INFRARED THERMAL IMAGING CONTROL OF RADIATION DERMATITIS DYNAMICS

BACKGROUND

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Association of Staphylococcus aureus Colonization With Severity of Acute Radiation Dermatitis in Patients With Breast or Head and Neck Cancer

Importance

Pathogenesis of acute radiation dermatitis (ARD) is not completely understood. Pro-inflammatory cutaneous bacteria may contribute to cutaneous inflammation after radiation therapy.

Objective

To evaluate whether nasal colonization with Staphylococcus aureus (SA) before radiation therapy is associated with ARD severity in patients with breast or head and neck cancer.

Design, Setting, and Participants

This prospective cohort study with observers blinded to colonization status was conducted from July 2017 to May 2018 at an urban academic cancer center. Patients aged 18 years or older with breast or head and neck cancer and plans for fractionated radiation therapy (≥15 fractions) with curative intent were enrolled via convenience sampling. Data were analyzed from September to October 2018.

Exposures

Staphylococcus aureus colonization status before radiation therapy (baseline).

Main Outcomes and Measures

The primary outcome was ARD grade using the Common Terminology Criteria for Adverse Event Reporting, version 4.03.

Results

Among 76 patients analyzed, mean (SD) age was 58.5 (12.6) years and 56 (73.7%) were female. All 76 patients developed ARD: 47 (61.8%) with grade 1, 22 (28.9%) with grade 2, and 7 (9.2%) with grade 3. The prevalence of baseline nasal SA colonization was higher among patients who developed grade 2 or higher ARD compared with those who developed grade 1 ARD (10 of 29 [34.5%] vs 6 of 47 [12.8%]; P = .02, by χ2 test).

Conclusions and Relevance

In this cohort study, baseline nasal SA colonization was associated with development of grade 2 or higher ARD in patients with breast or head and neck cancer. The findings suggest that SA colonization may play a role in the pathogenesis of ARD.

The Ability of the Nitric Oxide Synthases Inhibitor T1023 to Selectively Protect the Non-Malignant Tissues

Previously, we showed that a nitric oxide synthase (NOS) inhibitor, compound T1023, induces transient hypoxia and prevents acute radiation syndrome (ARS) in mice. Significant efficacy (according to various tests, dose modifying factor (DMF)-1.6-1.9 against H-ARS/G-ARS) and safety in radioprotective doses (1/5-1/4 LD10) became the reason for testing its ability to prevent complications of tumor radiation therapy (RT). Research methods included studying T1023 effects on skin acute radiation reactions (RSR) in rats and mice without tumors and in tumor-bearing animals. The effects were evaluated using clinical, morphological and histological techniques as well as RTOG classification. T1023 administration prior to irradiation significantly limited the severity of acute RSR. This was due to a decrease in radiation alteration of the skin and underlying tissues, and the preservation of the functional activity of cell populations that are critical in the pathogenesis of radiation burn. The DMF values for T1023 for skin protection were 1.4-1.7. Moreover, its radioprotective effect was fully selective to normal tissues in RT models of solid tumors-T1023 reduced the severity of acute RSR and did not modify the antitumor effects of γ-radiation. The results indicate that T1023 can selectively protect the non-malignant tissues against γ-radiation due to hypoxic mechanism of action and potentiate opportunities of NOS inhibitors in RT complications prevention.

A prospective feasibility study of a 1-mm bolus for postmastectomy radiotherapy

BACKGROUND

The optimal chest wall bolus regimen for postmastectomy radiotherapy (PMRT) remains unknown. We aimed to prospectively evaluate the use of a 1-mm-thick daily tissue-equivalent bolus in patients who received PMRT using thermoluminescent dosimeters (TLDs) and skin toxicity assessment.

METHODS

Patients with a 1-mm-thick daily bolus during PMRT were prospectively enrolled at The Juntendo University Hospital. The surface dose was measured in vivo under the 1-mm-thick bolus on the chest wall. We assessed the acute skin toxicity weekly during PMRT, and 1, 2, 4, and 12 weeks after the completion of PMRT.

