Eighteen women with breast cancer who received radiotherapy and developed moist desquamation were enrolled. Erhegao cream, a Traditional Chinese Medicine formula consisting of zinc oxide powder, calamine powder, and lithospermum oil, was applied on areas of moist desquamation. Application was repeated once a day until healing. The primary end point for efficacy was the time to healing of the moist desquamation areas. A numerical rating scale was used to measure wound pain relief daily. Incidence of toxicity was also assessed.

RESULTS

The average time to healing of the moist desquamation area was 13.56 days. The mean pain scores on the first, third, and seventh days were 5.22, 2.94, and 0.83, respectively. Eight-three percent of patients reported pain relief after the first 3 days, and 94%, after the first week. The mean daily reduction in the pain score was 0.40. None of the patients developed clinical infections or reported any toxicity.

CONCLUSIONS

This formula is effective and safe, especially for pain relief, and may be an alternative treatment for radiotherapy-induced moist desquamation in patients with breast cancer. Future randomized, controlled studies are needed to better evaluate the efficacy of Erhegao cream.