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Ramelyte E, Welti M, Gardin F, Maul JT, Dummer R, Imhof L. Post-Excision Soft X-Ray Radiotherapy for Keloids: Experience in a Tertiary Referral Center. Dermatology 2024; 240:572-580. [PMID: 38897192 PMCID: PMC11309064 DOI: 10.1159/000539782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 06/02/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Keloid is an abnormal proliferation of scar tissue that grows beyond the original margins of the injury. Even after complete resection, recurrences are common and pose a poorly understood challenge in dermatology. There is lack of large prospective clinical trials; thus, treatment recommendations are based on retrospective analyses and small cohort studies. Superficial radiotherapy is recommended in recurrent keloids; however, the successful treatment rates vary greatly. The aim of this study was to evaluate the keloid recurrence rate after post-excision soft X-ray radiotherapy and the associated factors. METHODS We reviewed retrospective data of all patients, treated with adjuvant post-excision soft X-ray radiotherapy with 12 Gy in 6 sessions at the tertiary referral center, Department of Dermatology, University Hospital Zurich, Switzerland, between 2005 and 2018. We analyzed individual keloids as separate cases. Successful treatment was defined as no sign of recurrence within 2 years. RESULTS Of the 200 identified patients, 90 met the inclusion criteria and were included in the final analysis. In 90 patients, 104 cases of treated keloids were analyzed. Keloids were mainly located on the trunk (49%) and were mostly caused by previous surgery (52.2%). 50% of the keloids did not relapse within 2 years after therapy. A significant factor leading to recurrence was the presence of previous therapy, with prior topical therapies, such as steroid injections or 5-fluorouracil, leading to most relapses. 69.2% of keloid cases who relapsed were pretreated. Soft X-ray radiotherapy was well tolerated, with posttreatment hyperpigmentation noted in 34% of patients, particularly in patients with non-Caucasian origin (61.3%). CONCLUSION Treatment of refractory keloids is difficult. Post-excision radiotherapy is an established adjuvant treatment option; nevertheless, recurrence rates are high, especially in pretreated keloids. Prospective studies determining the exact dosage and fraction of post-excisional radiotherapy are needed to determine the optimal radiation parameters.
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Affiliation(s)
- Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Michèle Welti
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Fabian Gardin
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
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Li Q, Feng S, Yu Z, Wang Y, Tian L, Geng H, Guo C, Ning F, Luo J, Liu C. Amelioration of Acute Radiation Dermatitis in Breast Cancer Patients by a Bioadhesive Barrier-Forming Gel (Episil): A Single-Center, Open, Parallel, Randomized, Phase I/II Controlled Trial. Clin Pharmacol Ther 2024; 115:1085-1091. [PMID: 38159264 DOI: 10.1002/cpt.3171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
Episil is a bioadhesive barrier-forming liquid gel that can relieve mucositis caused by radiotherapy (RT) and effectively relieve pain. The purpose of this trial is to compare the efficacy and safety of Episil in improving acute radiation dermatitis (ARD) in patients with breast cancer. This study included patients who met the criteria for postoperative RT for breast cancer. The primary end point was the grade of RD during treatment. A total of 102 patients were included in this study. The patients were grouped in a 2:1 ratio using the randomized number table method: 67 patients received Episil combined with conventional skin care (the Episil group), whereas the remaining 35 patients served as the control group and received conventional skin care only (the control group). According to the grading criteria of the Radiation Therapy Oncology Group (RTOG), the skin reaction rate and severity were significantly better in the Episil group than the control group (24.62%, 72.31%, 3.08, 0, 0 vs. 0, 85.71%, 14.29%, 0, 0, 0) across grades 0 to 4 (P < 0.05). The itchiness score exhibited s significant reduction in the Episil group as compared with the control group (P < 0.05). The results of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) showed that the overall health (z = -5.855, P < 0.001) and overall quality of life (z = -6.583, P < 0.001) were better in the Episil group than the control group after RT. Overall, in patients with breast cancer receiving RT, the topical application of Episil may significantly reduce the grading of ARD, alleviate patient symptoms, and improve the patient's overall quality of life.
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Affiliation(s)
- Qian Li
- Binzhou Medical University, Binzhou, Shandong, China
| | - Shanhui Feng
- Binzhou Medical University, Binzhou, Shandong, China
| | - Zeshun Yu
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Yue Wang
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Lijun Tian
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Haitao Geng
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Chen Guo
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Fangling Ning
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
| | - Judong Luo
- Tongji Hospital of Tongji University School of Medicine, Shanghai, China
| | - Changmin Liu
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, China
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Layer JP, Layer K, Glasmacher AR, Sarria GR, Böhner AMC, Layer YL, Dejonckheere CS, Wiegreffe S, Nour Y, Caglayan L, Grau F, Feyer P, Baumert BG, Baumann R, Krug D, Scafa D, Leitzen C, Landsberg J, Giordano FA, Schmeel LC. Pharmaceutical management of acute radiation dermatitis in the German speaking radiation oncology community. J Dtsch Dermatol Ges 2024; 22:198-207. [PMID: 38092687 DOI: 10.1111/ddg.15279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/20/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Radiation dermatitis (RD) remains the most common side effect in radiation therapy (RT) with various pharmaceutical options available for prevention and treatment. We sought to determine pharmaceutical management patterns of radiation dermatitis among radiation oncology professionals. METHODS We conducted a survey on RD among the German-speaking community of radiation oncologists inquiring for their opinion on preventive and therapeutic pharmaceutical approaches for acute RD. RESULTS 244 health professionals participated. Dexpanthenol lotion is the agent most widely used both for prevention (53.0%) and treatment (76.9%) of RD, followed by urea (29.8%) for prevention and corticosteroids (46.9%) for treatment. A wide range of substances is used by participants, though the overall experience with them is rather limited. 32.5% of participants do generally not recommend any preventative treatment. 53.4% of participants recommend alternative medicine for RD management. While seldomly used, corticosteroids were considered most effective in RD therapy, followed by dexpanthenol and low-level laser therapy. A majority of participants prefers moist over dry treatment of moist desquamation and 43.8% prescribe antiseptics. CONCLUSIONS Pharmaceutical management of RD in the German-speaking radiation oncology community remains controversial, inconsistent, and partially not supported by evidence-based medicine. Stronger evidence level and interdisciplinary consensus is required amongst practitioners to improve these care patterns.
