1
|
Saadatmand P, Mahdavi SR, Nikoofar A, Jazaeri SZ, Ramandi FL, Esmaili G, Vejdani S. A dosiomics model for prediction of radiation-induced acute skin toxicity in breast cancer patients: machine learning-based study for a closed bore linac. Eur J Med Res 2024; 29:282. [PMID: 38735974 PMCID: PMC11089719 DOI: 10.1186/s40001-024-01855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Radiation induced acute skin toxicity (AST) is considered as a common side effect of breast radiation therapy. The goal of this study was to design dosiomics-based machine learning (ML) models for prediction of AST, to enable creating optimized treatment plans for high-risk individuals. METHODS Dosiomics features extracted using Pyradiomics tool (v3.0.1), along with treatment plan-derived dose volume histograms (DVHs), and patient-specific treatment-related (PTR) data of breast cancer patients were used for modeling. Clinical scoring was done using the Common Terminology Criteria for Adverse Events (CTCAE) V4.0 criteria for skin-specific symptoms. The 52 breast cancer patients were grouped into AST 2 + (CTCAE ≥ 2) and AST 2 - (CTCAE < 2) toxicity grades to facilitate AST modeling. They were randomly divided into training (70%) and testing (30%) cohorts. Multiple prediction models were assessed through multivariate analysis, incorporating different combinations of feature groups (dosiomics, DVH, and PTR) individually and collectively. In total, seven unique combinations, along with seven classification algorithms, were considered after feature selection. The performance of each model was evaluated on the test group using the area under the receiver operating characteristic curve (AUC) and f1-score. Accuracy, precision, and recall of each model were also studied. Statistical analysis involved features differences between AST 2 - and AST 2 + groups and cutoff value calculations. RESULTS Results showed that 44% of the patients developed AST 2 + after Tomotherapy. The dosiomics (DOS) model, developed using dosiomics features, exhibited a noteworthy improvement in AUC (up to 0.78), when spatial information is preserved in the dose distribution, compared to DVH features (up to 0.71). Furthermore, a baseline ML model created using only PTR features for comparison with DOS models showed the significance of dosiomics in early AST prediction. By employing the Extra Tree (ET) classifiers, the DOS + DVH + PTR model achieved a statistically significant improved performance in terms of AUC (0.83; 95% CI 0.71-0.90), accuracy (0.70), precision (0.74) and sensitivity (0.72) compared to other models. CONCLUSIONS This study confirmed the benefit of dosiomics-based ML in the prediction of AST. However, the combination of dosiomics, DVH, and PTR yields significant improvement in AST prediction. The results of this study provide the opportunity for timely interventions to prevent the occurrence of radiation induced AST.
Collapse
Affiliation(s)
- Pegah Saadatmand
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seied Rabi Mahdavi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Alireza Nikoofar
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyede Zohreh Jazaeri
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Division of NeuroscienceCellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Soheil Vejdani
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Allali S, Carton M, Everhard S, Rivera S, Ghannam Y, Peignaux K, Guilbert P, De La Lande B, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Cottu P, André F, Kirova Y. CANTO skin: Evaluation of skin toxicity risk factors in patients treated for breast cancer. Int J Cancer 2023; 153:1797-1808. [PMID: 37572223 DOI: 10.1002/ijc.34664] [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: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 08/14/2023]
Abstract
Skin reaction is a common toxicity during oncology management, especially followed during the radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients treated for an early breast cancer (BC). We evaluated 8561 patients during their overall management for a BC. We focus on specific skin toxicities: erythema, fibrosis, telangiectasia and changes of skin colour. These toxicities were assessed at the baseline defined as 0-3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months. The prevalence of toxicities of interest varied over time, so at M0, 30.4% of patients had erythema while 17.7% of patients had fibrosis. At M60, the prevalence of erythema was 2%, while fibrosis remained stable at about 19%. After adjustments, at M0, there was a significant association between the onset of cutaneous erythema and obesity, the presence of axillary dissection, the type of surgery and the tumour phenotype RH+/HER2+. Concerning fibrosis, a significant association was found, at M12, with the age of the patient, obesity, Charlson score and type of surgery. Concerning the modification of skin colour at M12, we find a link between the age of the patient, obesity, tobacco consumption and alcohol consumption. The prevention of this toxicity is a major issue for the quality of life. Our results allow us to understand the risk of developing skin toxicity in a patient, depending on her intrinsic, tumour or therapeutic characteristics and to implement adapted means of prevention and monitoring.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - David Pasquier
- Centre Oscar Lambret, Academic Department of Radiation Oncology, Lille, France
- Université de Lille, CHU Lille, CNRS, Centrale Lille, Lille, France
| | | | | | | | | | | |
Collapse
|
3
|
Park SY, Park JM, Kim JI, Choi CH, Chun M, Chang JH, Kim JH. Quantitative radiomics approach to assess acute radiation dermatitis in breast cancer patients. PLoS One 2023; 18:e0293071. [PMID: 37883380 PMCID: PMC10602246 DOI: 10.1371/journal.pone.0293071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE We applied a radiomics approach to skin surface images to objectively assess acute radiation dermatitis in patients undergoing radiotherapy for breast cancer. METHODS A prospective cohort study of 20 patients was conducted. Skin surface images in normal, polarized, and ultraviolet (UV) modes were acquired using a skin analysis device before starting radiotherapy ('Before RT'), approximately 7 days after the first treatment ('RT D7'), on 'RT D14', and approximately 10 days after the radiotherapy ended ('After RT D10'). Eighteen types of radiomic feature ratios were calculated based on the values acquired 'Before RT'. We measured skin doses in ipsilateral breasts using optically stimulated luminescent dosimeters on the first day of radiotherapy. Clinical evaluation of acute radiation dermatitis was performed using the Radiation Therapy Oncology Group scoring criteria on 'RT D14' and 'After RT D10'. Several statistical analysis methods were used in this study to test the performance of radiomic features as indicators of radiodermatitis evaluation. RESULTS As the skin was damaged by radiation, the energy for normal mode and sum variance for polarized and UV modes decreased significantly for ipsilateral breasts, whereas contralateral breasts exhibited a smaller decrease with statistical significance. The radiomic feature ratios at 'RT D7' had strong correlations to skin doses and those at 'RT D14' and 'after RT D10' with statistical significance. CONCLUSIONS The energy for normal mode and sum variance for polarized and UV modes demonstrated the potential to evaluate and predict acute radiation, which assists in its appropriate management.
