Relationships between the changes of skin temperature and radiation skin injury

INFRARED THERMAL IMAGING CONTROL OF RADIATION DERMATITIS DYNAMICS

BACKGROUND

Radiation-induced dermatitis impairs the quality of life of cancer patients and may lead to the need of interrupting radiotherapy. The grade of dermatitis is subjectively assessed by the visual examination. There is an urgent need for both objective and quantitative methods for assessing the current grade of dermatitis and predicting its severity at an early stage of radiotherapy.

AIM

The aim of the study was to evaluate the advantages and limitations of infrared thermography for monitoring the current level of radiation-induced dermatitis and predicting its severity by quantitative analysis of the thermal field dynamics in the irradiated zone.

MATERIALS AND METHODS

30 adult patients were examined by infrared thermography during the course of 2D conventional radiotherapy for malignant tumors of various types and localizations. Our approach for quantifying the thermal field caused by dermatitis alone was applied. A statistical (correlation and ROC) analysis was performed.

RESULTS

Dermatitis of varying severity was observed in 100% of the patients studied. The dynamics in the intensity of the anomalous thermal fields in the irradiated zone correlated with the dynamics of dermatitis grades, excluding the case of a radiosensitive tumor (correlation coefficient 0.74÷0.84). It was found that the maximum toxicity (dermatitis grade ≥ 3) develops in patients who how significant hyperthermia in the area of interest (≥ 0.7 °C) at an early stage of radiotherapy. The ROC analysis demonstrated the "good quality" of the prognosis method (AUC = 0.871).

CONCLUSIONS

The non-invasive and cheap infrared thermography is a suitable tool for objective quantitative monitoring the current dermatitis grade during radiotherapy as well as predicting its severity for any tumor location.

Efficacy and safety of epigallocatechin-3-gallate in treatment acute severe dermatitis in patients with cancer receiving radiotherapy: a phase I clinical trial

To evaluate the safety and effectiveness of epigallocatechin-3-gallate (EGCG) solution treating the acute severe dermatitis in patients receiving radiotherapy. This phase I research enrolled patients with thoracic cancer receiving radiotherapy at Shandong Cancer Hospital and Institute in Shandong, China. EGCG solution was sprayed to the radiation field when grade III radiation-induced dermatitis (RID) first appearance. EGCG concentration escalated from 660 to 2574 μmol/L using modified-Fibonacci dose-escalation. RID and related symptoms were followed up every day. Between March 2021 and November 2021, 19 patients were enrolled in this phase I research. The median dose of grade III RID first observation was 44 Gy (30.6-52 Gy). As the EGCG treatment was performed continuously, all these grade III RID reactions were significantly decreased to grade I or grade II RID at three days after use of EGCG (p < 0.001). Significant relief can be observed in burning sensation (p < 0.001), tractive sensation (p < 0.001), tenderness (p < 0.001), erythema (p < 0.001), itching (p < 0.001) and pain (p < 0.001) after 15 days of EGCG treatment. No radiation therapy delay or interruption for all 19 patients. No adverse events were observed and reported associated with EGCG. The highest dose of this Phase I trial (2574 μmol/L) was recommended for continuous Phase II trial for further evaluation. In this phase I clinical research, use of EGCG solution is safe and can significantly relief grade III RID in patients receiving radiotherapy. Thus, EGCG might be a new choice for acute sever RID.Trial Registration: ClinicalTrials.gov Identifier: NCT02580279 (Full date of first registration: 12/2014).

Comparison of the Thermal Reaction of Patients after Conserving Procedures and after Mastectomy to the Radiation Dose Obtained during Radiotherapy

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.

The Use of Infrared Thermography in the Assessment of Thermal Reaction of Patients Treated with Radiotherapy after Breast-Conserving Procedures

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.

Efficacy of Epigallocatechin-3-Gallate in Preventing Dermatitis in Patients With Breast Cancer Receiving Postoperative Radiotherapy: A Double-Blind, Placebo-Controlled, Phase 2 Randomized Clinical Trial

Importance

Safe and effective prophylactic therapies for radiation-induced dermatitis (RID) remain an unmet need.

Objective

To determine if epigallocatechin-3-gallate (EGCG) solution reduces the incidence of RID in patients undergoing radiotherapy after breast cancer surgery.

Design, Setting, and Participants

This phase 2 double-blind, placebo-controlled randomized clinical trial enrolled 180 patients with breast cancer receiving postoperative radiotherapy at Shandong Cancer Hospital and Institute in Shandong, China, between November 2014 and June 2019. Data analysis was performed from September 2019 to January 2020.

Interventions

Participants were randomly assigned (2:1) to receive either EGCG solution (660 μmol/L) or placebo (0.9% NaCl saline) sprayed to the whole radiation field from day 1 of the radiation until 2 weeks after radiation completion.

Main Outcomes and Measures

The primary end point was incidence of grade 2 or worse RID, defined by the Radiation Therapy Oncology Group scale. The secondary end points included RID index (RIDI), symptom index, changes in the skin temperature measured by infrared thermal images, and safety.

Results

A total of 180 eligible patients were enrolled, of whom 165 (EGCG, n = 111; placebo, n = 54) were evaluable for efficacy (median [range] age, 46 [26-67] years). The occurrence of grade 2 or worse RID was significantly lower (50.5%; 95% CI, 41.2%-59.8%) in the EGCG group than in the placebo group (72.2%; 95% CI, 60.3%-84.1%) (P = .008). The mean RIDI in the EGCG group was significantly lower than that in the placebo group. Furthermore, symptom indexes were significantly lower in patients receiving EGCG. Four patients (3.6%) had adverse events related to the EGCG treatment, including grade 1 pricking skin sensation (3 [2.7%]) and pruritus (1 [0.9%]).

Conclusions and Relevance

In this randomized clinical trial, prophylactic use of EGCG solution significantly reduced the incidence and severity of RID in patients receiving adjuvant radiotherapy for breast cancer. It has the potential to become a new choice of skin care for patients receiving radiotherapy.

Trial Registration

ClinicalTrials.gov Identifier: NCT02580279.

Twelve-Month Evaluation of Temperature Effects of Radiotherapy in Patients after Mastectomy

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.

The Use of Thermal Imaging in the Evaluation of Temperature Effects of Radiotherapy in Patients after Mastectomy-First Study

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.

Opium poisoning following self-medication of radiation-induced dermatitis with topical use of opium latex traditional extract; a teaching case

Despite Radiation-induced dermatitis is a self-limiting complication, it can be complicated if inappropriate self-medications have been used such as opium latex traditional extract.