1
|
Zhang Z, Cao Q, Xia Y, Cui C, Qi Y, Zhang Q, Wu Y, Liu J, Liu W. Combination of biodegradable hydrogel and antioxidant bioadhesive for treatment of breast cancer recurrence and radiation skin injury. Bioact Mater 2024; 31:408-421. [PMID: 37692912 PMCID: PMC10482898 DOI: 10.1016/j.bioactmat.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
Postoperative radiotherapy is the standard method for inhibition of breast cancer recurrence and metastasis, whereas radiation resistant and ineluctable skin radiation injury are still key problems encountered in the prognosis of breast cancer. Herein, we design an internally implantable biodegradable hydrogel and extracutaneously applicable antioxidant bioadhesive to concurrently prevent postoperative tumor recurrence and radioactive skin injury after adjuvant radiotherapy. The biodegradable silk fibroin/perfluorocarbon hydrogel loading doxorubicin (DOX) formed by consecutive ultrasonication-induced β-sheets-crosslinked amphiphilic silk fibroin/perfluorocarbon/DOX nanoemulsion, exhibits continuous release of oxygen in physiological environment to improve hypoxia and sensitivity of radiotherapy, as well as simultaneous release of DOX to finally achieve effective anti-cancer effect. A stretchable bioadhesive is fabricated by copolymerization of α-thioctic acid and N, N-diacryloyl-l-lysine, and gold nanorods and gallic acid are loaded into the bioadhesive to afford gentle photothermal therapy and antioxidant functions. The near-infrared light-induced controlled release of gallic acid and mild photothermal therapy can efficiently eliminate excess free radicals generated by radiotherapy and promote radioactive wound healing. Ultimately, in vivo animal studies substantiate the efficacy of our methodology, wherein the post-tumor resection administration of hydrogel and concomitant application of an antioxidant bioadhesive patch effectively inhibit tumor recurrence and attenuate the progression of skin radiation damage.
Collapse
Affiliation(s)
- Zhuodan Zhang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Qiannan Cao
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Yi Xia
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Chunyan Cui
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Ying Qi
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Qian Zhang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Yuanhao Wu
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Jianfeng Liu
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Wenguang Liu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| |
Collapse
|
2
|
Dejonckheere CS, Dejonckheere E, Layer JP, Layer K, Sarria GR, Koch D, Abramian A, Kaiser C, Lindner K, Bachmann A, Anzböck T, Röhner F, Schmeel FC, Schmeel LC. Barrier films for the prevention of acute radiation dermatitis in breast cancer: A systematic review and meta-analysis of randomised controlled trials. Breast 2023; 71:31-41. [PMID: 37473629 PMCID: PMC10404536 DOI: 10.1016/j.breast.2023.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE Radiation dermatitis (RD) is the most common side effect of adjuvant whole-breast or chest wall irradiation, majorly impacting quality of life in numerous patients. The use of barrier films (polyurethane dressings such as Hydrofilm® and Mepitel® film remaining on the skin for the duration of the radiation treatment) has been investigated as a prophylactic measure in several prospective trials. Here, we critically appraise the available evidence behind preventive barrier film application in the context of breast cancer treatment. METHODS International literature was reviewed and high-quality randomised controlled trials (RCTs) were included in this meta-analysis. RESULTS The results of 5 RCTs (663 patients; >90% Caucasian) were analysed. Overall, barrier films lead to improved clinician- and patient-reported outcomes: fewer grade ≥2 RD (11% vs. 42%; OR = 0.16; p < 0.001) and moist desquamation (2% vs. 16%; OR = 0.12; p = 0.006), as well as less patient-reported pain (standardised mean difference [SMD] -0.51; p < 0.001), itching (SMD -0.52; p = 0.001), burning (SMD -0.41; p = 0.011), and limitations in daily activities (SMD -0.20; p = 0.007). Furthermore, barrier films have a high acceptance rate among patients, as well as a favourable cost-benefit ratio. Possible side effects due to its application are mild and mostly self-limiting. Overall, there was a lack of information on the radiation treatment techniques used. CONCLUSION The evidence presented in this meta-analysis suggests that barrier films are an excellent tool in the prevention of RD among Caucasian patients receiving whole-breast or chest wall irradiation. Its use should therefore be considered routinely in these patients.