Collapse
Affiliation(s)
- So-Yeon Park
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jong Min Park
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Jung-in Kim
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Heon Choi
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minsoo Chun
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Ji Hyun Chang
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Ho Kim
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
4
|
Wang J, Zhou B, Yang X, Tridandapani S, Lin J, Torres MA, Liu T. Ultrasound-Based Grading System for Radiation-Induced Acute Breast Toxicity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1307-1317. [PMID: 36583524 DOI: 10.1002/jum.16144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/11/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To introduce an ultrasound-based scoring system for radiation-induced breast toxicity and test its reliability. METHODS Breast ultrasound (BUS) was performed on 32 patients receiving breast radiotherapy (RT) to assess the radiation-induced acute toxicity. For each patient, both the untreated and irradiated breasts were scanned at five locations: 12:00, 3:00, 6:00, 9:00, and tumor bed to evaluate for heterogenous responses to radiation within the entire breast. In total, 314 images were analyzed. Based on ultrasound findings such as skin thickening, dermis boundary irregularity, and subcutaneous edema, a 4-level, Likert-like grading scheme is proposed: none (G0), mild (G1), moderate (G2), and severe (G3) toxicity. Two ultrasound experts graded the severity of breast toxicity independently and reported the inter- and intra-observer reliability of the grading system. Imaging findings were compared with standard clinical toxicity assessments using Common Terminology Criteria for Adverse Events (CTCAE). RESULTS The inter-observer Pearson correlation coefficient (PCC) was 0.87 (95% CI: 0.83-0.90, P < .001). For intra-observer repeatability, the PCC of the repeated scores was 0.83 (95% CI: 0.78-0.87, P < .001). Imaging findings were compared with standard clinical toxicity assessments using CTCAE scales. The PCC between BUS scores and CTCAE results was 0.62 (95% CI: 0.35-0.80, P < .001). Among all locations, 6:00 and tumor bed showed significantly greater toxicity compared with 12:00 (P = .04). CONCLUSIONS BUS can investigate the cutaneous and subcutaneous tissue changes after RT. This BUS-based grading system can complement subjective clinical assessments of radiation-induced breast toxicity with cutaneous and subcutaneous sonographic information.
Collapse
Affiliation(s)
- Jing Wang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Boran Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, Alabama, USA
| | - Jolinta Lin
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Mylin A Torres
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Tian Liu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Chen W, Lu W, Yuan Y, Li L, Deng H, Ye X. The role of ultrasound quantitative parameters in the assessment of acute radiodermatitis after breast-conserving surgery. JOURNAL OF RADIATION RESEARCH 2023:7153713. [PMID: 37154691 DOI: 10.1093/jrr/rrad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/14/2022] [Indexed: 05/10/2023]
Abstract
This study aimed to assess the severity of acute radiodermatitis (ARD) by ultrasound quantitative parameters and to try to identify the influencing factors of skin toxicity. A total of 55 patients who underwent radiotherapy after unilateral breast-conserving surgery (BCS) were included in the study. The irradiated side of the breast was used as the research object and the quantitative ultrasound parameters (skin thickness, shear wave elasticity) were evaluated before radiotherapy, every week during radiotherapy. Two weeks after radiotherapy, the patients were divided into two groups, according to the World Health Organization scoring standard: mild (0-2 grade) and severe (3-4 grade). The differences in the parameters between the groups and the changes during radiotherapy were compared, and the relationship between these parameters and the severity of ARD was analyzed. In addition, some clinical factors that may affect ARD were also included in our study. Ninety-eight percent of patients developed different degrees of ARD, and Group 2 accounted for ~31%. At the end of 5 weeks of radiotherapy, the difference in thickness between the two groups was statistically significant (P < 0.05). There was no significant change in the elastic modulus of breast skin between the two groups (P > 0.05). Body mass index >25 kg/m2, breast thickness ≥18 mm, skin basic elastic modulus <23 kPa and skin thickness increment >0.3 mm were considered to be associated with severe skin reactions (P < 0.05). Ultrasound can be a useful tool for the non-invasive and objective assessment of skin changes during radiotherapy, documenting quantitative changes in the skin of breast cancer patients following BCS undergoing radiotherapy.
Collapse
Affiliation(s)
- Wenqin Chen
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Wenjuan Lu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Ya Yuan
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Lu Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Hongyan Deng
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xinhua Ye
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| |
Collapse
|
6
|
Cilla S, Romano C, Macchia G, Boccardi M, Pezzulla D, Buwenge M, Castelnuovo AD, Bracone F, Curtis AD, Cerletti C, Iacoviello L, Donati MB, Deodato F, Morganti AG. Machine-learning prediction model for acute skin toxicity after breast radiation therapy using spectrophotometry. Front Oncol 2023; 12:1044358. [PMID: 36686808 PMCID: PMC9853396 DOI: 10.3389/fonc.2022.1044358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose Radiation-induced skin toxicity is a common and distressing side effect of breast radiation therapy (RT). We investigated the use of quantitative spectrophotometric markers as input parameters in supervised machine learning models to develop a predictive model for acute radiation toxicity. Methods and materials One hundred twenty-nine patients treated for adjuvant whole-breast radiotherapy were evaluated. Two spectrophotometer variables, i.e. the melanin (IM) and erythema (IE) indices, were used to quantitatively assess the skin physical changes. Measurements were performed at 4-time intervals: before RT, at the end of RT and 1 and 6 months after the end of RT. Together with clinical covariates, melanin and erythema indices were correlated with skin toxicity, evaluated using the Radiation Therapy Oncology Group (RTOG) guidelines. Binary group classes were labeled according to a RTOG cut-off score of ≥ 2. The patient's dataset was randomly split into a training and testing set used for model development/validation and testing (75%/25% split). A 5-times repeated holdout cross-validation was performed. Three supervised machine learning models, including support vector machine (SVM), classification and regression tree analysis (CART) and logistic regression (LR), were employed for modeling and skin toxicity prediction purposes. Results Thirty-four (26.4%) patients presented with adverse skin effects (RTOG ≥2) at the end of treatment. The two spectrophotometric variables at the beginning of RT (IM,T0 and IE,T0), together with the volumes of breast (PTV2) and boost surgical cavity (PTV1), the body mass index (BMI) and the dose fractionation scheme (FRAC) were found significantly associated with the RTOG score groups (p<0.05) in univariate analysis. The diagnostic performances measured by the area-under-curve (AUC) were 0.816, 0.734, 0.714, 0.691 and 0.664 for IM, IE, PTV2, PTV1 and BMI, respectively. Classification performances reported precision, recall and F1-values greater than 0.8 for all models. The SVM classifier using the RBF kernel had the best performance, with accuracy, precision, recall and F-score equal to 89.8%, 88.7%, 98.6% and 93.3%, respectively. CART analysis classified patients with IM,T0 ≥ 99 to be associated with RTOG ≥ 2 toxicity; subsequently, PTV1 and PTV2 played a significant role in increasing the classification rate. The CART model provided a very high diagnostic performance of AUC=0.959. Conclusions Spectrophotometry is an objective and reliable tool able to assess radiation induced skin tissue injury. Using a machine learning approach, we were able to predict grade RTOG ≥2 skin toxicity in patients undergoing breast RT. This approach may prove useful for treatment management aiming to improve patient quality of life.
