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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Layer JP, Fischer P, Dejonckheere CS, Sarria GR, Mispelbaum R, Hattenhauer T, Wiegreffe S, Glasmacher AR, Layer K, Nour Y, Caglayan L, Grau F, Müdder T, Köksal M, Scafa D, Giordano FA, Lopez-Pastorini A, Stoelben E, Schmeel LC, Leitzen C. Safety and efficacy of helical tomotherapy following lung-sparing surgery in locally advanced malignant pleural mesothelioma. Strahlenther Onkol 2023:10.1007/s00066-023-02174-7. [PMID: 37993554 DOI: 10.1007/s00066-023-02174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/22/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE To assess the value of radiation therapy (RT) with helical tomotherapy (HT) in the management of locally advanced malignant pleural mesothelioma (MPM) receiving no or lung-sparing surgery. METHODS Consecutive MPM cases not undergoing extrapleural pneumonectomy and receiving intensity-modulated (IM) HT were retrospectively evaluated for local control, distant control, progression-free survival (PFS), and overall survival (OS). Impact of age, systemic treatment, RT dose, and recurrence patterns was analyzed by univariate and multivariate analysis. As a secondary endpoint, reported toxicity was assessed. RESULTS A total of 34 localized MPM cases undergoing IMHT were identified, of which follow-up data were available for 31 patients. Grade 3 side effects were experienced by 26.7% of patients and there were no grade 4 or 5 events observed. Median PFS was 19 months. Median OS was 20 months and the rates for 1‑ and 2‑year OS were 86.2 and 41.4%, respectively. OS was significantly superior for patients receiving adjuvant chemotherapy (p = 0.008). CONCLUSION IMHT of locally advanced MPM after lung-sparing surgery is safe and feasible, resulting in satisfactory local control and survival. Adjuvant chemotherapy significantly improves OS. Randomized clinical trials incorporating modern RT techniques as a component of trimodal treatment are warranted to establish an evidence-based standard of care pattern for locally advanced MPM.
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Affiliation(s)
- Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany.
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany.
| | - Pascal Fischer
- Department of Thoracic Surgery, St. Hildegardis Hospital, Augustinerinnen Krankenhäuser gGmbH, Cologne, Germany
| | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Rebekka Mispelbaum
- Department of Oncology, Hematology, Rheumatology and Immune-Oncology, University Hospital Bonn, Bonn, Germany
| | - Tessa Hattenhauer
- Department of Oncology, Hematology, Rheumatology and Immune-Oncology, University Hospital Bonn, Bonn, Germany
| | - Shari Wiegreffe
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andrea R Glasmacher
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Youness Nour
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Lara Caglayan
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Franziska Grau
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thomas Müdder
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
- DKFZ-Hector Cancer Institute of the University Medical Center Mannheim, Mannheim, Germany
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, St. Hildegardis Hospital, Augustinerinnen Krankenhäuser gGmbH, Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, St. Hildegardis Hospital, Augustinerinnen Krankenhäuser gGmbH, Cologne, Germany
| | | | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn/Venusberg-Campus 1, 53127, Bonn, Germany
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Layer K, Layer JP, Glasmacher AR, Sarria GR, Böhner AMC, Layer YL, Dejonckheere CS, Garbe S, Feyer P, Baumert BG, Schendera A, Baumann R, Krug D, Köksal MA, Koch D, Scafa D, Leitzen C, Hölzel M, Giordano FA, Schmeel LC. Risk assessment, surveillance, and nonpharmaceutical prevention of acute radiation dermatitis: results of a multicentric survey among the German-speaking radiation oncology community. Strahlenther Onkol 2023; 199:891-900. [PMID: 37099166 PMCID: PMC10542714 DOI: 10.1007/s00066-023-02074-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/05/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Radiation dermatitis (RD) represents one of the most frequent side effects in radiotherapy (RT). Despite technical progress, mild and moderate RD still affects major subsets of patients and identification and management of patients with a high risk of severe RD is essential. We sought to characterize surveillance and nonpharmaceutical preventive management of RD in German-speaking hospitals and private centers. METHODS We conducted a survey on RD among German-speaking radiation oncologists inquiring for their evaluation of risk factors, assessment methods, and nonpharmaceutical preventive management of RD. RESULTS A total of 244 health professionals from public and private institutions in Germany, Austria, and Switzerland participated in the survey. RT-dependent factors were deemed most relevant for RD onset followed by lifestyle factors, emphasizing the impact of treatment conceptualization and patient education. While a broad majority of 92.8% assess RD at least once during RT, 59.0% of participants report RD at least partially arbitrarily and 17.4% stated to classify RD severity solely arbitrarily. 83.7% of all participants were unaware of patient-reported outcomes (PROs). Consensus exists on some lifestyle recommendations like avoidance of sun exposure (98.7%), hot baths (95.1%), and mechanical irritation (91.8%) under RT, while deodorant use (63.4% not at all, 22.1% with restrictions) or application of skin lotion (15.1% disapproval) remain controversial and are not recommended by guidelines or evidence-based practices. CONCLUSION Identification of patients at an increased risk of RD and subsequent implementation of adequate preventive measures remain relevant and challenging aspects of clinical routines. Consensus exists on several risk factors and nonpharmaceutical prevention recommendations, while RT-dependent risk factors, e.g., the fractionation scheme, or hygienic measures like deodorant use remain controversial. Surveillance is widely lacking methodology and objectivity. Intensifying outreach in the radiation oncology community is needed to improve practice patterns.
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Affiliation(s)
- Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Andrea R Glasmacher
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander M C Böhner
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Yonah L Layer
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Petra Feyer
- Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubünden, Graubünden, Switzerland
| | - Anke Schendera
- Department of Radiation Oncology, Community Hospital Mittelrhein, Koblenz, Germany
| | - 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
| | - Mümtaz A Köksal
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Leonard Christopher Schmeel
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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