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Affiliation(s)
- Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Andrea R Glasmacher
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Alexander M C Böhner
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Yonah L Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Shari Wiegreffe
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Youness Nour
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Lara Caglayan
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Franziska Grau
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Petra Feyer
- Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - René Baumann
- Department of Radiation Oncology, St. Marien Hospital Siegen, Siegen, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Jennifer Landsberg
- Department of Dermatology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
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Layer JP, Layer K, Glasmacher AR, Sarria GR, Böhner AMC, Layer YL, Dejonckheere CS, Wiegreffe S, Nour Y, Caglayan L, Grau F, Feyer P, Baumert BG, Baumann R, Krug D, Scafa D, Leitzen C, Landsberg J, Giordano FA, Schmeel LC. Pharmazeutische Behandlung der akuten Radiodermatitis in der deutschsprachigen strahlentherapeutischen Gemeinschaft: Pharmaceutical management of acute radiation dermatitis in the German speaking radiation oncology community. J Dtsch Dermatol Ges 2024; 22:198-209. [PMID: 38361198 DOI: 10.1111/ddg.15279_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/20/2023] [Indexed: 02/17/2024]
Abstract
ZusammenfassungHintergrundDie Radiodermatitis (RD) ist die häufigste Nebenwirkung der Strahlentherapie (RT), wobei verschiedene pharmazeutische Optionen zur Vorbeugung/Behandlung zur Verfügung stehen. Unser Ziel war, die pharmazeutischen Behandlungsmuster für die RD unter strahlentherapeutischen Fachleuten zu ermitteln.MethodikWir haben eine Umfrage zum Thema RD in der deutschsprachigen radioonkologischen Gemeinschaft durchgeführt und ihre Meinung zu präventiven und therapeutischen pharmazeutischen Therapieansätzen betreffend die akute RD erfragt.Ergebnisse244 Angehörige zugehöriger Gesundheitsberufe nahmen teil. Dexpanthenol‐Lotion ist das am häufigsten verwendete Mittel sowohl zur Vorbeugung (53%) als auch zur Behandlung (76,9%) der RD, gefolgt von Harnstoff (29,8%) zur Vorbeugung und Kortikosteroiden (46,9%) zur Behandlung. Die Teilnehmer verwenden eine breite Palette an Substanzen, haben aber insgesamt wenig Erfahrung mit diesen. 32,5% der Teilnehmer empfehlen generell keine präventive Behandlung. 53,4% der Teilnehmer empfehlen Alternativmedizin. Obwohl selten eingesetzt, wurden Kortikosteroide als wirksamstes Behandlungsmittel angesehen, gefolgt von Dexpanthenol und Low‐Level‐Lasertherapie. Die Mehrheit der Teilnehmer bevorzugt die feuchte gegenüber der trockenen Behandlung der feuchten Desquamation und 43,8% verschreiben Antiseptika.SchlussfolgerungenDie pharmazeutische Behandlung der RD in der deutschsprachigen strahlentherapeutischen Fachwelt ist nach wie vor umstritten, sowie mitunter inkonsistent und nicht durch evidenzbasierte Medizin gestützt. Ein interdisziplinärer Konsens ist erforderlich, um die bestehenden Behandlungskonzepte zu verbessern.
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Affiliation(s)
- Julian P Layer
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
- Institut für Experimentelle Onkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Katharina Layer
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Andrea R Glasmacher
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Gustavo R Sarria
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Alexander M C Böhner
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Yonah L Layer
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Cas S Dejonckheere
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Shari Wiegreffe
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Youness Nour
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Lara Caglayan
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Franziska Grau
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Petra Feyer
- Abteilung für Strahlenonkologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | | | - René Baumann
- Abteilung für Strahlenonkologie, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - David Krug
- Abteilung für Strahlenonkologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Davide Scafa
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Christina Leitzen
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Jennifer Landsberg
- Abteilung für Dermatologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
| | - Frank A Giordano
- Abteilung für Strahlenonkologie, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland
- DKFZ Hector Cancer Institute am Universitätsklinikum Mannheim, Mannheim, Germany
| | - Leonard Christopher Schmeel
- Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Bonn, Universität Bonn, Bonn, Deutschland
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Jimenez-Garcia C, Perula-de Torres LA, Villegas-Becerril E, Muñoz-Gavilan JJ, Espinosa-Calvo M, Montes-Redondo G, Romero-Rodriguez E. Efficacy of an aloe vera, chamomile, and thyme cosmetic cream for the prophylaxis and treatment of mild dermatitis induced by radiation therapy in breast cancer patients: a controlled clinical trial (Alantel Trials). Trials 2024; 25:84. [PMID: 38273379 PMCID: PMC10809581 DOI: 10.1186/s13063-024-07901-8] [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: 03/28/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Dermatitis is a skin condition caused by multiple causes, including radiotherapy treatment. Pharmacological treatments can become chronic and are not exempt from side effects. The latest recommendations of the American Academy of Dermatology establish the use of natural, nourishing, and moisturizing cosmetic products as prevention and the first therapeutic step for dermatitis. Alantel® is a cream developed to reduce redness and irritation, promote the local immune system, combat immunosenescence, and promote the healing of epidermal lesions. The objective was to evaluate the effect of a cream (Alantel) based on natural products at high concentrations for the preventive and curative treatment (at early stages) of radiation-induced dermatitis in patients with breast cancer. METHODS Our protocol is an experimental, prospective, triple-blind, multicenter, controlled clinical trial with two parallel arms. The experimental group will be treated with Alantel, while the control group will receive another moisturizing cream. Radiotherapy oncology professionals will recruit a total of 88 patients (44 per comparison group) with breast cancer who will receive radiotherapy oncology treatment for 15 days, and they will be randomly allocated to the experimental or control group. Selected patients will be followed up for four visits by primary care physicians for up to 1 week after completion of radiotherapy. The main study variable will be the incidence rate of mild post-radiation dermatitis. An intention-to-treat analysis will be performed, applying a comparison test for independent means and proportions. A bivariate and multivariate analysis will also be developed to check the treatment effect, adjusting for predictive sociodemographic and clinical variables. DISCUSSION By carrying out this clinical trial, it is expected to verify that Alantel cream, based on natural products at high concentrations, has advantages over a moisturizing cream for the preventive and curative treatment of RD in patients with breast cancer. The COVID-19 pandemic has been influenced by delaying the start of the study. One of the main limitations of this study will be the time required to recruit the patients from the planned sample, given that the selection criteria are restrictive and, although the study is multicenter, recruitment will be coordinated through a single service on radiotherapy oncology. TRIAL REGISTRATION ClinicalTrials.gov NCT04116151 . Registered on 4 October 2019.