RESULTS

A total of 19 patients aged 32-79 years old received PMRT from July 2019 to January 2020. All patients completed the protocol treatment without interruptions, and the median follow-up was 32 weeks. In vivo dosimetry analysis revealed surface doses between 77 and 113% of the prescribed dose, with a mean of 92% of the prescribed radiation dose, and a standard deviation of 7% being delivered. Grade 2 dermatitis was found in 10 patients (53%), and Grade 3 dermatitis was found in one patient (5%). All cases of Grade 2 and 3 dermatitis were improved 4 weeks after PMRT. There were no cases of Grade 4 dermatitis and no chest wall recurrences during the treatment or follow-up period.

CONCLUSIONS

Results confirmed the feasibility of using a 1-mm-thick daily bolus for PMRT, exhibiting an appropriate dose buildup and acceptable skin toxicity without treatment interruptions.

TRIAL REGISTRATION

The University Hospital Medical Information Network Clinical Trials Registry, UMIN000035773 . Registered 1 July 2019.

Anti-inflammatory Effect of Red Macroalgae Bulung Sangu (Gracilaria sp.) Extract in UVB-Irradiated Mice

BACKGROUND AND OBJECTIVE

Bulung Sangu, like many other macroalgae, is a source of beneficial phytochemical for health. This study was aimed to determine the anti-inflammatory effect of bulung sangu ethanol extract cream.

MATERIALS AND METHODS

The compounds of bulung sangu ethanol extract were identified by using gas chromatography. The antioxidant activity of the extract was examined by the DPPH assay. The anti-inflammatory effect was analyzed in vivo against ultraviolet B (UVB) induction through variables of epidermal thickening and epidermal erosion scores.

RESULTS

Our results showed that bulung sangu ethanol extract contained 18 compounds, in which, 11 compounds considered active as antioxidant and/or anti-inflammatory. Cream extract in both concentrations showed scavenging for more than 50%, with a concentration of 10% cream extract exhibited higher antioxidant activity compared to 5%. The in vivo assay showed a reduction of epidermal thickness and epidermal erosion in the application of both concentrations. The concentration of 10% cream extract showed higher reduction compared to 5% with results produced resembling normal.

CONCLUSION

It can be concluded that bulung sangu displayed a potential source for being developed for the health and medicine aspect, especially for various activities supported by antioxidants and anti-inflammatory.

LATE RADIATION TOXICITY AFTER RADICAL RADIOTHERAPY FOR GENITAL CANCER

Radiation therapy for malignant tumors of the female genital area, even with the use of modern radiotherapy equipment and dosimetric planning, causes the development of local radiation changes. An approach involving methodsof general and local exposure is used in their treatment. One of the most promising directions is the creation of optimal combinations of medicines (in the form of ointments, gels, aerosols, suppositories, etc.), which have a therapeutic effect on the inflammatory process. The article reflects the clinical course and stage of occurrence of late radiation reactions of the skin, vaginal/cervix mucosa, bladder, and intestines, as well as the features of their treatment.Literary data and own practical experience in the treatment of radiation complications are presented. Whenreviewing the topic under study, it could be concluded that the leading cause of the development of local radiationdamage is the errors in the planning and implementation of radiation therapy, when high absorbed doses thatexceed the tolerance of healthy tissues are used. Another reason for this is the poor accounting for dose distribution of ionizing radiation in tissues, the presence of concomitant diseases in patients, and the underestimation ofthe long-term effects of radiation.

Intratumoral Hydrogen Peroxide With Radiation Therapy in Locally Advanced Breast Cancer: Results From a Phase 1 Clinical Trial

PURPOSE

Hydrogen peroxide (H2O2) plays a vital role in normal cellular processes but at supraphysiological concentrations causes oxidative stress and cytotoxicity, a property that is potentially exploitable for the treatment of cancer in combination with radiation therapy (RT). We report the first phase 1 trial testing the safety and tolerability of intratumoral H2O2 + external beam RT as a novel combination in patients with breast cancer and exploratory plasma marker analyses investigating possible mechanisms of action.