Collapse
Affiliation(s)
| | - Egon Dejonckheere
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000, Leuven, Belgium; Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioural Sciences, 5037, Tilburg, the Netherlands
| | - Julian Philipp Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany; Institute of Experimental Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | | | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Alina Abramian
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Christina Kaiser
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Kira Lindner
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Anne Bachmann
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Teresa Anzböck
- Department of Gynaecology, Division of Gynaecological Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Fred Röhner
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | | | | |
Collapse
|
3
|
Tao R, Mao Y, Li Y, Sun M, Cao X, Chen N, Xu S, Wang D, Zhao Y. Connexin26 Modulates Radiation-Induced Skin Damage by Regulating Chemokine CCL27 through MAPK Signaling. Radiat Res 2023; 200:281-288. [PMID: 37450610 DOI: 10.1667/rade-20-00085.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Connexin26 (Cx26) plays an important role in ionizing radiation-induced damage, and CC chemokine ligand 27 (CCL27) regulates the skin immune response. However, the relationship between Cx26 and CCL27 in radiation-induced skin damage is unclear. After X-ray irradiation, clonogenic survival and micronucleus formation were assessed in immortalized human keratinocytes (HaCaT). Proteins in the mitogen activated protein kinase (MAPK) signaling pathway and CCL27-related proteins were detected by immunoblotting. HaCaTCx26-/- cells were constructed to verify the effects of Cx26 on CCL27 secretion. A mouse model was established to examine the expression of CCL27 and skin inflammation in vivo. The degree of skin injury induced by 6 MV of X rays was closely related to CCL27. The phosphorylation of ERK, p38 and NF-κB was significantly increased in irradiated cells. The secretion of CCL27 was significantly decreased in HaCaT wild-type cells relative to HaCaTCx26-/- cells. Whereas cell survival fractions decreased, and the micronuclei formation rate increased as a function of increasing X-ray dose in HaCaT cells, the opposite trend occurred in HaCaTCx26-/- cells. Our findings show that Cx26 likely plays a role in the activation of the MAPK and NF-κB/COX-2 signaling pathways and regulates the secretion of CCL27 in keratinocytes after X-ray radiation-induced skin damage.
Collapse
Affiliation(s)
- Rui Tao
- Teaching and Research Section of Nuclear Medicine, School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, People's Republic of China
| | - Yiwen Mao
- Teaching and Research Section of Nuclear Medicine, School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, People's Republic of China
| | - Yuan Li
- Teaching and Research Section of Nuclear Medicine, School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, People's Republic of China
| | - Minqiong Sun
- Teaching and Research Section of Nuclear Medicine, School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, People's Republic of China
| | - Xiaoping Cao
- Teaching and Research Section of Nuclear Medicine, School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, People's Republic of China
| | - Ni Chen
- Teaching and Research Section of Nuclear Medicine, School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, People's Republic of China
| | - Shengmin Xu
- Institutes of Physical Sciences and Information Technology, Anhui University, Hefei 230601, Anhui, People's Republic of China
| | - Dong Wang
- Teaching and Research Section of Nuclear Medicine, School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, People's Republic of China
| | - Ye Zhao
- Teaching and Research Section of Nuclear Medicine, School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, People's Republic of China
| |
Collapse
|
4
|
Alcorn SR, Corbin KS, Shumway DA. Integrating the Patient's Voice in Toxicity Reporting and Treatment Decisions for Breast Radiotherapy. Semin Radiat Oncol 2022; 32:207-220. [DOI: 10.1016/j.semradonc.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
DIURNAL PREFERENCE CONTRIBUTES TO MAXIMAL ULTRAVIOLET RADIATION B SENSITIVITY BY THE HOUR OF THE DAY IN HUMAN SKIN IN VIVO. J Invest Dermatol 2022; 142:2289-2291.e5. [PMID: 35143821 DOI: 10.1016/j.jid.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/06/2022] [Accepted: 01/24/2022] [Indexed: 11/23/2022]
|
6
|
Quantitative assessments of late radiation-induced skin and soft tissue toxicity and correlation with RTOG scales and biological equivalent dose in breast cancer. Clin Transl Oncol 2021; 24:836-845. [PMID: 34792726 PMCID: PMC8600910 DOI: 10.1007/s12094-021-02729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/31/2021] [Indexed: 11/13/2022]
Abstract
Purpose Radiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer. Methods Patients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration. Results In 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased (p < 0.001, p = 0.016, p = 0.005, respectively). Conclusions The multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT. Supplementary Information The online version contains supplementary material available at 10.1007/s12094-021-02729-z.
Collapse
|
7
|
Schmeel LC, Koch D, Schmeel FC, Bücheler B, Leitzen C, Mahlmann B, Kunze D, Heimann M, Brüser D, Abramian AV, Schoroth F, Müdder T, Röhner F, Garbe S, Baumert BG, Schild HH, Wilhelm-Buchstab TM. Hydrofilm Polyurethane Films Reduce Radiation Dermatitis Severity in Hypofractionated Whole-Breast Irradiation: An Objective, Intra-Patient Randomized Dual-Center Assessment. Polymers (Basel) 2019; 11:E2112. [PMID: 31888185 PMCID: PMC6960998 DOI: 10.3390/polym11122112] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 01/04/2023] Open
Abstract
Radiation-induced skin injury represents the most frequent side effect in breast cancer patients undergoing whole-breast irradiation (WBI). Numerous clinical studies on systemic and topical treatments for radiation dermatitis have failed to provide sustainable treatment strategies. While protective skin products such as dressings are undoubtedly the standard of care in wound care management, their utilization as preventive treatment in radiotherapy has been somewhat neglected in recent years. In this prospective, intra-patient randomized observational study, Hydrofilm polyurethane films were prophylactically applied to either the medial or lateral breast-half of 74 patients with breast cancer undergoing hypofractionated whole-breast irradiation following breast-preserving surgery. Maximum radiation dermatitis severity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.03 toxicity scores, photospectrometric erythema and pigmentation measurements and patient-assessed modified Radiation-Induced Skin Reaction Assessment Scale (RISRAS) scale. Phantom studies revealed a clinically negligible dose build-up of less than 0.1% with Hydrofilm. Compared to the control compartments physician-assessed radiation dermatitis severity was reduced in the hydrofilm compartments (mean 0.54 vs. 1.34; p = < 0.001). Objective photospectrometric skin measurements showed decreased erythema (p = 0.0001) and hyperpigmentation (p = 0.002) underneath Hydrofilm. Hydrofilm also completely prevented moist desquamation, and significantly reduced patients' treatment-related symptoms of itching, burning, pain, and limitations of day-to-day-activities. Significant beneficial effects were observed in terms of radiation dermatitis severity, erythema, hyperpigmentation as well as subjective treatment-related symptom experiences, while adverse reactions were rare and minor. Therefore, a prophylactic application of Hydrofilm polyurethane films can be suggested in hypofractionated WBI.