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Affiliation(s)
- Celia Jimenez-Garcia
- Epidemiology Service, Cordoba-Guadalquivir Health District, Cordoba, Spain
- Maimonides Institute for Biomedical Research (IMIBIC)/Hospital Reina Sofia/Universidad de Cordoba, Cordoba, Spain
| | - Luis Angel Perula-de Torres
- Maimonides Institute for Biomedical Research (IMIBIC)/Hospital Reina Sofia/Universidad de Cordoba, Cordoba, Spain.
| | - Enrique Villegas-Becerril
- Maimonides Institute for Biomedical Research (IMIBIC)/Hospital Reina Sofia/Universidad de Cordoba, Cordoba, Spain
- Maser Clinic, Maimonides Institute for Biomedical Research (IMIBIC), Cordoba, Spain
| | | | | | - Gertrudis Montes-Redondo
- Maimonides Institute for Biomedical Research (IMIBIC)/Hospital Reina Sofia/Universidad de Cordoba, Cordoba, Spain
- Santa Rosa Health Center, Cordoba-Guadalquivir Health District, Cordoba, Spain
| | - Esperanza Romero-Rodriguez
- Maimonides Institute for Biomedical Research (IMIBIC)/Hospital Reina Sofia/Universidad de Cordoba, Cordoba, Spain
- Carlos Castilla del Pino Health Center, Cordoba-Guadalquivir Health District, Cordoba, Spain
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Zhang Y, Yan T, Mo W, Song B, Zhang Y, Geng F, Hu Z, Yu D, Zhang S. Altered bile acid metabolism in skin tissues in response to ionizing radiation: deoxycholic acid (DCA) as a novel treatment for radiogenic skin injury. Int J Radiat Biol 2023; 100:87-98. [PMID: 37540505 DOI: 10.1080/09553002.2023.2245461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 07/19/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Radiogenic skin injury (RSI) is a common complication during cancer radiotherapy or accidental exposure to radiation. The aim of this study is to investigate the metabolism of bile acids (BAs) and their derivatives during RSI. METHODS Rat skin tissues were irradiated by an X-ray linear accelerator. The quantification of BAs and their derivatives were performed by liquid chromatography-mass spectrometry (LC-MS)-based quantitative analysis. Key enzymes in BA biosynthesis were analyzed from single-cell RNA sequencing (scRNA-Seq) data of RSI in the human patient and animal models. The in vivo radioprotective effect of deoxycholic acid (DCA) was detected in irradiated SD rats. RESULTS Twelve BA metabolites showed significant differences during the progression of RSI. Among them, the levels of cholic acid (CA), DCA, muricholic acid (MCA), chenodeoxycholic acid (CDCA), glycocholic acid (GCA), glycohyodeoxycholic acid (GHCA), 12-ketolithocholic acid (12-ketoLCA) and ursodeoxycholic acid (UDCA) were significantly elevated in irradiated skin, whereas lithocholic acid (LCA), tauro-β-muricholic acid (Tβ-MCA) and taurocholic acid (TCA) were significantly decreased. Additionally, the results of scRNA-Seq indicated that genes involved in 7a-hydroxylation process, the first step in BA synthesis, showed pronounced alterations in skin fibroblasts or keratinocytes. The alternative pathway of BA synthesis is more actively altered than the classical pathway after ionizing radiation. In the model of rat radiogenic skin damage, DCA promoted wound healing and attenuated epidermal hyperplasia. CONCLUSIONS Ionizing radiation modulates the metabolism of BAs. DCA is a prospective therapeutic agent for the treatment of RSI.
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Affiliation(s)
- Yining Zhang
- Department of Radiation Medicine, Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Tao Yan
- Department of Radiation Medicine, Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Wei Mo
- School of Radiation Medicine and Protection, State Key Laboratory of Radiation Medicine, Soochow University, Suzhou, China
| | - Bin Song
- Department of Radiation Medicine, Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Yuehua Zhang
- Department of Radiation Medicine, Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Fenghao Geng
- Department of Radiation Medicine, Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Zhimin Hu
- Key Laboratory of Radiation Physics and Technology of Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, China
| | - Daojiang Yu
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Shuyu Zhang
- Department of Radiation Medicine, Laboratory of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
- School of Radiation Medicine and Protection, State Key Laboratory of Radiation Medicine, Soochow University, Suzhou, China
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, Mianyang, China
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Hao Y, Li H, Guo J, Wang D, Zhang J, Liu J, Yang C, Zhang Y, Li G, Liu J. Bio-Inspired Antioxidant Heparin-Mimetic Peptide Hydrogel for Radiation-Induced Skin Injury Repair. Adv Healthc Mater 2023; 12:e2203387. [PMID: 36934301 DOI: 10.1002/adhm.202203387] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/23/2023] [Indexed: 03/20/2023]
Abstract
Radiotherapy is one of the most important means of cancer treatment, however, radiation can also cause adverse reactions and even serious injuries to the skin. Radiation-induced excess reactive oxygen species (ROS) production and inflammatory infiltration make skin wounds difficult to heal compared to normal skin injuries. Herein, an antioxidant heparin-mimetic peptide hydrogel (K16, KYKYEYEYAGEGDSS-4Sa) is designed for radiation-induced skin injury (RISI) repair. First, the K16 peptide can self-assemble into a hydrogel with a 3D mesh-like porous nanofiber structure, which can provide certain physical support for skin repair like extracellular matrix (ECM). Then, K16 hydrogel not only scavenges ROS and prevents radiation damage to cellular DNA, but also promotes cell proliferation, migration, and angiogenesis. Meanwhile, 4-sulfobenzoic acid (4Sa) modified at the N-terminal end of the K16 peptide can adsorb inflammatory cytokines, thus acting to eliminate inflammation at the wound site. In vivo experiments showed that K16 hydrogel can inhibit early wound degradation, reduce inflammatory infiltration, and promote angiogenesis and collagen deposition, thus promoting wound healing. Therefore, the K16 hydrogel designed in this study has good potential for application in the field of radiation-induced skin injury repair.