METHODS AND MATERIALS

Twelve patients with breast tumors ≥3 cm (surgically or medically inoperable) received intratumoral H2O2 with either 36 Gy in 6 twice-weekly fractions (n = 6) or 49.5 Gy in 18 daily fractions (n = 6) to the whole breast ± locoregional lymph nodes in a single-center, nonrandomized study. H2O2 was mixed in 1% sodium hyaluronate gel (final H2O2 concentration 0.5%) before administration to slow drug release and minimize local discomfort. The mixture was injected intratumorally under ultrasound guidance twice weekly 1 hour before RT. The primary endpoint was patient-reported maximum intratumoral pain intensity before and 24 hours postinjection. Secondary endpoints included grade ≥3 skin toxicity and tumor response by ultrasound. Blood samples were collected before, during, and at the end of treatment for cell-death and immune marker analysis.

RESULTS

Compliance with H2O2 and RT was 100%. Five of 12 patients reported moderate pain after injection (grade 2 Common Terminology Criteria for Adverse Events v4.02) with median duration 60 minutes (interquartile range, 20-120 minutes). Skin toxicity was comparable to RT alone, with maintained partial/complete tumor response relative to baseline in 11 of 12 patients at last follow-up (median 12 months). Blood marker analysis highlighted significant associations of TRAIL, IL-1β, IL-4, and MIP-1α with tumor response.

CONCLUSIONS

Intratumoral H2O2 with RT is well tolerated with no additional toxicity compared with RT alone. If efficacy is confirmed in a randomized phase 2 trial, the approach has potential as a cost-effective radiation response enhancer in multiple cancer types in which locoregional control after RT alone remains poor.

Interferon-α inducible protein 6 (IFI6) confers protection against ionizing radiation in skin cells

BACKGROUND

Radiation-induced skin injury is one of the main adverse effects and a dose-limiting factor of radiotherapy without feasible treatment. The underlying mechanism of this disease is still limited.

OBJECTIVE

To investigate the potential molecular pathways and mechanisms of radiation-induced skin injury.

METHODS

mRNA expression profiles were determined by Affymetrix Human HTA2.0 microarray.IFI6 overexpression and knockdown were mediated by lentivirus. The functional changes of skin cells were measured by flow cytometry, ROS probe and Edu probe. Protein distribution was detected by immunofluorescence experiment, and IFI6-interacting proteins were detected by immunoprecipitation (IP) combined with mass spectrometry. The global gene changes in IFI6-overexpressed skin cells after irradiation were detected by RNA-seq.

RESULTS

mRNA expression profiling showed 50 upregulated and 13 down regulated genes and interferon alpha inducible protein 6 (IFI6) was top upregulated. Overexpression of IFI6 promoted cell proliferation and reduced cell apoptosis as well as ROS production following radiation, and conversely, increased the radiosensitivity of HaCaT and human skin fibroblast (WS1). IFI6 was translocated into nucleus in irradiated skin cells and the interacting relationship with mitochondrial single-stranded DNA-binding protein 1 (SSBP1), which could enhance the transcriptional activity of heat shock transcription factor 1 (HSF1).IFI6 augmented HSF1 activity following radiation in HaCaT and WS1 cells. RNA-seq analysis showed IFI6 modulated virus infection and cellular response to stress pathways, which may help to further explore how IFI6 regulate the transcriptional activity of HSF1.

CONCLUSION

This study reveals that IFI6 is induced by ionizing radiation and confers radioprotection in skin cells.