Collapse
Affiliation(s)
- Leonard Christopher Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - David Koch
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Frederic Carsten Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Bettina Bücheler
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christina Leitzen
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Birgit Mahlmann
- Radiotherapy Bonn-Rhein-Sieg, Practice at academic St. Marien Hospital, Robert-Koch-Str. 1, 53115 Bonn, Germany
| | - Dorothea Kunze
- Radiotherapy Bonn-Rhein-Sieg, Practice at academic St. Marien Hospital, Robert-Koch-Str. 1, 53115 Bonn, Germany
| | - Martina Heimann
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Dilini Brüser
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alina-Valik Abramian
- Department of Gynecology and Obstetrics, Division of Senology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Felix Schoroth
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Thomas Müdder
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Fred Röhner
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Stephan Garbe
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Brigitta Gertrud Baumert
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Institute of Radiation Oncology, Graubuenden Cantonal Hospital, Loestr. 170, 7000 Chur, Switzerland
| | - Hans Heinz Schild
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Timo Martin Wilhelm-Buchstab
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Radiotherapy Bonn-Rhein-Sieg, Practice at academic Protestant Johanniter Clinics Bonn, Waldstr. 73, 53177 Bonn, Germany
| |
Collapse
|
8
|
Lam AC, Yu E, Vanwynsberghe D, O'Neil M, D'Souza D, Cao J, Lock M. Phase III Randomized Pair Comparison of a Barrier Film vs. Standard Skin Care in Preventing Radiation Dermatitis in Post-lumpectomy Patients with Breast Cancer Receiving Adjuvant Radiation Therapy. Cureus 2019; 11:e4807. [PMID: 31404344 PMCID: PMC6682394 DOI: 10.7759/cureus.4807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Patients undergoing adjuvant radiotherapy to the breast often experience radiation dermatitis ranging from mild erythema to moist desquamation. In post-lumpectomy patients, the axilla and inframammary fold are at an increased risk for friction dermatitis. Dermatitis can impact patients’ quality-of-life and may require treatment break/cessation. Our objectives are to assess the efficacy of 3M Cavilon Barrier Film (BF) in preventing and/or delaying the onset of grade-two dermatitis and reducing patient-reported sensation scores. Methods A total of 55 patients were randomized to receive BF on the medial or lateral breast. BF was applied twice weekly during treatment. Skin toxicity was evaluated weekly by a blinded clinical investigator using the Skin Toxicity Assessment Tool (STAT) and the modified Radiation Therapy Oncology Group Visual Assessment Score (RTOG VAS). On day one, baseline photographs were taken; seven-to-ten days post-treatment, patients returned for photographs, the STAT/RTOG VAS, and patient-opinion questions in the form of the global questionnaire. Results The paired analysis found BF did not significantly reduce dermatitis either during or post-treatment. However, the unpaired analysis found significantly reduced RTOG VAS on the lateral compartment during treatment (BF:0.91 vs. Control:1.21, p = 0.0408). This difference resolved post-treatment. Additionally, BF was able to reduce pruritus (p = 0.047) on the medial components and burning sensations on the lateral components (p = 0.035). There was no significant difference between the time-to-onset or proportion of patients who developed grade-two dermatitis. Conclusion In an unpaired analysis, BF significantly reduced dermatitis on the lateral compartment during treatment. Additionally, BF significantly reduced pruritus and burning sensations. A larger study using a more reliable scoring method is required to clarify the effect of BF on radiation-associated skin toxicity.
Collapse
Affiliation(s)
- Andrew Cl Lam
- Radiation Oncology, University of Toronto, Toronto, CAN
| | - Edward Yu
- Oncology, Schulich School of Medicine and Dentistry, Western University, London, CAN
| | | | - Melissa O'Neil
- Radiation Oncology, London Regional Cancer Program, Western University, London, CAN
| | - David D'Souza
- Radiation Oncology, London Regional Cancer Program, Western University, London, CAN
| | - Jeffrey Cao
- Radiation Oncology, London Regional Cancer Program, Western University, London, CAN
| | - Michael Lock
- Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London, CAN
| |
Collapse
|
9
|
Fuzissaki MDA, Paiva CE, Gozzo TDO, Maia MDA, Canto PPL, Maia YCDP. Is there agreement between evaluators that used two scoring systems to measure acute radiation dermatitis? Medicine (Baltimore) 2019; 98:e14917. [PMID: 30985641 PMCID: PMC6485857 DOI: 10.1097/md.0000000000014917] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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
To analyze the agreement between the nurses evaluating radiodermatitis that used the Radiation Therapy Oncology Group (RTOG) and the World Health Organization (WHO) scales.A prospective and longitudinal study conducted in 2016 to 2017, in a university hospital. We analyzed 855 images of irradiated sites of 100 breast cancer women during radiotherapy. In order to evaluate the agreement between 3 observers that evaluated theses irradiated sites Krippendorff's alpha and weighted kappa were obtained and analyzed.The pairwise agreement among the evaluators was fair and moderate (RTOG scale: 0.408, 95% confidence interval, CI 0.370-0.431; WHO scale: 0.559, 95% CI 0.529-0.590). In addition, the general agreement rates were 10.2% and 29.2%, respectively. When assessing the overall absolute agreement between the evaluators according with different phototypes and types of surgery, there was a fair agreement according to the RTOG scale when evaluating patients with phototype V or VI and mastectomy (3.7% and 8.8%, respectively).The RTOG and WHO scales should be used with caution in clinical practice to identify the prevalence of radiodermatitis and the severity. Another point of caution is that skin phototype and the type of surgery may influence the analysis outcome. An illustrative scale was designed and proposed, by our group, aiming to improve accuracy and agreement between evaluators that will be tested in subsequent clinical studies.