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Affiliation(s)
- Yusen Hao
- Lab of Functional and Biomedical Nanomaterials, College of Materials Science and Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
| | - Hui Li
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, P. R. China
| | - Jiajun Guo
- Lab of Functional and Biomedical Nanomaterials, College of Materials Science and Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
| | - Dan Wang
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, P. R. China
| | - Jiamin Zhang
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, P. R. China
| | - Jinjian Liu
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, P. R. China
| | - Cuihong Yang
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, P. R. China
| | - Yumin Zhang
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, P. R. China
| | - Guoliang Li
- Lab of Functional and Biomedical Nanomaterials, College of Materials Science and Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
| | - Jianfeng Liu
- Lab of Functional and Biomedical Nanomaterials, College of Materials Science and Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, P. R. China
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8
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Simman R, Bach K, Abbas F, Klomparens K, Brickman BJ. Management of Radiation-induced Tissue Injuries: A Review of Current Treatment Strategies. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5043. [PMID: 37456134 PMCID: PMC10348732 DOI: 10.1097/gox.0000000000005043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 04/10/2023] [Indexed: 07/18/2023]
Abstract
Although radiation therapy remains an integral component in cancer treatment, the sequela of tissue damage can result in long-term morbidity and mortality for patients. This article aimed to perform a comprehensive review of the current literature for both nonsurgical and surgical management strategies for radiation-induced injuries. Methods A literature search was performed on PubMed to review the current described management and treatment options for radiation-induced injuries. Patient demographics, medical diagnoses, complications, strategies of management care, and outcomes were reviewed. Results The most commonly described management options and reconstructive techniques of radiation wounds were analyzed and reported. Conclusions Consideration of current techniques and outcomes in the management of radiation-induced wounds demonstrates that impaired wound healing remains a major problem. This literature review provides a detailed overview of the most frequently used therapies with recommendations for surgeons.
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Affiliation(s)
- Richard Simman
- From the Department of Surgery, Jobst Vascular Institute, ProMedica Health Network, Toledo, Ohio
- Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Karen Bach
- Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Fuad Abbas
- Department of Surgery, Wayne State School of Medicine, Detroit, Mich
| | - Kara Klomparens
- Department of Surgery, Wayne State School of Medicine, Detroit, Mich
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9
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Queiroz Schmidt FM, Serna González CV, Mattar RC, Lopes LB, dos Santos MF, Santos VLCDG. Topical application of a cream containing nanoparticles with vitamin E for radiodermatitis prevention in women with breast cancer: A randomized, triple-blind, controlled pilot trial study. Eur J Oncol Nurs 2022; 61:102230. [DOI: 10.1016/j.ejon.2022.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/04/2022]
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10
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Teng X, Zhang X, Zhi X, Chen Y, Xu D, Meng A, Zhu Y. Risk factors of dermatitis during radiation for vulvar carcinoma. PRECISION MEDICAL SCIENCES 2022. [DOI: 10.1002/prm2.12077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Xue Teng
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Xian Zhang
- Department of Radiation Oncology The Affiliated Hospital of Xuzhou Medical University Xuzhou China
| | - Xiaoxu Zhi
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Yan Chen
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Dejing Xu
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Aifeng Meng
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Ying Zhu
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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11
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Deep learning-based automatic assessment of radiation dermatitis in nasopharyngeal carcinoma (NPC) patients. Int J Radiat Oncol Biol Phys 2022; 113:685-694. [PMID: 35304306 DOI: 10.1016/j.ijrobp.2022.03.011] [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: 08/07/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Radiation dermatitis (RD) is a common, unpleasant side-effect of patients receiving radiotherapy. In clinical practice, the severity of RD is graded manually through visual inspection, which is labor-intensive and often leads to large inter-rater variations. To overcome these shortcomings, this study aims to develop an automatic RD assessment based on deep learning (DL) techniques, which could efficiently assist the RD severity classification in clinical application. METHODS A total of 1205 photographs of the head and neck region were collected from nasopharyngeal carcinoma (NPC) patients undergoing radiotherapy. The severity of RD in these photographs was graded by five qualified assessors based on the Radiation Therapy Oncology Group (RTOG) guidance. An end-to-end RD grading framework was developed by combining a DL-based segmentation network and a DL-based RD severity classifier, which are used for segmenting the neck region from the camera-captured photographs and grading, respectively. U-Net was used for segmentation and another convolutional neural network (CNN) classifier (DenseNet-121) was applied to RD severity classification. Dice Similarity Coefficient (DSC) was used to evaluate the performance of segmentation. Severity classification was evaluated by several metrics, including overall accuracy, precision, recall, and F1-score. RESULTS Results of segmentation showed that the averaged DSCs were 91.2% and 90.8% for front and side view, respectively. For RD severity classification, the overall accuracy of test photographs was 83.0%. Our method accurately classified 90.5% of Grade 0, 67.2% of Grade 1, 93.8% of Grade 2, and 100% of Above Grade 2 cases. The overall prediction performance was comparable with human assessors. There was no significant difference in accuracy when using manually or automatically segmented regions (p = 0.683). CONCLUSION We have successfully demonstrated a DL-based method for automatic assessment of RD severity in NPC patients. This method holds great potential for efficient and effective assessing and monitoring of RD in NPC patients.