Topical Application of Phlorotannins from Brown Seaweed Mitigates Radiation Dermatitis in a Mouse Model

Radiation dermatitis (RD) is one of the most common side effects of radiotherapy; its symptoms progress from erythema to dry and moist desquamation, leading to the deterioration of the patients’ quality of life. Active metabolites in brown seaweed, including phlorotannins (PTNs), show anti-inflammatory activities; however, their medical use is limited. Here, we investigated the effects of PTNs in a mouse model of RD in vivo. X-rays (36 Gy) were delivered in three fractions to the hind legs of BALB/c mice. Macroscopic RD scoring revealed that PTNs significantly mitigated RD compared with the vehicle control. Histopathological analyses of skin tissues revealed that PTNs decreased epidermal and dermal thickness compared with the vehicle control. Western blotting indicated that PTNs augmented nuclear factor erythroid 2-related factor 2 (NRF2)/heme oxygenase-1 (HO-1) pathway activation but attenuated radiation-induced NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) and inflammasome activation, suggesting the mitigation of acute inflammation in irradiated mouse skin. PTNs also facilitated fast recovery, as indicated by increased aquaporin 3 expression and decreased γH2AX (histone family member X) expression. Our results indicate that topical PTN application may alleviate RD symptoms by suppressing oxidative stress and inflammatory signaling and by promoting the healing process. Therefore, PTNs may show great potential as cosmeceuticals for patients with cancer suffering from radiation-induced inflammatory side effects such as RD.

Two hypofractionated schedules for early stage breast cancer: Comparative retrospective analysis for acute and late radiation induced dermatitis

PURPOSE

To compare two hypofractionated radiation schedules in early breast cancer concerning skin toxicity.

METHODS

We retrospectively analyzed 80 patients (group A) versus 54 (group B) who underwent hypofractionated radiotherapy after breast conserving surgery. Group Α received 42.75Gy in 15 fractions over 5 weeks (3 fractions/ week) plus 8.55Gy boost to the tumor bed (3 fractions). Group Β received 45.05Gy (5 fractions/week) and 7.95Gy boost (3 fractions). Multivariate logistic regression analysis (MVLRA) was conducted for relevant parameters regarding RTOG/EORTC skin toxicity.

RESULTS

Median follow up was 60 months. Median age was 75 years (group A) and 56 (group B). Mean values of radio-dermatitis were significantly higher in group A vs B until 3 months post RT (p<0.001 and p=0.002, respectively), while 6 months thereafter toxicity was regressed without any significant difference between groups. MVLRA showed a significant (p<0.001) odds ratio for age (2.36, 95%CI:1.11-3.75) and group A (1.31, 95%CI:1.12-1.49).

CONCLUSION

Schedule B would be preferable in younger women in favor of toxicity. Schedule A could still be applied in elderly patients, unavailable attending daily schedules, with acceptable toxicity.

Non-small-cell Lung Cancer with Severe Skin Manifestations Related to Radiation Recall Dermatitis after Atezolizumab Treatment

Radiation recall dermatitis (RRD) is an inflammatory reaction that occurs at previously irradiated skin regions after drug administration. We herein report a patient with non-small-cell lung cancer treated previously with thoracic radiotherapy who developed severe RRD induced by atezolizumab [anti-programmed death 1 ligand 1 (PD-L1) antibody]. Immunohistochemistry of the skin biopsy showed dermatitis with infiltration of CD8+ lymphocytes, suggesting that atezolizumab might provoke an immune-related inflammatory reaction at previously irradiated skin regions. When administering anti-PD-L1 antibody to patients who have undergone radiotherapy previously, physicians should carefully monitor the irradiated skin for the potential occurrence of RRD.

The ion channel, TRPM2, contributes to the pathogenesis of radiodermatitis

Radiodermatitis is a painful side effect for cancer patients undergoing radiotherapy. Irradiation of the skin causes inflammation and breakdown of the epidermis and can lead to significant morbidity and mortality in severe cases, as seen in exposure from accidents or weapons such as "dirty bombs" and ultimately leads to tissue fibrosis. However, the pathogenesis of radiodermatitis is not fully understood. Using a mouse model of radiodermatitis, we showed that the Transient Receptor Potential Melastatin 2 (TRPM2) ion channel plays a significant role in the development of dermatitis following exposure to ionizing radiation. Irradiated TRPM2-deficient mice developed less inflammation, fewer severe skin lesions and decreased fibrosis when compared to wild type mice. The TRPM2-deficient mice also showed a faster recovery period as seen by their increased weight gain post irradiation. Finally, TRPM2-deficient mice exhibited lower systemic inflammation with a reduction in inflammatory cytokines present in the serum. These findings suggest that TRPM2 may be a potential therapeutic target for reducing the severity of radiodermatitis.