Collapse
Affiliation(s)
| | - Carlos Eduardo Paiva
- Department of Clinical Oncology, Division of Breast and Gynecology, Barretos Cancer Hospital, Barretos-SP
| | - Thais de Oliveira Gozzo
- Department of Maternal-Child Nursing and Public Health, Ribeirão Preto College of Nursing, University of São Paulo
| | | | - Paula Philbert Lajolo Canto
- Department of Clinical Oncology, Clinic's Hospital, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Yara Cristina de Paiva Maia
- Graduate Program in Health Sciences, Medicine School, Federal University of Uberlandia, Uberlandia, Minas Gerais
| |
Collapse
|
10
|
Schmeel LC, Koch D, Stumpf S, Leitzen C, Simon B, Schüller H, Vornholt S, Schoroth F, Müdder T, Röhner F, Garbe S, Schmeel FC, Schild HH, Wilhelm-Buchstab TM. Prophylactically applied Hydrofilm polyurethane film dressings reduce radiation dermatitis in adjuvant radiation therapy of breast cancer patients. Acta Oncol 2018; 57:908-915. [PMID: 29463159 DOI: 10.1080/0284186x.2018.1441542] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Radiation-induced skin injury represents one of the most common side effects in breast cancer patients receiving adjuvant whole-breast radiotherapy. Numerous systemic and topical treatments have been studied in the prevention and management of radiation-induced skin injury without providing sustainable treatment strategies. While superficial barrier-forming skin products such as dressings are the standard of care in wound care management, their utilization as preventive treatment approach in radiotherapy has barely attracted attention. METHODS In this prospective, intra-patient randomized study, Hydrofilm polyurethane film dressings were applied prophylactically to either the medial or lateral breast half of 62 patients with breast cancer undergoing adjuvant radiation therapy following breast conserving surgery. The breast half contralateral to the film dressing was concurrently treated with 5% urea lotion as control skin care. Maximum severity of radiation dermatitis was assessed using RTOG/EORTC toxicity scores, photospectrometric erythema measurements and patient-assessed modified RISRAS scale. RESULTS In the Hydrofilm compartments, mean maximum RTOG/EORTC radiation dermatitis severity grades were significantly reduced from 1.33 to 0.35 and photospectrometric measurements showed significantly reduced erythema severity, as compared to the control compartments, with an overall response rate of 89.3%. Hydrofilm completely prevented moist desquamation and significantly reduced patients' subjective experience of itching and pain. CONCLUSION The obtained results along with a favorable cost-benefit ratio and an easy and quick application suggest a prophylactic application of Hydrofilm in adjuvant radiotherapy of breast cancer patients to reduce or even prevent radiation dermatitis.
Collapse
Affiliation(s)
- Leonard Christopher Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - David Koch
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Sabina Stumpf
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Christina Leitzen
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Birgit Simon
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Heinrich Schüller
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Susanne Vornholt
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Felix Schoroth
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Thomas Müdder
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Fred Röhner
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Frederic Carsten Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Hans Heinz Schild
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Timo Martin Wilhelm-Buchstab
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| |
Collapse
|
11
|
Sekiguchi K, Akahane K, Ogita M, Haga C, Ito R, Arai S, Ishida Y, Tsukada Y, Kawamori J. Efficacy of heparinoid moisturizer as a prophylactic agent for radiation dermatitis following radiotherapy after breast-conserving surgery: a randomized controlled trial. Jpn J Clin Oncol 2018; 48:450-457. [PMID: 29635534 PMCID: PMC5926546 DOI: 10.1093/jjco/hyy045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/28/2018] [Indexed: 11/14/2022] Open
Abstract
Background The application of heparinoid moisturizer for 2 weeks following whole-breast radiotherapy (WBRT) was previously reported to significantly increase skin water content (WC) and help improve skin dryness and desquamation. The prospective open-label, randomized trial included an exploratory arm to investigate the preventive efficacy of heparinoid moisturizer for acute radiation dermatitis (ARD). Methods Between April 2011 and April 2013, patients receiving WBRT were assigned (1:2:2) to receive either: moisturizer for prophylaxis (group P), moisturizer starting 2 weeks after WBRT for treatment (group M), and no moisturizer (group C). This paper presents the results of comparison between the exploratory arm and no moisturizer group. Skin WC was measured prior to WBRT, on the last day of WBRT, and 2 weeks, 4 weeks and 3 months following WBRT. Signs and symptoms were also assessed. Results Comparing two groups, WC values were significantly higher in group P until 4 weeks following WBRT. At 2 weeks following WBRT, mean WC values in group P and C were 38.5 ± 6.1 arbitrary units (a.u.) and 30.2 ± 7.8 a.u., respectively (P < 0.001). In group C, dryness was more severe at 2 and 4 weeks following WBRT and desquamation more severe until 3 months following WBRT. However, the erythema score showed no difference between the two groups. Regarding symptoms, group C pain scores on the last day of WBRT were significantly higher than in group P (P < 0.030). Conclusions The preventive application of heparinoid moisturizer has the potential of reducing skin desquamation and dryness in patients receiving WBRT.