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12
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Schmidt FMQ, González CVS, Mattar RC, Lopes LB, Dos Santos MF, de Gouveia Santos VLC. Topical cream containing nanoparticles with vitamin E to prevent radiodermatitis in women with breast cancer: a clinical trial protocol. J Wound Care 2021; 30:S44-S50. [PMID: 34120463 DOI: 10.12968/jowc.2021.30.sup6.s44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Little is known about the efficacy of products aiming to prevent radiodermatitis, which affects between 90-95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidenceon their effectiveness. Here, the authors present a clinical trial protocol to evaluate the effects of applying a cream containing nanoparticles with vitamin E to prevent radiodermatitis in patients with breast cancer. METHOD The protocol recommends that 108 women with breast cancer, receiving radiotherapy, are included in this triple-blinded, randomized, controlled study at an oncology hospital. Patients will be divided in three groups of 36 individuals each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will receive a cream without nanoparticles nor vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree, and time of onset of radiodermatitis. The secondary endpoints will focus on the quality of life, symptoms, and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved and registered on an international trials database.
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Affiliation(s)
| | | | | | | | - Marinilce Fagundes Dos Santos
- Cell Biology and Development Department. 4-5 Universidade de São Paulo, Instituto de Ciências Biomédicas (ICB-USP), Sao Pablo, Brazil
| | - Vera L C de Gouveia Santos
- Department of Medial-Surgical Nursing. 2-6 Universidade de São Paulo, Escola de Enfermagem (EEUSP), Sao Paulo, Brazil
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13
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Xie J, Zhao M, Wang C, Yong Y, Gu Z, Zhao Y. Rational Design of Nanomaterials for Various Radiation-Induced Diseases Prevention and Treatment. Adv Healthc Mater 2021; 10:e2001615. [PMID: 33506624 DOI: 10.1002/adhm.202001615] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/05/2020] [Indexed: 12/17/2022]
Abstract
Radiation treatments often unfavorably damage neighboring healthy organs and cause a series of radiation sequelae, such as radiation-induced hematopoietic system diseases, radiation-induced gastrointestinal diseases, radiation-induced lung diseases, and radiation-induced skin diseases. Recently, emerging nanomaterials have exhibited good superiority for these radiation-induced disease treatments. Given this background, the rational design principle of nanomaterials, which helps to optimize the therapeutic efficiency, has been an increasing need. Consequently, it is of great significance to perform a systematic summarization of the advances in this field, which can trigger the development of new high-performance nanoradioprotectors with drug efficiency maximization. Herein, this review highlights the advances and perspectives in the rational design of nanomaterials for preventing and treating various common radiation-induced diseases. Furthermore, the sources, clinical symptoms, and pathogenesis/injury mechanisms of these radiation-induced diseases will also be introduced. Furthermore, current challenges and directions for future efforts in this field are also discussed.
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Affiliation(s)
- Jiani Xie
- School of Food and Biological Engineering Chengdu University Chengdu 610106 China
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety Institute of High Energy Physics Chinese Academy of Sciences Beijing 100049 China
| | - Maoru Zhao
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety Institute of High Energy Physics Chinese Academy of Sciences Beijing 100049 China
- Center of Materials Science and Optoelectronics Engineering College of Materials Science and Optoelectronic Technology University of Chinese Academy of Sciences Beijing 100049 China
| | - Chengyan Wang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety Institute of High Energy Physics Chinese Academy of Sciences Beijing 100049 China
- Center of Materials Science and Optoelectronics Engineering College of Materials Science and Optoelectronic Technology University of Chinese Academy of Sciences Beijing 100049 China
| | - Yuan Yong
- College of Chemistry and Environment Protection Engineering Southwest Minzu University Chengdu 610041 China
| | - Zhanjun Gu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety Institute of High Energy Physics Chinese Academy of Sciences Beijing 100049 China
- Center of Materials Science and Optoelectronics Engineering College of Materials Science and Optoelectronic Technology University of Chinese Academy of Sciences Beijing 100049 China
- GBA Research Innovation Institute for Nanotechnology Guangdong 510700 China
| | - Yuliang Zhao
- Center of Materials Science and Optoelectronics Engineering College of Materials Science and Optoelectronic Technology University of Chinese Academy of Sciences Beijing 100049 China
- GBA Research Innovation Institute for Nanotechnology Guangdong 510700 China
- CAS Center for Excellence in Nanoscience National Center for Nanoscience and Technology of China Chinese Academy of Sciences Beijing 100190 China
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14
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Radiation dermatitis: the evaluation of a new topical therapy for the treatment and prevention of radiation-induced skin damage and moist desquamation: a multicentre UK case cohort study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:Radiotherapy is a mainstay of cancer therapy for a wide variety of anatomical areas. An unfortunate side effect of treatment can be radiation damage to the skin which can be a painful and debilitating problem. Previous experience from the experimental use of Flamigel® in two large-scale clinical studies on affected skin has proven sufficiently positive for the addition of a new product in the Flamigel® family (now commercially available in the UK as Flamigel RT®, Flen Health UK). The aim of this investigation is to evaluate the use of this new product to study how effective it is in the prevention and/or treatment of radiation-induced skin damage.Materials and methods:A survey was conducted among radiotherapy specialist teams in dedicated UK radiotherapy centres between 1 January 2017 and 31 October 2017. This report is of a preliminary evaluation conducted by UK-based specialists on 108 patients undergoing radiotherapy. The scoring system for skin reactions of the ‘Radiation Therapy Oncology Group’ was used.Results:Results show that the use of Flamigel® has the potential to soothe (p = 0·0001), reduce pain (p = 0·0001) and reduce pruritus (p = 0·004). The product met the expectations of the clinicians involved (p < 0·0001) of whom most were happy to continue use or to recommend its use to colleagues (p < 0·0001).Conclusions:Flamigel® is an effective treatment in the management of radiation-induced skin reactions. Erythema was unchanged through the study period (p = 0·42). No adverse reactions were reported after the use of Flamigel from twice to six times a day.