Application of red light phototherapy in the treatment of radioactive dermatitis in patients with head and neck cancer

BACKGROUND

To observe the effect of red light phototherapy (RLPT) on radioactive dermatitis (RD) caused by radiotherapy in patients with head and neck cancer (HNC).

METHODS

Sixty patients with HNC admitted to our hospital were randomly divided into experimental group and control group, 30 patients in each group. The control group received routine daily care during radiotherapy treatment. In the experimental group, in addition to routine daily care during radiotherapy treatment, photon therapy apparatus RLPT was added, 10 min/time, 2 times/day, and lasted until the end of radiotherapy. The pain and conditions of the patients' skin were assessed daily, and the skin pain and dermatitis grades of the two groups were compared.

RESULTS

In terms of the reaction degree of RD, experimental group was mainly grade 0-2, and control group was mainly grade 2-3, with a significant difference (P < 0.05). In terms of skin pain, according to the pain records at week 2, 3, and 4, the pain degree increased with time. However, the score of wound pain in experimental group was significantly lower than that in control group, and there was a significant difference between the two groups (P < 0.05).

CONCLUSIONS

The application of RLPT in the treatment of RD can help accelerate wound healing and significantly shorten healing time. It can not only reduce wounds pain of patients, promote inflammation and ulcer healing, but also ensure the smooth progress of patients' radiotherapy and improve their quality of lives, which is worth popularization and application in the clinical practice.

Docetaxel-induced radiation recall dermatitis with atypical features: A case report

INTRODUCTION

Radiation recall dermatitis (RRD) associated with actinomycin D was first described by in 1959, followed by the reporting of several RRD-inducing drugs. In 1994, a study demonstrated docetaxel-induced RRD for the first time; however, despite some case studies reporting RRD, a little has been reported on it since then. Here we present a rare case of atypical docetaxel-induced RRD.

CASE PRESENTATION

The patient in his 60s was administered radiotherapy for high-risk prostate cancer. He continued receiving hormonal therapy for 2 years because of being in a high-risk group and became nadir. Six months since the completion of hormonal therapy, his prostate-specific antigen (PSA) level increased again. Based on the radiological examination, he was diagnosed with multiple lung, bone, and lymph node metastases. Accordingly, we started docetaxel (75 mg/m) every 5 weeks in consideration of myelosuppression for hormone-resistant multiple metastases. Although lung metastasis shrunk by one cycle docetaxel, radiotherapy for the thoracic and lumbar vertebrae was performed for back pain and lumbago. On day 21, at the end of radiotherapy, the same dose of docetaxel was administrated for the third time. On day 7, after third docetaxel administration, erythema appeared in a irradiated field of the thoracic and lumbar vertebra. Erythema primarily appeared on the anterior side of the body, and no skin reaction was noted on the posterior part of the thoracic irradiated area. Notably, no skin reaction was observed in the previously irradiated field for prostate cancer.

CONCLUSIONS

This case report draws attention to the development of atypical RRD after administration of docetaxel and advises careful follow-up even if RRD does not appear after the first docetaxel administration.

Atypical Radiation Toxicity in Patients with Classical Kaposi's Sarcoma

The classical (non-AIDS-related) form of Kaposi's sarcoma (KS) typically affects older patients of Eastern European or Mediterranean ethnic background. Although radiotherapy is a standard part of the treatment armamentarium for KS patients, a high incidence of radiotoxicity has been reported in epidemic AIDS-related cases. In order to determine whether this radiotoxicity is observed only in patients with the epidemic form of the disease, we have conducted a retrospective chart review of 30 patients with classical KS treated with radiation for whom follow-up information was available. Seven out of 30 (23 %) were found to have unexpectedly high levels of radiotoxicity after tumor doses of 22–42 Gy. This toxicity consisted either of significantly increased edema or chronic skin break-down and severe radiodermatitis, in some cases requiring multiple surgical corrective procedures. We suggest that the abnormal lymphaticovenous development and chronic lymphokine stimulation associated with KS of both epidemic and classical forms may be responsible in part for the observed radiotoxicity.