Collapse
Affiliation(s)
- Kenji Sekiguchi
- Department of Radiation Oncology, St. Luke's International Hospital.,Department of Radiation Oncology, Sonoda-kai Radiation Oncology Clinic, Tokyo
| | - Keiko Akahane
- Department of Radiology, Saitama Medical Center Jichi Medical University, Saitama
| | - Mami Ogita
- Department of Radiation Oncology, St. Luke's International Hospital.,Department of Radiology, The University of Tokyo Hospital
| | - Chiori Haga
- Department of Radiation Oncology, St. Luke's International Hospital
| | - Ryoko Ito
- Department of Radiation Oncology, St. Luke's International Hospital
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital
| | - Yasushi Ishida
- Center for Clinical Epidemiology, St. Luke's International Hospital
| | - Yoichiro Tsukada
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital
| |
Collapse
|
12
|
Chin MS, Siegel-Reamer L, FitzGerald GA, Wyman A, Connor NM, Lo YC, Sioshansi S, Moni J, Giulia Cicchetti M, Lalikos JF, FitzGerald TJ. Association between cumulative radiation dose, adverse skin reactions, and changes in surface hemoglobin among women undergoing breast conserving therapy. Clin Transl Radiat Oncol 2017; 4:15-23. [PMID: 29594203 PMCID: PMC5833900 DOI: 10.1016/j.ctro.2017.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/26/2022] Open
Abstract
Introduction Radiation therapy is crucial to effective cancer treatment. Modern treatment strategies have reduced possible skin injury, but few clinical studies have addressed the dose relationship between radiation exposure and skin reaction. This prospective clinical study analyzes skin oxygenation/perfusion in patients undergoing fractionated breast conserving therapy via hyperspectral imaging (HSI). Methods Forty-three women undergoing breast conserving therapy were enrolled in this study. Optically stimulated luminescent dosimeters (OSLDs) measured radiation exposure in four sites: treatment breast, lumpectomy scar, medial tattoo and the control breast. The oxygenation/perfusion states of these sites were prospectively imaged before and after each treatment fraction with HSI. Visual skin reactions were classified according to the RTOG system. Results 2753 observations were obtained and indicated a dose-response relationship between radiation exposure and oxygenated hemoglobin (OxyHb) after a 600 cGy cumulative dose threshold. There was a relatively weak association between DeoxyHb and radiation exposure. Results suggest strong correlations between changes in mean OxyHb and skin reaction as well as between radiation exposure and changes in skin reaction. Conclusion HSI demonstrates promise in the assessment of skin dose as well as an objective measure of skin reaction. The ability to easily identify adverse skin reactions and to modify the treatment plan may circumvent the need for detrimental treatment breaks.
Collapse
Affiliation(s)
- Michael S Chin
- Occupational and Environmental Medicine Program, Harvard T.H. Chan School of Public Health, USA
| | | | | | - Allison Wyman
- Department of Surgery, University of Massachusetts Medical School, USA
| | - Nikole M Connor
- Department of Radiation Oncology, University of Massachusetts Medical School, USA
| | - Yuan-Chyuan Lo
- Department of Radiation Oncology, University of Massachusetts Medical School, USA
| | - Shirin Sioshansi
- Department of Radiation Oncology, University of Massachusetts Medical School, USA
| | - Janaki Moni
- Department of Radiation Oncology, University of Massachusetts Medical School, USA
| | | | - Janice F Lalikos
- Department of Surgery, University of Massachusetts Medical School, USA
| | - Thomas J FitzGerald
- Department of Radiation Oncology, University of Massachusetts Medical School, USA
| |
Collapse
|
13
|
Baines CR, McGuiness W, O'Rourke GA. An integrative review of skin assessment tools used to evaluate skin injury related to external beam radiation therapy. J Clin Nurs 2017; 26:1137-1144. [PMID: 27322721 DOI: 10.1111/jocn.13430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES To review literature associated with external beam radiotherapy and skin damage. A focus of the literature search is to highlight and discuss the myriad of skin assessment tools that are available to the clinician when assessing skin injury in patients receiving external beam radiation therapy. BACKGROUND It is apparent that despite considerable work being progressed in the development of individualised skin assessment tools, uptake and use is poor. These tools are designed to assist the clinician in the evaluation of damaged skin and predict the radiation wound development pathway. DESIGN An integrated review can be used to address a mature or new and emerging topic through a systematic methodology, which is either theoretical or empirical, gained from research, practice or policy initiatives (Whittemore & Knafl, Journal of Advanced Nursing, 52, 2005, 546). This review is particularly concerned with the employment of skin assessment tools by clinicians in patients with radiation damaged skin. Using the search terms synonyms for radiation, skin and epidermal damage, PubMed/MEDLINE, Medical Complete and Web of Science databases were searched. Consulting professional peers was employed as part of the inclusion and exclusion process. CONCLUSION There is a high level of unpredictability about which patient will have an uncomplicated course of external beam radiotherapy. Variables may include, but are not limited to, an acute reaction, a delayed reaction resulting in actual skin damage or no visible skin disturbance. The skin assessment tools that are readily available are not regularly referenced in clinical practice when attempting to manage the many side effects of radiation therapy. Skin assessment tools require ongoing clinical validation, so they can be used to guide practitioners to undertake further assessment of skin integrity. RELEVANCE TO CLINICAL PRACTICE The current body of knowledge suggests clinicians caring for patients receiving therapeutic radiotherapy should consider integrating a recognised patient assessment skin framework into their daily routine. Such validated tools may add value to postradiotherapy patient care by providing a consistency of management and accordingly refining best practice.