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15
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Liao Y, Wang D, Gu Z. Research Progress of Nanomaterials for Radioprotection. ACTA CHIMICA SINICA 2021. [DOI: 10.6023/a21070319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Yi Y, You X, Long Y, Huang Y. Efficacy of different plant extracts in the prevention of radiation dermatitis in radiotherapy patients with nasopharyngeal carcinoma: A protocol for a Bayesian network meta-analysis. Medicine (Baltimore) 2020; 99:e23523. [PMID: 33371074 PMCID: PMC7748178 DOI: 10.1097/md.0000000000023523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Radiation dermatitis is a common complication in patients with nasopharyngeal carcinoma (NPC) when treated with radiotherapy. Plant extracts have good effects on the prevention of radiation dermatitis in patients with NPC when treated with radiotherapy. However, there is insufficient comparison among the currently used plant extracts. Therefore, the purpose of this study was to explore the efficacy of different plant extracts in the prevention of radiation dermatitis in patients with NPC by Bayesian network meta-analysis. METHODS We searched Chinese and English databases to collect all randomized controlled trials (RCT) of plant extracts for the prevention of radiation dermatitis in NPC patients who underwent radiotherapy up to October 2020. Two researchers then independently screened articles, extracted data and evaluated the quality selected literatures. All data were processed by Stata 14.0 and WinBUGS V.1.4.3. RESULTS We applied Bayesian statistical model for network meta-analysis, ranked the effects of various plant extracts, and adopted GRADE method to explain the results. CONCLUSION Our study is expected to provide high-quality evidence-based medicine advice for the prevention of radiation dermatitis in patients suffering from NPC undergoing radiotherapy. ETHICS AND DISSEMINATION Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and will be shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/6SV45.
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Affiliation(s)
- Yi Yi
- Department of Otolaryngology, The Second Branch of Chongqing Ninth People's Hospital
| | - Xingli You
- Department of Medical Insurance, Chongqing Fifth People's Hospital
| | - Ying Long
- Department of Medical Insurance, Chongqing Fifth People's Hospital
| | - Ya Huang
- Department of Oncology, Chongqing Ninth People's Hospital, Chongqing, China
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17
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McQuestion M, Cashell A. A qualitative descriptive study of patients' experiences of a radiation skin reaction associated with treatment for a head and neck cancer. Can Oncol Nurs J 2020; 30:287-292. [PMID: 33165369 DOI: 10.5737/23688076304287292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The majority of patients receiving radiation therapy will experience a radiation skin reaction, ranging from mild erythema to severe moist desquamation. The anticipated skin reaction will vary by cancer diagnosis, dose of radiation, size of treatment field, and other treatment-and patient-related factors. Recently, research has dispelled long-held myths about avoiding skin care products prior to treatment, and the use of deodorant or antiperspirant during treatment for breast cancer and any potential for an increased skin dose with the use of skin care products. Patients no longer are restricted in using these products. Most of the research regarding skin reactions due to radiation has been conducted with women with breast cancer. No research has been found on the experience of a radiation skin reaction in patients with head and neck cancer (HNC), who often get the most severe skin reactions across all patient groups. Using the qualitative interpretive descriptive approach based on the methodological work by Thorne (1997), nine participants were interviewed about their experience of having a radiation skin reaction resulting from their treatment for HNC. Three themes emerged from the interviews, including 1) the symptom experience, 2) comparison to others, and 3) the experience of support and information. Implications include recommendations for practice and patient education.
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18
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McQuestion M, Cashell A. Étude qualitative descriptive sur l’expérience des patients avec réactions cutanées induites par la radiothérapie pour un cancer de la tête et du cou. Can Oncol Nurs J 2020; 30:293-299. [PMID: 33165391 DOI: 10.5737/23688076304293299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
La majorité des patients recevant de la radiothérapie auront une réaction cutanée radio-induite allant d’un érythème léger à une desquamation humide étendue. Les réactions cutanées attendues varieront en fonction du diagnostic de cancer, de la dose et de la taille du champ d’irradiation ainsi que d’autres facteurs liés au traitement et au patient. Récemment, la recherche a dissipé les mythes longtemps entretenus sur les produits pour le soin de la peau qui auraient été à éviter avant le traitement, tout comme le déodorant et l’antisudorifique durant les traitements contre le cancer du sein (on craignait une surdose accrue pour la peau causée par l’utilisation de ces produits). Cette limitation a été levée. Or, la plupart des recherches sur les réactions cutanées radio-induites ont été menées auprès de femmes atteintes d’un cancer du sein; aucune n’a été trouvée sur les patients atteints de cancer de la tête et du cou, alors que de tous les groupes de patients, ce sont très souvent ceux-ci qui présentent les réactions cutanées les plus graves. Nous avons fait appel à la méthode descriptive interprétative qualitative basée sur le travail méthodologique de Thorne (1997) pour interroger neuf participants sur leurs réactions cutanées par suite de radiations pour leur cancer de la tête et du cou. Trois thèmes sont ressortis des entretiens : 1) l’expérience des symptômes; 2) la comparaison avec d’autres; 3) l’expérience du soutien et de l’information. Les implications comprennent des recommandations pour la pratique et l’éducation des patients.
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19
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Iacovelli NA, Torrente Y, Ciuffreda A, Guardamagna VA, Gentili M, Giacomelli L, Sacerdote P. Topical treatment of radiation-induced dermatitis: current issues and potential solutions. Drugs Context 2020; 9:dic-2020-4-7. [PMID: 32587626 PMCID: PMC7295106 DOI: 10.7573/dic.2020-4-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
Approximately 95% of patients receiving radiotherapy (RT) will ultimately develop radiation-induced dermatitis (RID) during or after the course of treatment, with major consequences on quality of life and treatment outcomes. This paper reviews the pathophysiology of RID and currently used topical products for the prevention and treatment of RID. Although there is no consensus on the appropriate management, recent evidence suggests that the use of topical products supports to protect and promote tissue repair in patients with RID. Basic recommendations include advice to wear loose clothing, using electric razors if necessary, and avoiding cosmetic products, sun exposure or extreme temperatures. Based on mechanisms involved and on the clinical characteristics of oncological patients, the profile of the ideal topical product for addressing RID can be designed; it should have limited risk of adverse events, systemic adsorption and drug–drug interactions, should be characterized by multiple clinical activities, with a special focus on localized pain, and should have a careful formulation as some vehicles can block the RT beam.