Collapse
Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy,*Correspondence: Savino Cilla, ;
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | | | | | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Francesca Bracone
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy,Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | | | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy,Istituto di Radiologia, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy
| |
Collapse
|
7
|
Park YI, Choi SH, Hong CS, Cho MS, Son J, Han MC, Kim J, Kim H, Kim DW, Kim JS. A New Approach to Quantify and Grade Radiation Dermatitis Using Deep-Learning Segmentation in Skin Photographs. Clin Oncol (R Coll Radiol) 2023; 35:e10-e19. [PMID: 35918275 DOI: 10.1016/j.clon.2022.07.001] [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: 12/08/2021] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 01/04/2023]
Abstract
AIMS Objective evaluation of radiation dermatitis is important for analysing the correlation between the severity of radiation dermatitis and dose distribution in clinical practice and for reliable reporting in clinical trials. We developed a novel radiation dermatitis segmentation system based on convolutional neural networks (CNNs) to consistently evaluate radiation dermatitis. MATERIALS AND METHODS The radiation dermatitis segmentation system is designed to segment the radiation dermatitis occurrence area using skin photographs and skin-dose distribution. A CNN architecture with a dilated convolution layer and skip connection was designed to estimate the radiation dermatitis area. Seventy-three skin photographs obtained from patients undergoing radiotherapy were collected for training and testing. The ground truth of radiation dermatitis segmentation is manually delineated from the skin photograph by an experienced radiation oncologist and medical physicist. We converted the skin photographs to RGB (red-green-blue) and CIELAB (lightness (L∗), red-green (a∗) and blue-yellow (b∗)) colour information and trained the network to segment faint and severe radiation dermatitis using three different input combinations: RGB, RGB + CIELAB (RGBLAB) and RGB + CIELAB + skin-dose distribution (RGBLAB_D). The proposed system was evaluated using the Dice similarity coefficient (DSC), sensitivity, specificity and normalised Matthews correlation coefficient (nMCC). A paired t-test was used to compare the results of different segmentation performances. RESULTS Optimal data composition was observed in the network trained for radiation dermatitis segmentation using skin photographs and skin-dose distribution. The average DSC, sensitivity, specificity and nMCC values of RGBLAB_D were 0.62, 0.61, 0.91 and 0.77, respectively, in faint radiation dermatitis, and 0.69, 0.78, 0.96 and 0.83, respectively, in severe radiation dermatitis. CONCLUSION Our study showed that CNN-based radiation dermatitis segmentation in skin photographs of patients undergoing radiotherapy can describe radiation dermatitis severity and pattern. Our study could aid in objectifying the radiation dermatitis grading and analysing the reliable correlation between dosimetric factors and the morphology of radiation dermatitis.
Collapse
Affiliation(s)
- Y I Park
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea; Medical Physics and Biomedical Engineering Lab (MPBEL), Yonsei University College of Medicine, Seoul, South Korea
| | - S H Choi
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Yongin Severance Hospital, Yongin, South Korea
| | - C-S Hong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea.
| | - M-S Cho
- Department of Radiation Oncology, Yongin Severance Hospital, Yongin, South Korea
| | - J Son
- Department of Radiation Oncology, Yongin Severance Hospital, Yongin, South Korea
| | - M C Han
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - J Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - H Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - D W Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - J S Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea; Medical Physics and Biomedical Engineering Lab (MPBEL), Yonsei University College of Medicine, Seoul, South Korea.
| |
Collapse
|
8
|
Plaza D, Baic A, Lange B, Brzęk A, Ślosarek K, Stanek A, Cholewka A. Comparison of the Thermal Reaction of Patients after Conserving Procedures and after Mastectomy to the Radiation Dose Obtained during Radiotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16085. [PMID: 36498157 PMCID: PMC9738999 DOI: 10.3390/ijerph192316085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
The main aim of the study was to compare the temperature response of the body to the dose received during breast cancer radiotherapy. The control group consisted of 50 healthy volunteers. They underwent one thermographic examination and compared the temperatures between the left and right breasts. The research group consisted of 50 patients. Based on the treatment plan, the area PTV and isodose was marked on the thermograms. Five thermographs were performed in each patient (before radiotherapy and in each week of treatment). A qualitatively similar increase in mean temperature during treatment was observed in both subgroups in the analyzed areas. The highest increase in temperature was obtained in the third week of treatment. Compared with the value before treatment, the increase in the mean temperature in PTV in patients after partial surgery was 0.78 °C, these values are statistically significant p = 0.000055. In the case of post-mastectomy patients, 0.8 °C was obtained, these values are statistically significant p = 0.00369. In addition, strong correlation was calculated between isodoses read from treatment plans and isotherms obtained from the analysis of thermal images. In post-mastectomy patients for PTV r = 0.77, 30 Gy r = 0.94, 20 Gy r = 0.96, and 10 Gy r = 0.75. For patients after partial surgery for PTV r = 0.74, 30 Gy r = 0.89, 20 Gy r = 0.83, and 10 Gy r = 0.89. Infrared thermography seems to be a useful method of assessing the thermal response of the body to the dose received during radiotherapy of breast cancer and may be a clinically useful method of assessing the early skin response to radiation.
Collapse
Affiliation(s)
- Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Agnieszka Baic
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Barbara Lange
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Anna Brzęk
- Department of Physiotherapy, School of Health Sciences, Katowice Medical University of Silesia in Katowice, Poniatowskiego Street 15, 40-055 Katowice, Poland
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Agata Stanek
- Chair and Clinical Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia in Katowice, 41-902 Bytom, Poland
| | - Armand Cholewka
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| |
Collapse
|
9
|
Plaza D, Baic A, Lange B, Michalecki Ł, Ślosarek K, Stanek A, Cholewka A. The Use of Infrared Thermography in the Assessment of Thermal Reaction of Patients Treated with Radiotherapy after Breast-Conserving Procedures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14187. [PMID: 36361065 PMCID: PMC9657152 DOI: 10.3390/ijerph192114187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The aim of the study was to assess the usefulness of the infrared thermography method in the assessment of the body's thermal reaction in patients during radiotherapy. Studies have shown how the temperature distribution changes with the dose of radiation used in each treatment week. Fifty-four patients participated in the study. The control group consisted of healthy patients, among whom the difference in mean temperatures between the breasts was checked. The study group included patients after conserving procedures qualified for radiotherapy. Measurements were taken and analyzed for each patient during each week of treatment. The target area (marked by a doctor) and the 30 Gy, 20 Gy and 10 Gy isodoses (generated from the treatment plan) were transferred on thermograms and then analyzed. This way of defining the observed areas is the most accurate and individually adjusted to each treated patient. The analysis showed an increase in temperature in the tested body surface areas, whereas the highest average temperature value was achieved during the third week of treatment. The observations may be used to evaluate the skin reaction from radiation; however, they require further studies and new quantitative parameters.