Collapse
Affiliation(s)
- Carol R Baines
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tas., Australia.,La Trobe University, Melbourne, Vic., Australia
| | | | - Geraldine A O'Rourke
- Nursing and Midwifery, Hobart, Tas., Australia.,Department of Health & Human Services, Hobart, Tas., Australia.,University Tasmania, Hobart, Tas., Australia
| |
Collapse
|
14
|
Aoki M, Akaishi S, Nakao J, Dohi T, Hyakusoku H, Ogawa R. Objective Spectrometric Measurement of Keloid Color in the East Asian Population: Pitfalls of Subjective Color Measurements. J NIPPON MED SCH 2016; 83:142-9. [PMID: 27680482 DOI: 10.1272/jnms.83.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Keloids are characterized by the formation of excessive scar tissue that extends beyond the area of the initial wound. Keloid redness is due to angiogenesis and chronic inflammation and is an important indicator of the severity of the lesion and the effectiveness of treatment. METHODS The color of 33 untreated keloids from 30 patients was measured with a narrow-band reflectance colorimeter. The erythema and melanin levels in the keloids (Ek and Mk, respectively) were recorded with control data obtained from the flexor aspect of the forearm (Ec and Mc, respectively). The keloid color was also evaluated subjectively. RESULTS The Ek or Mk values did not vary significantly according to symptom intensity, scar region, patient age, and patient sex. Younger patients (<40 years) and female patients had significantly higher Ek/Ec ratios than did older patients and male patients, respectively. Subjective keloid redness evaluations distinguished keloids with high Ek/Ec ratios from keloids with low Ek/Ec ratios (P<0.0001) but could not distinguish keloids with high Ek from keloids with low Ek. CONCLUSIONS Subjective evaluations of keloids in Japanese subjects reflected Ek/Ec ratios, which were strongly affected by variation in background skin color. The subjective assessment of the color of keloids or other skin disorders should be performed with caution in Asian populations.
Collapse
Affiliation(s)
- Masayo Aoki
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School
| | | | | | | | | | | |
Collapse
|
15
|
Singh M, Alavi A, Wong R, Akita S. Radiodermatitis: A Review of Our Current Understanding. Am J Clin Dermatol 2016; 17:277-92. [PMID: 27021652 DOI: 10.1007/s40257-016-0186-4] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Radiodermatitis (radiation dermatitis, radiation-induced skin reactions, or radiation injury) is a significant side effect of ionizing radiation delivered to the skin during cancer treatment as well as a result of nuclear attacks and disasters, such as that which occurred in Fukushima in 2011. More specifically, 95 % of cancer patients receiving radiation therapy will develop some form of radiodermatitis, including erythema, dry desquamation, and moist desquamation. These radiation skin reactions result in a myriad of complications, including delays in treatment, diminished aesthetic appeal, and reduced quality of life. Recent technological advancements and novel treatment regimens have only been successful in partly ameliorating these adverse side effects. This article examines the current knowledge surrounding the pathogenesis, clinical manifestations, differential diagnoses, prevention, and management of radiodermatitis. Future research should examine therapies that incorporate the current understanding of the pathophysiology of radiodermatitis while measuring effectiveness using objective and universal outcome measures.
Collapse
|
16
|
Jang WH, Shim S, Wang T, Yoon Y, Jang WS, Myung JK, Park S, Kim KH. In vivo characterization of early-stage radiation skin injury in a mouse model by two-photon microscopy. Sci Rep 2016; 6:19216. [PMID: 26755422 PMCID: PMC4709756 DOI: 10.1038/srep19216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/07/2015] [Indexed: 11/23/2022] Open
Abstract
Ionizing radiation (IR) injury is tissue damage caused by high energy electromagnetic waves such as X-ray and gamma ray. Diagnosis and treatment of IR injury are difficult due to its characteristics of clinically latent post-irradiation periods and the following successive and unpredictable inflammatory bursts. Skin is one of the many sensitive organs to IR and bears local injury upon exposure. Early-stage diagnosis of IR skin injury is essential in order to maximize treatment efficiency and to prevent the aggravation of IR injury. In this study, early-stage changes of the IR injured skin at the cellular level were characterized in an in vivo mouse model by two-photon microscopy (TPM). Various IR doses were applied to the mouse hind limbs and the injured skin regions were imaged daily for 6 days after IR irradiation. Changes in the morphology and distribution of the epidermal cells and damage of the sebaceous glands were observed before clinical symptoms. These results showed that TPM is sensitive to early-stage changes of IR skin injury and may be useful for its diagnosis.