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Affiliation(s)
| | - Yvan Torrente
- Stem Cell Laboratory, Department of Pathophysiology and Transplantation, Universitá degli Studi di Milano, Milan, Italy.,Unit of Neurology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centro Dino Ferrari, Milan, Italy
| | - Adriana Ciuffreda
- Medico Chirurgo, Specialista in Dermatologia e Venereologia, Dermatologia Pediatrica, Milan, Italy
| | - Vittorio A Guardamagna
- Division of Palliative Care and Pain Therapy, IRCCS Istituto Europeo di Oncologia IEO, Milan, Italy.,Director of ESMO, Designated Center of Integrated Oncology and Palliative Care, Milan, Italy
| | | | - Luca Giacomelli
- Polistudium SRL, Milan, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Science, University of Milano, Milan, Italy
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20
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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.
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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
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21
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Schmidt FMQ, González CVS, Mattar RC, Lopes LB, Santos MFD, de Gouveia Santos VLC. Topical cream containing nanoparticles with vitamin E to prevent radiodermatitis in women with breast cancer: a clinical trial protocol. J Wound Care 2020; 29:18-26. [PMID: 33249985 DOI: 10.12968/jowc.2020.29.latam_sup_1.18.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Little is known about the efficacy of products aiming to prevent radiodermatitis, which affects between 90-95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidenceon their effectiveness. Here, the authors present a clinical trial protocol to evaluate the effects of applying a cream containing nanoparticles with vitamin E to prevent radiodermatitis in patients with breast cancer. METHOD The protocol recommends that 108 women with breast cancer, receiving radiotherapy, are included in this triple-blinded, randomized, controlled study at an oncology hospital. Patients will be divided in three groups of 36 individuals each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will receive a cream without nanoparticles nor vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree, and time of onset of radiodermatitis. The secondary endpoints will focus on the quality of life, symptoms, and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved and registered on an international trials database.
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Affiliation(s)
| | - Carol V Serna González
- Graduate Program in Adult Health Nursing, Universidade de São Paulo, Escola de Enfermagem (EEUSP), Sao Paulo, Brazil
| | | | - Luciana Biagini Lopes
- Pharmacology Department, Universidade de São Paulo, Instituto de Ciências Biomédicas (ICB-USP), Sao Pablo, Brazil
| | - Marinilce Fagundes Dos Santos
- Cell Biology and Development Department, Universidade de São Paulo, Instituto de Ciências Biomédicas (ICB-USP), Sao Pablo, Brazil
| | - Vera L C de Gouveia Santos
- Department of Medial-Surgical Nursing, Universidade de São Paulo, Escola de Enfermagem (EEUSP), Sao Paulo, Brazil
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22
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Schmidt FMQ, González CVS, Mattar RC, Lopes LB, Santos MFD, de Gouveia Santos VLC. Clinical protocol for the topical use of a cream with nanoparticles and vitamin E to prevent radiodermatitis in patients with breast cancer]. J Wound Care 2020; 29:18-26. [PMID: 31859604 DOI: 10.12968/jowc.2020.29.latam_sup_1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Sinopsis: Objetivo: Poco se conoce sobre la eficacia de productos para la prevención de radiodermatitis, que afecta al 90–95% de las mujeres con cáncer de mama. El uso de antioxidantes es promisorio, sin embargo, poco estudiado. Los autores desarrollaron un protocolo de ensayo clínico para evaluar el efecto potencial de la aplicación de crema con nanopartículas con vitamina E para prevenir radiodermatitis aguda en mujeres con cáncer de mama. Método: El protocolo sugiere que 108 mujeres adultas con cáncer de mama, que estén recibiendo radioterapia, sean incluidas en este ensayo clínico, controlado, aleatorizado y triple ciego, en un hospital oncológico. Se prevé la distribución de pacientes en tres grupos de 36 personas: el grupo A recibirá una crema con nanopartículas lipídicas con vitamina E, el grupo B obtendrá una crema sin nanopartículas ni vitamina E, y el grupo C usará una crema con nanopartículas sin vitamina E. Los resultados primarios evaluarán la incidencia, el grado y el tiempo de surgimiento de la radiodermatitis. Los resultados secundarios se centrarán en la calidad de vida, los síntomas y la temperatura local. Las pacientes serán evaluadas tres veces por semana, desde el inicio de la radioterapia hasta dos semanas después de la última sesión. El presente proyecto fue aprobado por el comité de ética en investigación de las instituciones involucradas.