Collapse
Affiliation(s)
- Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Agnieszka Baic
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Barbara Lange
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Łukasz Michalecki
- Department of Radiation Oncology, University Clinical Center, Medical University of Silesia, Ceglana Street 35, 40-514 Katowice, Poland
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
| | - Armand Cholewka
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| |
Collapse
|
10
|
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]
|
11
|
Baic A, Plaza D, Lange B, Michalecki Ł, Stanek A, Kowalczyk A, Ślosarek K, Cholewka A. Long-Term Skin Temperature Changes after Breast Cancer Radiotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6891. [PMID: 35682472 PMCID: PMC9180487 DOI: 10.3390/ijerph19116891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/16/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022]
Abstract
The aim of the study was to use thermal imaging to evaluate long-term chest temperature changes in patients who had previously been treated with radiotherapy. The examination with a thermal imaging camera involved 144 women-48 of them were patients after RT, 48 were females before breast cancer radiotherapy and the last group of participants were 48 healthy women. All patients (before and after radiotherapy) were divided into women after mastectomy and those after conservative surgery. In addition, the first group of women, those who had received radiotherapy, were divided into three other groups: up to 1 year after RT, over 1 year and up to 5 years after RT and over 5 years after RT. Due to this, it was possible to compare the results and analyse the differences between the temperature in the healthy and treated breasts. The comparison of obtained temperature results showed that the area treated by ionizing radiation is characterized by a higher temperature even a few years after the finished treatment. It is worth mentioning that despite the fact that the difference was visible on the thermograms, the patients had no observable skin lesion or change in color at the treatment site. For the results of the study provided for the group of healthy patients, there were no significant differences observed between the average temperatures in the breasts. The use of thermal imaging in the evaluation of skin temperature changes after radiotherapy showed that the average temperature in the treated breast area can change even a long time after treatment.
Collapse
Affiliation(s)
- Agnieszka Baic
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty Street 1A, 41-500 Chorzów, Poland;
| | - Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (K.Ś.)
| | - Barbara Lange
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland;
| | - Łukasz Michalecki
- Department of Radiation Oncology, University Clinical Center, Medical University of Silesia, Ceglana Street 35, 40-514 Katowice, Poland;
| | - Agata Stanek
- Clinical Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Poniatowskiego Steet 15, 40-055 Katowice, Poland;
| | - Anna Kowalczyk
- Department of Physiotherapy, School of Health Sciences, Medical University of Silesia, Medyków Street 12, 40-752 Katowice, Poland;
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (K.Ś.)
| | - Armand Cholewka
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty Street 1A, 41-500 Chorzów, Poland;
| |
Collapse
|
12
|
Finkelstein S, Kanee L, Behroozian T, Wolf JR, van den Hurk C, Chow E, Bonomo P. Comparison of clinical practice guidelines on radiation dermatitis: a narrative review. Support Care Cancer 2022. [PMID: 35067732 DOI: 10.1007/s00-022-06829-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10 years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC). METHODS Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines. RESULTS Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT. CONCLUSIONS Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.
Collapse
Affiliation(s)
| | | | | | | | | | - Edward Chow
- University of Toronto, Toronto, ON, Canada.
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | | |
Collapse
|
13
|
Kondziołka J, Wilczyński S, Michalecki Ł. Potential Use of Novel Image and Signal Processing Methods to Develop a Quantitative Assessment of the Severity of Acute Radiation Dermatitis in Breast Cancer Radiotherapy. Clin Cosmet Investig Dermatol 2022; 15:725-733. [PMID: 35497689 PMCID: PMC9041143 DOI: 10.2147/ccid.s354320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022]
Abstract
More than 95% of patients who undergo radiotherapy report symptoms of radiation dermatitis, which is a side effect of this therapy. Erythema, edema, dry and moist desquamation intensify with each fraction of irradiation and can significantly reduce a patient's quality of life. Therefore, an effective skin care procedure is needed for skin that has been exposed to ionizing radiation in order to avoid unplanned treatment interruptions. The methods that are currently used to assess the severity of an acute radiation reaction are based on visual scales (RTOG, EORTC, NCI CTCAE, LENT-SOMA). Because the assessment is made subjectively, the results depend on the researchers, their experience and perceptiveness. Until now, several studies have been carried out to check the possibility of using an objective methods like hyperspectral imaging, thermal imaging, laser Doppler flowmetry, dielectric and electrochemical methods, reflection spectrophotometry and Courage-Khazaka Multi-skin instrument to radiation-induced dermatitis assessment. Unfortunately, due to various limitations that occurred in the research, none of these techniques was successfully implement as alternative for visual assessment. The continuous development of technology enables researchers to access new techniques that might constitute useful diagnostic and cognitive tools. Infrared thermal imaging, hyperspectral imaging and reflectance spectroscopy are examples of the visual techniques that have been used for many years in various fields of medicine, including dermatology and chronic wound or burn care. They provide information on the skin parameters, such as the temperature, concentration and distribution of chromophores (eg, hemoglobin and melanin), saturation or perfusion changes. The aim of this study is to review the available literature on the use of imaging methods in the clinical assessment of skin with lesions of various origins, evaluation of their suitability for the assessment of radiation reaction and consideration the possibility of creating a quantitative scale for assessing severity of acute radiation dermatitis.
Collapse
Affiliation(s)
- Joanna Kondziołka
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Łukasz Michalecki
- University Clinical Center of the Medical University of Silesia, Katowice, Poland
| |
Collapse
|
14
|
Park SY, Kim JH, Chang JH, Park JM, Choi CH, Kim JI. Quantitative evaluation of radiodermatitis following whole-breast radiotherapy with various color space models: A feasibility study. PLoS One 2022; 17:e0264925. [PMID: 35263372 PMCID: PMC8906630 DOI: 10.1371/journal.pone.0264925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/18/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
We analyzed skin images with various color space models to objectively assess radiodermatitis severity in patients receiving whole-breast radiotherapy.
Methods
Twenty female patients diagnosed with breast cancer were enrolled prospectively. All patients received whole-breast radiotherapy without boost irradiation. Skin images for both irradiated and unirradiated breasts were recorded in red-green-blue (RGB) color space using a mobile skin analysis device. For longitudinal analysis, the images were acquired before radiotherapy (RTbefore), approximately 7 days after the first fraction of radiotherapy (RT7days), RT14days, and approximately 10 days after radiotherapy completion (RTafter). Four color space models (RGB, hue-saturation-value (HSV), L*a*b*, and YCbCr models) were employed to calculate twelve color space parameters for each skin image. Skin dose measurements for irradiated breasts were performed using nanoDot optically stimulated luminescent dosimeters on the first fraction of radiotherapy. Subsequently, acute radiation dermatitis in each patient was assessed according to the Radiation Therapy Oncology Group scoring criteria at both RT14days and RTafter. Finally, several statistical analysis methods were applied to investigate the performance of the color space parameters to objectively assess the radiodermatitis.