Collapse
Affiliation(s)
- Won Hyuk Jang
- Divison of Integrative Biosciences &Biotechnology, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, Rep. of 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, Rep. of Korea
| | - Taejun Wang
- Divison of Integrative Biosciences &Biotechnology, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, Rep. of Korea
| | - Yeoreum Yoon
- Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, Rep. of 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, Rep. of 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, Rep. of Korea.,Laboratory of Experimental Pathology, Korea Cancer Centre Hospital, Korea Institute of Radiological &Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, Rep. of Korea.,Department of Pathology, Korea Cancer Centre Hospital, Korea Institute of Radiological &Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, Rep. of 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, Rep. of Korea.,Laboratory of Experimental Pathology, Korea Cancer Centre Hospital, Korea Institute of Radiological &Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, Rep. of Korea.,Department of Pathology, Korea Cancer Centre Hospital, Korea Institute of Radiological &Medical Sciences (KIRAMS), 75 Nowon-ro, Nowon-gu, Seoul 01812, Rep. of Korea
| | - Ki Hean Kim
- Divison of Integrative Biosciences &Biotechnology, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, Rep. of Korea.,Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk 37673, Rep. of Korea
| |
Collapse
|
17
|
Matsubara H, Matsufuji N, Tsuji H, Yamamoto N, Karasawa K, Nakajima M, Takahashi W, Karube M. Objective assessment in digital images of skin erythema caused by radiotherapy. Med Phys 2015; 42:5568-77. [PMID: 26329003 DOI: 10.1118/1.4928890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Skin toxicity caused by radiotherapy has been visually classified into discrete grades. The present study proposes an objective and continuous assessment method of skin erythema in digital images taken under arbitrary lighting conditions, which is the case for most clinical environments. The purpose of this paper is to show the feasibility of the proposed method. METHODS Clinical data were gathered from six patients who received carbon beam therapy for lung cancer. Skin condition was recorded using an ordinary compact digital camera under unfixed lighting conditions; a laser Doppler flowmeter was used to measure blood flow in the skin. The photos and measurements were taken at 3 h, 30, and 90 days after irradiation. Images were decomposed into hemoglobin and melanin colors using independent component analysis. Pixel values in hemoglobin color images were compared with skin dose and skin blood flow. The uncertainty of the practical photographic method was also studied in nonclinical experiments. RESULTS The clinical data showed good linearity between skin dose, skin blood flow, and pixel value in the hemoglobin color images; their correlation coefficients were larger than 0.7. It was deduced from the nonclinical that the uncertainty due to the proposed method with photography was 15%; such an uncertainty was not critical for assessment of skin erythema in practical use. CONCLUSIONS Feasibility of the proposed method for assessment of skin erythema using digital images was demonstrated. The numerical relationship obtained helped to predict skin erythema by artificial processing of skin images. Although the proposed method using photographs taken under unfixed lighting conditions increased the uncertainty of skin information in the images, it was shown to be powerful for the assessment of skin conditions because of its flexibility and adaptability.
Collapse
Affiliation(s)
- H Matsubara
- National Institute of Radiological Sciences (NIRS), Chiba 263-8555, Japan
| | - N Matsufuji
- National Institute of Radiological Sciences (NIRS), Chiba 263-8555, Japan
| | - H Tsuji
- National Institute of Radiological Sciences (NIRS), Chiba 263-8555, Japan
| | - N Yamamoto
- National Institute of Radiological Sciences (NIRS), Chiba 263-8555, Japan
| | - K Karasawa
- National Institute of Radiological Sciences (NIRS), Chiba 263-8555, Japan
| | - M Nakajima
- National Institute of Radiological Sciences (NIRS), Chiba 263-8555, Japan
| | - W Takahashi
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - M Karube
- National Institute of Radiological Sciences (NIRS), Chiba 263-8555, Japan
| |
Collapse
|
18
|
Glennie DL, Hayward JE, Farrell TJ. Modeling changes in the hemoglobin concentration of skin with total diffuse reflectance spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:035002. [PMID: 25751028 DOI: 10.1117/1.jbo.20.3.035002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/16/2015] [Indexed: 05/20/2023]
Abstract
The ability to monitor changes in the concentration of hemoglobin in the blood of the skin in real time is a key component to personalized patient care. Since hemoglobin has a unique absorption spectrum in the visible light range, diffuse reflectance spectroscopy is the most common approach. Although the collection of the diffuse reflectance spectrum with an integrating sphere (IS) has several calibration challenges, this collection method is sufficiently user-friendly that it may be worth overcoming the initial difficulty. Once the spectrum is obtained, it is commonly interpreted with a log-inverse-reflectance (LIR) or “absorbance” analysis that can only accurately monitor changes in the hemoglobin concentration when there are no changes to the nonhemoglobin chromophore concentrations which is not always the case. We address the difficulties associated with collection of the diffuse reflectance spectrum with an IS and propose a model capable of retrieving relative changes in hemoglobin concentration from the visible light spectrum. The model is capable of accounting for concentration changes in the nonhemoglobin chromophores and is first characterized with theoretical spectra and liquid phantoms. The model is then used in comparison with a common LIR analysis on temporal measurements from blanched and reddened human skin.