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Affiliation(s)
- Fernanda Mateus Queiróz Schmidt
- 1Enfermera, estomaterapeuta, MSc, PhD, profesora doctora, Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais (IFSULDEMINAS), Pasos, Minas Gerais, Brasil
| | - Carol V Serna González
- 2Enfermera, estomaterapeuta, MSc, estudiante de PhD, Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA), Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Rodrigo Calixto Mattar
- 3Médico radioterapeuta, Hospital Regional de Câncer, Santa Casa de Misericórdia de Passos, Minas Gerais, Brasil
| | - Luciana Biagini Lopes
- 4Farmaceuta, MSc, PhD, profesora asociada, Departamento de Farmacología, Instituto de Ciências Biomédicas, Universidade de São Paulo, San Pablo, Brasil
| | - Marinilce Fagundes Dos Santos
- 5Odontóloga, MSc, PhD, profesora titular, Departamento de Biología Celular y del desarrollo, Instituto de Ciências Biomédicas, Universidade de São Paulo, San Pablo, Brasil
| | - Vera L C de Gouveia Santos
- 6Enfermera, estomaterapeuta, MSc, PhD, profesora titular, Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
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23
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Jacobson LK, Johnson MB, Dedhia RD, Niknam-Bienia S, Wong AK. Impaired wound healing after radiation therapy: A systematic review of pathogenesis and treatment. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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24
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Fernández-Castro M, Martín-Gil B, Peña-García I, López-Vallecillo M, García-Puig ME. Effectiveness of semi-permeable dressings to treat radiation-induced skin reactions. A systematic review. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28417508 DOI: 10.1111/ecc.12685] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
Abstract
The aim of this systematic review is to assess the available evidence concerning the effectiveness of semi-permeable dressings, on the full range of skin reactions, related to radiation therapy in cancer patients, from local erythema to moist desquamation, including subjective symptoms such as pain, discomfort, itchiness, burning and the effect on daily life activities. The bibliographic search was carried out looking for Randomised Clinical Trials (RCTs) indexed in PubMed, Cinhal, Cochrane plus and Biblioteca Nacional de Salud, published in the English and Spanish language, between 2010 and 2015. Data extraction and evaluation of study quality was undertaken by peer reviewers using the Critical Appraisal Skills Programme (CASP). Of 181 studies, nine full texts were assessed. Finally, six RCT were included in the final synthesis: three analysed the application of Mepilex® Lite in breast cancer and head & neck cancer; one evaluated the application of Mepitel® Film in breast cancer; and two assessed the use of silver nylon dressings in breast cancer and in patients with lower gastrointestinal cancer. The results show that semi-permeable dressings are beneficial in the management of skin toxicity related to radiation therapy. However, rigorous trials showing stronger evidence are needed.
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Affiliation(s)
- M Fernández-Castro
- Radiation Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,GACELA Care Management Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - B Martín-Gil
- Radiation Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - I Peña-García
- GACELA Care Management Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M López-Vallecillo
- GACELA Care Management Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Faculty of Nursing, University of Valladolid, Valladolid, Spain
| | - M E García-Puig
- Surrey and Sussex Healthcare NHS Trust, UK.,University of Valencia, Valencia, Spain
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25
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Laiakis EC, Pannkuk EL, Diaz-Rubio ME, Wang YW, Mak TD, Simbulan-Rosenthal CM, Brenner DJ, Fornace AJ. Implications of genotypic differences in the generation of a urinary metabolomics radiation signature. Mutat Res 2016; 788:41-9. [PMID: 27040378 PMCID: PMC4887295 DOI: 10.1016/j.mrfmmm.2016.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 03/04/2016] [Accepted: 03/24/2016] [Indexed: 02/04/2023]
Abstract
The increased threat of radiological terrorism and accidental nuclear exposures, together with increased usage of radiation-based medical procedures, has made necessary the development of minimally invasive methods for rapid identification of exposed individuals. Genetically predisposed radiosensitive individuals comprise a significant number of the population and require specialized attention and treatments after such events. Metabolomics, the assessment of the collective small molecule content in a given biofluid or tissue, has proven effective in the rapid identification of radiation biomarkers and metabolic perturbations. To investigate how the genotypic background may alter the ionizing radiation (IR) signature, we analyzed urine from Parp1(-/-) mice, as a model radiosensitive genotype, exposed to IR by utilizing the analytical power of liquid chromatography coupled with mass spectrometry (LC-MS), as urine has been thoroughly investigated in wild type (WT) mice in previous studies from our laboratory. Samples were collected at days one and three after irradiation, time points that are important for the early and efficient triage of exposed individuals. Time-dependent perturbations in metabolites were observed in the tricarboxylic acid pathway (TCA). Other differentially excreted metabolites included amino acids and metabolites associated with dysregulation of energy metabolism pathways. Time-dependent apoptotic pathway activation between WT and mutant mice following IR exposure may explain the altered excretion patterns, although the origin of the metabolites remains to be determined. This first metabolomics study in urine from radiation exposed genetic mutant animal models provides evidence that this technology can be used to dissect the effects of genotoxic agents on metabolism by assessing easily accessible biofluids and identify biomarkers of radiation exposure. Applications of metabolomics could be incorporated in the future to further elucidate the effects of IR on the metabolism of Parp1(-/-) genotype by assessing individual tissues.
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Affiliation(s)
- Evagelia C Laiakis
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington DC, USA.
| | - Evan L Pannkuk
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington DC, USA
| | - Maria Elena Diaz-Rubio
- Pediatrics, Division of Developmental Nutrition, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yi-Wen Wang
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington DC, USA
| | - Tytus D Mak
- Mass Spectrometry Data Center, National Institute of Standards and Technology (NIST), Gaithersburg MD, USA
| | | | | | - Albert J Fornace
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington DC, USA; Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA; Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah 22254, Saudi Arabia
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Abstract
Radiotherapy is a highly effective cancer treatment that not only offers cure but also excellent palliation of disease related symptoms and complications. Although radiotherapy is primarily an outpatient treatment, delivered within specialist centres, a diverse range of health professionals may be involved in the treatment pathway before, during and after treatment. Radiotherapy can, and does, make a significant contribution to improving a patient's wellbeing through effective symptom management. However, treatment-related side-effects do occur, with an acute skin reaction being one of the most common. It is imperative that radiotherapy-induced skin reactions are correctly assessed and appropriately managed in promoting patient comfort, treatment compliance and enhanced quality of life. This article describes how the use of a recognised assessment tool and evidence-based guidelines can facilitate consistent, high-quality care in the management of radiotherapy-induced skin reactions.
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Affiliation(s)
- Ellen Trueman
- Deputy Nurse Manager, Community and Day Services/Clinical Nurse Specialist Palliative Care, St Gemma's Hospice, Leeds, UK
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27
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Affiliation(s)
- Kàren Morgan
- Macmillan Consultant Radiographer, Taunton and Somerset Foundation Trust
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28
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Trueman E, Taylor L. Using a soft-silicone dressing to treat moist desquamation. ACTA ACUST UNITED AC 2014; 23:S32, S34-7. [DOI: 10.12968/bjon.2014.23.sup10.s32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ellen Trueman
- Senior Radiotherapy Sister, St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust
| | - Lesley Taylor
- Head and Neck and Neuro Oncology Clinical Nurse Specialist and Team Leader, Oncology Support Team, Ninewells Hospital, Dundee
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