Results
Owing to radiation-induced skin damage, R value of RGB model as well as S and V values of the HSV model for irradiated breasts increased significantly, while those for unirradiated breasts showed smaller increases. These parameters showed the longitudinal changes in color space parameters within each group and between groups over time with statistical significance. Strong correlations of the parameters for irradiated breasts at RT7days with skin doses and those at RTafter were observed with statistical significance.
Conclusion
The R value of RGB model as well as the S and V values of HSV model showed relatively better performance in evaluating the acute radiation dermatitis. These color space parameters could therefore serve as useful tools to assess radiodermatitis severity in a dose-dependent manner.
Collapse
Affiliation(s)
- So-Yeon Park
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jin Ho Kim
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Hyun Chang
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong Min Park
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Heon Choi
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-In Kim
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| |
Collapse
|
15
|
Baic A, Plaza D, Lange B, Michalecki Ł, Stanek A, Ślosarek K, Cholewka A. Twelve-Month Evaluation of Temperature Effects of Radiotherapy in Patients after Mastectomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052834. [PMID: 35270526 PMCID: PMC8910534 DOI: 10.3390/ijerph19052834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
The aim of this study was to verify the changes in the temperature distribution within the breast at twelve months after the end of radiotherapy for breast cancer. The study included twenty-four women. The first test group consisted of twelve women who underwent breast mastectomy and qualified for radiotherapy according to standard medical treatment procedures. The second group included twelve healthy women. The tests were conducted before treatment with radiation therapy and two months, six months, nine months, and one year after the end of treatment. The mean temperature values changed depending on the time that had elapsed since the end of treatment. The highest temperature increase in all patients was observed six months after the end of radiotherapy. This research has confirmed that the assessment of temperature changes in the breast area after radiotherapy can evaluate the severity and lesions in the time course of the radiation reaction.
Collapse
Affiliation(s)
- Agnieszka Baic
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty Street 1A, 41-500 Chorzow, Poland;
- Correspondence:
| | - Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (K.Ś.)
| | - Barbara Lange
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland;
| | - Łukasz Michalecki
- Department of Radiation Oncology, University Clinical Center, Medical University of Silesia in Katowice, Ceglana Street 35, 40-514 Katowice, Poland;
| | - Agata Stanek
- Chair and Clinical Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego Street 15, 41-902 Bytom, Poland;
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (K.Ś.)
| | - Armand Cholewka
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty Street 1A, 41-500 Chorzow, Poland;
| |
Collapse
|
16
|
Comparison of clinical practice guidelines on radiation dermatitis: a narrative review. Support Care Cancer 2022; 30:4663-4674. [PMID: 35067732 DOI: 10.1007/s00520-022-06829-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10 years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC). METHODS Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines. RESULTS Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT. CONCLUSIONS Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.
Collapse
|
17
|
Allali S, Kirova Y. Radiodermatitis and Fibrosis in the Context of Breast Radiation Therapy: A Critical Review. Cancers (Basel) 2021; 13:cancers13235928. [PMID: 34885037 PMCID: PMC8656525 DOI: 10.3390/cancers13235928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Skin toxicity is the main complication during irradiation in the management of early-stage breast cancer. In some cases, it may cause treatment to stop. These toxicities may be acute (mainly radiodermatitis) and/or late (mainly fibrosis). Their understandings, their mechanisms of occurrence, as well as their management is indispensable in order to improve the management of these patients. Through this study we propose to provide a clear picture of these toxicities in relation to the modalities of radiotherapy, advances in their quantification, and management to help practitioners improve their knowledge and clinical practices on this topic. Abstract Background: Radiation therapy has been progressively improved in order to maintain a satisfactory tumour response, while reducing toxicity. We will review the incidence of radiodermatitis and fibrosis according to the various radiation and fractionation techniques. We will then focus on the various methods used to manage, prevent, and quantify this toxicity. Method: More than 1753 articles were identified using the various search terms. We selected 53 articles to answer the questions addressed in this study according to criteria set in advance. Result: The literature reports lower acute toxicity with IMRT compared to 3DCRT, but no significant differences in terms of late toxicities. Partial breast irradiation appears to be less effective in terms of local control with a higher rate of late toxicity. Intra operative radiation therapy appears to provide good results in terms of both local control and late toxicity. The hypofractionation has equivalent efficacy and safety to the normofractionated regimen, but with lower rates of radiodermatitis and fibrosis. The adddition of a boost, particularly a sequential boost, increases the risk of fibrosis and radiodermatitis during treatment. Conclusion: The development of IMRT has significantly reduced acute toxicity and has improved tolerability during treatment. Modified fractionation has reduced treatment time, as well as adverse effects.
Collapse
|
18
|
Baic A, Plaza D, Lange B, Reudelsdorf-Ullmann M, Michalecki Ł, Stanek A, Ślosarek K, Cholewka A. The Use of Thermal Imaging in the Evaluation of Temperature Effects of Radiotherapy in Patients after Mastectomy-First Study. SENSORS 2021; 21:s21217068. [PMID: 34770371 PMCID: PMC8588482 DOI: 10.3390/s21217068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study was to evaluate the temperature parameter of the breast area in patients undergoing radiotherapy at various intervals. The relationship between temperature changes on the patient’s skin and the time after the end of radiotherapy was studied. Measurements with a thermal imaging camera were performed in a group of twelve volunteers. Six of them were healthy women who did not have thermal asymmetry between the breasts, whereas six were diagnosed with breast cancer and underwent mastectomy due to the advanced stage of the disease. The patients were qualified for radiation therapy. Thermographic examinations were performed before treatment, two months later and then six months after the end of the treatment. Temperature differences between the healthy breasts and the treated areas were assessed. Additionally, the correlation between a patient’s skin temperature changes and the time after the end of radiotherapy was analyzed. The highest skin temperature increase (1.47 °C) was observed 6 months after the end of RT compared to the measurement before treatment. It seems that thermovision may bring a new tool for quantitative analyses of the temperature effects of radiotherapy.
Collapse
Affiliation(s)
- Agnieszka Baic
- Department of Medical Physics, A. Chełkowski Institute of Physics, University of Silesia, 75 Pułku Piechoty 1A St., 41-500 Chorzów, Poland;
- Correspondence:
| | - Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (M.R.-U.); (K.Ś.)
| | - Barbara Lange
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (M.R.-U.); (K.Ś.)
| | - Marta Reudelsdorf-Ullmann
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (M.R.-U.); (K.Ś.)
| | - Łukasz Michalecki
- Department of Radiation Oncology, University Clinical Center of the Medical University of Silesia, Medyków 14 St., 40-572 Katowice, Poland;
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland;
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (M.R.-U.); (K.Ś.)