Collapse
Affiliation(s)
- Diana L Glennie
- McMaster University, Department of Medical Physics and Applied Radiation Sciences, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Joseph E Hayward
- McMaster University, Department of Medical Physics and Applied Radiation Sciences, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, CanadabJuravinski Cancer Centre, Department of Medical Physics, 699 Concession Street, Hamilton, Ontario, L8V 5C2, Canada
| | - Thomas J Farrell
- McMaster University, Department of Medical Physics and Applied Radiation Sciences, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, CanadabJuravinski Cancer Centre, Department of Medical Physics, 699 Concession Street, Hamilton, Ontario, L8V 5C2, Canada
| |
Collapse
|
19
|
Acharya U, Cox J, Rinks M, Gaur P, Back M. Ability of radiation therapists to assess radiation-induced skin toxicity. J Med Imaging Radiat Oncol 2013; 57:373-7. [PMID: 23721149 DOI: 10.1111/1754-9485.12034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 11/04/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Radiation therapy has seen enhancement of the radiation therapist (RT) role, with RTs and nurses performing duties that were traditionally in the radiation oncologist's (RO) domain. This study aimed to assess whether RTs can consistently grade radiation-induced skin toxicity and their concordance with the gradings given by ROs. METHOD Digital photographs of skin reactions were taken at weeks 1, 3 and 6 of radiotherapy on nine patients with breast cancer. The randomly ordered photographs were reviewed once by eight ROs and four RO registrars and on two occasions separated by 6 weeks by 17 RTs. All graded the skin toxicities using the revised Radiation Therapy Oncology Group system. RESULTS No significant difference was seen between the median scores of the RTs at the first scoring session and the RO/Registrar group. The RTs at both measurement times showed greater inter-rater reliability than the RO/Registrars (W = 0.6866, time 1 and 0.6981 time 2, vs. 0.6517), with the experienced RTs the most consistent (W = 0.7078). The RTs also showed high intra-rater reliability (rho = 0.8461, P < 0.0010). CONCLUSION These results from RTs with no specific preparation indicate that experienced RTs could assess breast cancer skin toxicity as part of their role.
Collapse
Affiliation(s)
- Urvi Acharya
- Faculty of Health Science, The University of Sydney, Sydney, Australia
| | | | | | | | | |
Collapse
|
20
|
Graham PH, Plant NA, Graham JL, Browne LH, Borg M, Capp A, Delaney GP, Harvey J, Kenny L, Francis M, Zissiadis Y. Digital photography as source documentation of skin toxicity: An analysis from the Trans Tasman Radiation Oncology Group (TROG) 04.01 Post-Mastectomy Radiation Skin Care Trial. J Med Imaging Radiat Oncol 2012; 56:458-63. [DOI: 10.1111/j.1754-9485.2012.02365.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Rizza L, D'Agostino A, Girlando A, Puglia C. Evaluation of the effect of topical agents on radiation-induced skin disease by reflectance spectrophotometry. J Pharm Pharmacol 2010; 62:779-85. [DOI: 10.1211/jpp.62.06.0015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
22
|
GUPTA SA, WRATTEN CR, KILMURRAY J, NASH S, SELDON M, O'BRIEN PC, BELL KJL, DENHAM JW. Is there a relationship between skin erythema and fatigue in women undergoing irradiation after breast conserving surgery for early breast cancer? A prospective study. Asia Pac J Clin Oncol 2009. [DOI: 10.1111/j.1743-7563.2009.01236.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
23
|
Nyström J, Svensk AC, Lindholm-Sethson B, Geladi P, Larson J, Franzén L. Comparison of three instrumental methods for the objective evaluation of radiotherapy induced erythema in breast cancer patients and a study of the effect of skin lotions. Acta Oncol 2009; 46:893-9. [PMID: 17917821 DOI: 10.1080/02841860701243087] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A non-blinded three armed study of the effect of Aloe vera, Essex and no lotion on erythema was performed. The erythema is an effect of radiotherapy treatment in breast cancer patients. The study required testing of objective methods for measuring the erythema. The chosen experimental methods were Near Infrared Spectroscopy, Laser Doppler Imaging and Digital Colour Photography. The experimental setup was made in such a way that in parallel with testing the effect of the lotions there was also a test of the sensitivity of the instruments. Fifty women were selected consecutively to participate in the study. They were all subjected to treatment with high-energy electrons (9-20 MeV) after mastectomy, 2 Gy/day to a total dose of 50 Gy. Measurements were performed before the start of radiotherapy and thereafter once a week during the course of treatment. Aloe vera and Essex lotion were applied twice every radiation day in selected sites. The increase in skin redness could be monitored with all techniques with a detection limit of 8 Gy for Digital Colour Photography and Near Infrared Spectroscopy and 18 Gy for Laser Doppler Imaging. In clinical practice our recommendation is to use Digital Colour Photography. No significant median differences were observed between the pairs no lotion-Essex, no lotion-Aloe vera and Essex-Aloe vera for any of the techniques tested.
Collapse
|