| | - Armand Cholewka
- Department of Medical Physics, A. Chełkowski Institute of Physics, University of Silesia, 75 Pułku Piechoty 1A St., 41-500 Chorzów, Poland;
| |
Collapse
|
19
|
Plaza D, Baic A, Lange B, Stanek A, Ślosarek K, Kowalczyk A, Cholewka A. Correlation between Isotherms and Isodoses in Breast Cancer Radiotherapy-First Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E619. [PMID: 33450874 PMCID: PMC7828351 DOI: 10.3390/ijerph18020619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/17/2022]
Abstract
The study is focused on correlation of isotherms derived from thermal images with an isodoses describing treatment plan for patients with breast cancer treated by radiotherapy. The irradiated area covered the part of the body after mastectomy. The study included patients diagnosed with breast cancer who were qualified for radiotherapy treatment. All patients were monitored during each treatment week during the entire radiotherapy process. The measurements were made under strictly defined conditions. In the treatment planning system (TPS), the specific plan was created for each patient. Spatial dose distribution in the patient's body was obtained and presented by the isodoses (lines connecting points with the same dose values). The following areas from the treatment planning system were plotted on the thermograms: target (tumor area) and isodose: 45 Gy, 40 Gy, 30 Gy, 20 Gy and 10 Gy. The obtained results indicated a high correlation between magnitude of the dose represented as the isodose and the temperature of the treated skin. Moreover, preliminary analysis showed a repeatable increase of the mean temperature in the irradiated area during the treatment.
Collapse
Affiliation(s)
- Dominika Plaza
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (K.Ś.)
| | - Agnieszka Baic
- A. Chełkowski Institute of Physics, Department of Medical Physics, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland;
| | - Barbara Lange
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (K.Ś.)
| | - Agata Stanek
- Department and Clinic of Internal Diseases, Angiology and Physical Medicine in Bytom, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Batorego Street 15, 41-902 Bytom, Poland;
| | - Krzysztof Ślosarek
- Radiotherapy Planning Department, Maria Skłodowska—Curie National Research Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej Street 15, 44-102 Gliwice, Poland; (D.P.); (B.L.); (K.Ś.)
| | - Anna Kowalczyk
- Department of Physiotherapy, School of Health Sciences, Katowice Medical University of Silesia in Katowice, Poniatowskiego Street 15, 40-055 Katowice, Poland;
| | - Armand Cholewka
- A. Chełkowski Institute of Physics, Department of Medical Physics, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland;
| |
Collapse
|
20
|
Radiation dermatitis assessment tools used in breast cancer: A systematic review of measurement properties. Support Care Cancer 2020; 29:2265-2278. [DOI: 10.1007/s00520-020-05889-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
|
21
|
Ahn S, Sung K, Kim HJ, Choi YE, Lee YK, Kim JS, Lee SK, Roh JY. Reducing Radiation Dermatitis Using a Film-forming Silicone Gel During Breast Radiotherapy: A Pilot Randomized-controlled Trial. In Vivo 2020; 34:413-422. [PMID: 31882508 DOI: 10.21873/invivo.11790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To evaluate whether topical use of a film-forming silicone gel (StrataXRT®) could reduce radiation dermatitis compared to a moisturizing cream (X-derm®) in patients receiving whole breast radiotherapy. PATIENTS AND METHODS A total of 56 patients with breast cancer were randomized to use StrataXRT or X-derm. The severity of radiation dermatitis was graded using physiological skin parameters, clinician-assessed visual rating scales and patient-reported symptoms. Changes in these parameters from baseline to 4 weeks post-radiotherapy were evaluated every two weeks. RESULTS Two-way repeated-measures ANOVA revealed different patterns of changes in the erythema index (F=3.609, p=0.008) and melanin index (F=3.475, p=0.015). The post hoc analysis demonstrated a significantly lower erythema index and melanin index in the patients allocated to the StrataXRT group. CONCLUSION The use of StrataXRT can reduce radiation dermatitis with respect to objectively measured physiological skin parameters. The results of the present study will support the feasibility of conducting a larger randomized controlled trial.
Collapse
Affiliation(s)
- Songmi Ahn
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Kihoon Sung
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Hyun Ju Kim
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Young Eun Choi
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Young Kyu Lee
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Jeong Soo Kim
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Seul Ki Lee
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Joo-Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| |
Collapse
|
22
|
Svitina H, Swanepoel R, Rossouw J, Netshimbupfe H, Gouws C, Hamman J. Treatment of Skin Disorders with Aloe Materials. Curr Pharm Des 2020; 25:2208-2240. [PMID: 31269881 DOI: 10.2174/1381612825666190703154244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/20/2019] [Indexed: 01/09/2023]
Abstract
The skin is the largest organ and functions as a barrier to protect the underlying tissues against the elements and pathogens, while also fulfilling many physiological roles and biochemical functions such as preventing excessive water loss. Skin disorders vary greatly in terms of origin, severity, symptoms and affect persons of all ages. Many plants have been used for medicinal purposes since ancient times including the treatment of skin disorders and diseases. Aloe represents one of the earliest medicinal plant species mentioned in antique scriptures and even in rock art dating back thousands of years. Different Aloe species and materials have been used in the prevention and treatment of skin related disorders. Aloe vera is the most commonly used Aloe species for medicinal purposes. Some of the most prominent skin related applications and disorders that Aloe materials have been investigated for are discussed in this paper, which include cosmetic, radiation, cancer, wound and antimicrobial applications. Both in vitro and in vivo studies are included in the discussions of this paper and comprehensive summaries of all these studies are given in tables in each section. Although some contradictory results were obtained among studies, certain Aloe materials have shown excellent efficacy and exhibited potential for the treatment of skin related disorders and cosmetic applications.
Collapse
Affiliation(s)
- Hanna Svitina
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Roan Swanepoel
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Jacques Rossouw
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Happiness Netshimbupfe
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Chrisna Gouws
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Josias Hamman
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| |
Collapse
|
23
|
Saednia K, Tabbarah S, Lagree A, Wu T, Klein J, Garcia E, Hall M, Chow E, Rakovitch E, Childs C, Sadeghi-Naini A, Tran WT. Quantitative Thermal Imaging Biomarkers to Detect Acute Skin Toxicity From Breast Radiation Therapy Using Supervised Machine Learning. Int J Radiat Oncol Biol Phys 2020; 106:1071-1083. [PMID: 31982495 DOI: 10.1016/j.ijrobp.2019.12.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/11/2019] [Accepted: 12/24/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Radiation-induced dermatitis is a common side effect of breast radiation therapy (RT). Current methods to evaluate breast skin toxicity include clinical examination, visual inspection, and patient-reported symptoms. Physiological changes associated with radiation-induced dermatitis, such as inflammation, may also increase body-surface temperature, which can be detected by thermal imaging. Quantitative thermal imaging markers were identified and used in supervised machine learning to develop a predictive model for radiation dermatitis. METHODS AND MATERIALS Ninety patients treated for adjuvant whole-breast RT (4250 cGy/fx = 16) were recruited for the study. Thermal images of the treated breast were taken at 4 intervals: before RT, then weekly at fx = 5, fx = 10, and fx = 15. Parametric thermograms were analyzed and yielded 26 thermal-based features that included surface temperature (°C) and texture parameters obtained from (1) gray-level co-occurrence matrix, (2) gray-level run-length matrix, and (3) neighborhood gray-tone difference matrix. Skin toxicity was evaluated at the end of RT using the Common Terminology Criteria for Adverse Events (CTCAE) guidelines (Ver.5). Binary group classes were labeled according to a CTCAE cut-off score of ≥2, and thermal features obtained at fx = 5 were used for supervised machine learning to predict skin toxicity. The data set was partitioned for model training, independent testing, and validation. Fifteen patients (∼17% of the whole data set) were randomly selected as an unseen test data set, and 75 patients (∼83% of the whole data set) were used for training and validation of the model. A random forest classifier with leave-1-patient-out cross-validation was employed for modeling single and hybrid parameters. The model performance was reported using receiver operating characteristic analysis on patients from an independent test set. RESULTS Thirty-seven patients presented with adverse skin effects, denoted by a CTCAE score ≥2, and had significantly higher local increases in skin temperature, reaching 36.06°C at fx = 10 (P = .029). However, machine-learning models demonstrated early thermal signals associated with skin toxicity after the fifth RT fraction. The cross-validated model showed high prediction accuracy on the independent test data (test accuracy = 0.87) at fx = 5 for predicting skin toxicity at the end of RT. CONCLUSIONS Early thermal markers after 5 fractions of RT are predictive of radiation-induced skin toxicity in breast RT.
Collapse
Affiliation(s)
- Khadijeh Saednia
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Electrical Engineering and Computer Science, York University, Toronto, Canada
| | - Sami Tabbarah
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Andrew Lagree
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Tina Wu
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jonathan Klein
- Department of Radiation Oncology, Albert Einstein College of Medicine, New York City, New York
| | - Eduardo Garcia
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Michael Hall
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Eileen Rakovitch
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Charmaine Childs
- Department of Radiotherapy & Oncology, Sheffield Hallam University, Sheffield, United Kingdom
| | - Ali Sadeghi-Naini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Electrical Engineering and Computer Science, York University, Toronto, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - William T Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Radiotherapy & Oncology, Sheffield Hallam University, Sheffield, United Kingdom; Department of Biomedical Physics, Ryerson University, Toronto, Canada.
| |
Collapse
|
24
|
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
|
25
|
Kawamura M, Yoshimura M, Asada H, Nakamura M, Matsuo Y, Mizowaki T. A scoring system predicting acute radiation dermatitis in patients with head and neck cancer treated with intensity-modulated radiotherapy. Radiat Oncol 2019; 14:14. [PMID: 30665451 PMCID: PMC6341605 DOI: 10.1186/s13014-019-1215-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/07/2019] [Indexed: 12/25/2022] Open
Abstract
Background and purpose We created a scoring system incorporating dosimetric and clinical factors to assess the risk of severe, acute skin reactions in patients undergoing intensity-modulated radiation therapy (IMRT) to treat head and neck cancer (HNC). Materials and methods A total of 101 consecutive patients who received definitive IMRT or volumetric modulated arc therapy (VMAT) with a prescription dose of 70 Gy to treat HNC between 2013 and 2017 in our hospital were enrolled. Skin V5Gy, V10Gy, V20Gy, V30Gy, V40Gy, V50Gy, and V60Gy values delivered 5 mm within the body contour were compared between patients with Grades 1–2 and Grade 3 dermatitis. A scoring system was created based on logistic regression analysis (LRA) that identified the most significant dosimetric and clinical factors. Results The V60Gy was significantly associated with radiation dermatitis grade in both LRA and recursive partitioning analysis (RPA). A scoring system incorporating the V60Gy, concurrent chemotherapy status, age, and body mass index was used to divide all patients into three subgroups (0–1, 2–3, and 4–6 points) in the RPA. The incidence of Grade 3 dermatitis significantly differed among the subgroups (0, 20.5, and 58.6%, respectively, P < 0.01). Conclusions A risk analysis model incorporating dose-volume parameters successfully predicted acute skin reactions and will aid in the appropriate management of radiation dermatitis.
Collapse
Affiliation(s)
- Mitsue Kawamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
| | - Hiromi Asada
- Nursing Department, Kyoto University Hospital, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.,Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| |
Collapse
|
26
|
Ribeiro FE, Vanderlei LCM, Palma MR, Tebar WR, Caldeira DT, Teles Fregonesi CEP, Christofaro DGD. Body dissatisfaction and its relationship with overweight, sedentary behavior and physical activity in survivors of breast cancer. Eur J Obstet Gynecol Reprod Biol 2018; 229:153-158. [PMID: 30195967 DOI: 10.1016/j.ejogrb.2018.08.581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/24/2018] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study aimed to verify the prevalence of body satisfaction in breast cancer survivors and the association of this variable with overweight, sedentary behavior and physical activity in this population. STUDY DESIGN This is a cross-sectional study realized in Presidente Prudente-Brazil. Breast cancer survivors participated in this study. Questionnaires were used to obtain data on socioeconomic status, body dissatisfaction, sedentary behavior and level of physical activity. The association between body dissatisfaction and the independent variables was verified through binary logistic regression in the unadjusted model and model adjusted by socioeconomic level. RESULTS A total of 102 breast cancer survivors participated in this study with a mean age of 58.2 (±10.3) years. The prevalence of body dissatisfaction was 75.7%. Body dissatisfaction was higher in women with higher BMI (pvalue = 0.003) and in woman with high sedentary behavior (p-value = 0.049). Women with overweight had 7.87 times more chance of presenting body dissatisfaction. Women who reported hormone therapy were approximately 3 times more likely to be dissatisfacted with their body. CONCLUSION Body dissatisfaction was associated with lower age, high sedentary behavior and overweight in breast cancer survivors in the unadjusted analysis. When adjusted for socioeconomic status, only the variables of overweight and hormone therapy were associated with body dissatisfaction.
Collapse
Affiliation(s)
- Fernanda E Ribeiro
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil.
| | - Luiz Carlos M Vanderlei
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
| | - Mariana R Palma
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
| | - William R Tebar
- Programa de Pós-Graduação em Ciências da Motricidade, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
| | - Daniela T Caldeira
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
| | - Cristina E P Teles Fregonesi
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
| | - Diego G D Christofaro
- Programa de Pós-Graduação em Ciências da Motricidade, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil; Departamento de Educação Física, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
| |
Collapse
|
27
|
Fei W, Xu S, Ma J, Zhai W, Cheng S, Chang Y, Wang X, Gao J, Tang H, Yang S, Zhang X. Fundamental supply of skin blood flow in the Chinese Han population: Measurements by a full-field laser perfusion imager. Skin Res Technol 2018; 24:656-662. [PMID: 29740880 DOI: 10.1111/srt.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin blood flow is believed to link with many diseases, and shows a significant heterogeneity. There are several papers on basal cutaneous microcirculation perfusion in different races, while the data in Chinese is vacant. OBJECTIVE The aim was to establish the database of absolute fundamental supply of skin blood flow in the Chinese Han population. METHODS With a full-field laser perfusion imager (FLPI), the skin blood flow can be quantified. Cutaneous perfusion values were determined in 17 selected skin areas in 406 healthy participants aged between 20 and 80 years (mean 35.05 ± 11.33). Essential parameters such as weight, height were also measured and values of BMI were calculated. The perfusion values were reported in Arbitrary Perfusion Units (APU). RESULTS The highest cutaneous perfusion value fell on eyelid (931.20 ± 242.59 in male and 967.83 ± 225.49 in female), and pretibial had the lowest value (89.09 ± 30.28 in male and 85.08 ± 33.59 in female). The values were higher in men than women on the bank of fingertips, nose, forehead, cheek, neck and earlobe (P < .05). Perfusion values on stretch and flexion side of forearm had negative correlation with age (P = .01 and P = 4.88 × 10-3 , respectively) in male. Abdomen was negatively correlated with BMI in both gender (P = .02, respectively). CONCLUSIONS Skin blood flow values vary with skin regions. There is a tendency to measure higher perfusion values in men than in women. And the values are irrelevant with age or BMI.
Collapse
Affiliation(s)
- W Fei
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - S Xu
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - J Ma
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - W Zhai
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - S Cheng
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - Y Chang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - X Wang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - J Gao
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - H Tang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - S Yang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| | - X Zhang
- Institute of Dermatology and Department of Dermatology at NO.1 Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, China, Hefei, Anhui, China
| |
Collapse
|
28
|
Ryan Wolf J, Heckler CE, Guido JJ, Peoples AR, Gewandter JS, Ling M, Vinciguerra VP, Anderson T, Evans L, Wade J, Pentland AP, Morrow GR. Oral curcumin for radiation dermatitis: a URCC NCORP study of 686 breast cancer patients. Support Care Cancer 2018; 26:1543-1552. [PMID: 29192329 PMCID: PMC5876157 DOI: 10.1007/s00520-017-3957-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Despite advances in medical technology, radiation dermatitis occurs in 95% of patients receiving radiation therapy (RT) for cancer. Currently, there is no standard and effective treatment for the prevention or control of radiation dermatitis. The goal of the study was to determine the efficacy of oral curcumin, one of the biologically active components in turmeric, at reducing radiation dermatitis severity (RDS) at the end of RT, using the RDS scale, compared to placebo. METHODS This was a multisite, randomized, double-blinded, placebo-controlled trial of 686 breast cancer patients. Patients took four 500-mg capsules of placebo or curcumin three times daily throughout their prescribed course of RT until 1 week post-RT. RESULTS A total of 686 patients were included in the final analyses (87.5% white females, mean age = 58). Linear mixed-model analyses demonstrated that curcumin did not reduce radiation dermatitis severity at the end of RT compared to placebo (B (95% CI) = 0.044 (- 0.101, 0.188), p = 0.552). Fewer curcumin patients with RDS > 3.0 suggested a trend toward reduced severity (7.4 vs. 12.9%, p = 0.082). Patient-reported changes in pain, symptoms, and quality of life were not statistically significant between arms. CONCLUSIONS Oral curcumin did not significantly reduce radiation dermatitis severity compared to placebo. The skin rating variation and broad eligibility criteria could not account for the undetectable therapeutic effect. An objective measure for radiation dermatitis severity and further exploration for an effective treatment for radiation dermatitis is warranted.
Collapse
Affiliation(s)
- Julie Ryan Wolf
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA.
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA.
| | - Charles E Heckler
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Joseph J Guido
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Anita R Peoples
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Marilyn Ling
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Lisa Evans
- Southeast Clinical Oncology Research Consortium, Winston-Salem, NC, USA
| | | | - Alice P Pentland
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA
| | - Gary R Morrow
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
29
|
Maillot O, Leduc N, Atallah V, Escarmant P, Petit A, Belhomme S, Sargos P, Vinh-Hung V. Evaluation of acute skin toxicity of breast radiotherapy using thermography: Results of a prospective single-centre trial. Cancer Radiother 2018; 22:205-210. [DOI: 10.1016/j.canrad.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/13/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
|
30
|
Garnier M, Champeaux E, Laurent E, Boehm A, Briard O, Wachter T, Vaillant L, Patat F, Bens G, Machet L. High-frequency ultrasound quantification of acute radiation dermatitis: pilot study of patients undergoing radiotherapy for breast cancer. Skin Res Technol 2017; 23:602-606. [PMID: 28513053 DOI: 10.1111/srt.12378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute radiation dermatitis (ARD) is a frequent complication after breast cancer radiotherapy and is usually assessed by semi-quantitative clinical scores, which may be subject to inter-observer variability. High-frequency ultrasound imaging of the skin can reliably quantify thickness and edema in diseased skin. We aimed to compare the relative increase in dermal thickness of the irradiated zone in breast-cancer patients undergoing radiotherapy, with clinical severity. METHODS A consecutive series of patients undergoing treatment for breast cancer by lumpectomy and radiotherapy in a 6-month period also underwent clinical and ultrasound evaluation of ARD. RESULTS We included 34 female patients 17 had grade 1 (group 1), 17 had grade 2 or grade 3 ARD (group 2). The mean relative increase in dermal thickness in irradiated skin (RIDTIS) was greater for group 2 than 1: 0.53 vs 0.29 mm (P=.023). On univariate analysis, ARD was associated with skin phototype, breast volume and RIDTIS, and on multivariable analysis, breast volume and age remained predictive of the disease. CONCLUSION Patients with more severe dermatitis showed significantly increased dermal thickness. Dermal thickness is a quantitative variable that could help quantify the efficacy of drugs and improve the treatment of this disease in patients undergoing radiotherapy.
Collapse
Affiliation(s)
- M Garnier
- Department of Dermatology, CHRU Tours, Tours, France.,Department of Radiotherapy, CHR Orléans, Orléans, France
| | - E Champeaux
- Department of Radiotherapy, CHR Orléans, Orléans, France
| | - E Laurent
- Department of Epidemiology, CHRU Tours, Tours, France
| | - A Boehm
- Department of Radiotherapy, CHR Orléans, Orléans, France
| | - O Briard
- Department of Radiotherapy, CHR Orléans, Orléans, France
| | - T Wachter
- Department of Radiotherapy, CHR Orléans, Orléans, France
| | - L Vaillant
- Department of Dermatology, CHRU Tours, Tours, France.,Inserm U930, Université François-Rabelais de Tours, Tours, France
| | - F Patat
- Inserm U930, Université François-Rabelais de Tours, Tours, France
| | - G Bens
- Department of Dermatology, CHR Orléans, Orléans, France
| | - L Machet
- Department of Dermatology, CHRU Tours, Tours, France.,Inserm U930, Université François-Rabelais de Tours, Tours, France
| |
Collapse
|