Local Control and Toxicity of External Beam Reirradiation With a Pulsed Low-dose-rate Technique

PURPOSE

To evaluate the efficacy and toxicity of external beam reirradiation using a pulsed low-dose-rate (PLDR) technique.

METHODS AND MATERIALS

We evaluated patients treated with PLDR reirradiation from 2009 to 2016 at a single institution. Toxicity was graded using the Common Terminology Criteria for Adverse Events, version 4.0, and local control was assessed using the Response Evaluation Criteria In Solid Tumors, version 1.1. On univariate analysis (UVA), the χ2 and Fisher exact tests were used to assess the toxicity outcomes. Competing risk analysis using cumulative incidence function estimates were used to assess local progression.

RESULTS

A total of 39 patients were treated to 41 disease sites with PLDR reirradiation. These patients had a median follow-up time of 8.8 months (range 0.5-64.7). The targets were the thorax, abdomen, and pelvis, including 36 symptomatic sites. The median interval from the first radiation course and reirradiation was 26.2 months; the median dose of the first and second course of radiation was 50.4 Gy and 50 Gy, respectively. Five patients (13%) received concurrent systemic therapy. Of the 39 patients, 9 (23%) developed grade ≥2 acute toxicity, most commonly radiation dermatitis (5 of 9). None developed grade ≥4 acute or subacute toxicity. The only grade ≥2 late toxicity was late skin toxicity in 1 patient. On UVA, toxicity was not significantly associated with the dose of the first course of radiation or reirradiation, the interval to reirradiation, or the reirradiation site. Of the 41 disease sites treated with PLDR reirradiation, 32 had pre- and post-PLDR scans to evaluate for local control. The local progression rate was 16.5% at 6 months and 23.8% at 12 months and was not associated with the dose of reirradiation, the reirradiation site, or concurrent systemic therapy on UVA. Of the 36 symptomatic disease sites, 25 sites (69%) achieved a symptomatic response after PLDR, including 6 (17%) with complete symptomatic relief.

CONCLUSION

Reirradiation with PLDR is effective and well-tolerated. The risk of late toxicity and the durability of local control were limited by the relatively short follow-up duration in the present cohort.

Tamoxifen-induced radiation recall dermatitis

BACKGROUND

Radiation recall dermatitis (RRD) canpresent days to years after radiation exposure andis most commonly caused by chemotherapy drugs,with tamoxifen-induced radiation recall dermatitisbeing exceptionally rare.

PURPOSE

To report a newcase of tamoxifen-induced radiation recall dermatitisafter 4.5 years of tamoxifen exposure, making this thelongest time of onset to RRD after tamoxifen initiation.

MATERIALS AND METHODS

The case of a woman withtamoxifen-induced RRD is presented. Using PubMedand Google Scholar, the terms tamoxifen, radiation,recall, dermatitis were searched. Relevant citationswere utilized and discussed.

RESULTS

An adult womanwith history of inflammatory breast carcinomadeveloped an erythematous, scaly, tender plaquelocalized to previously irradiated skin of the left chestafter more than four years of tamoxifen therapy. Thepatient was diagnosed with RRD and was treated withtopical triamcinolone 0.1% cream twice daily to theaffected areas. The patient experienced subsequentrapid improvement despite continuation of tamoxifentreatment. Biopsy revealed changes consistent withradiation dermatitis with no evidence of malignancy.

CONCLUSION

Radiation recall dermatitis can havesignificant impact on affected patients and can posea diagnostic dilemma for clinicians who may mistakeRRD for infection or recurrence of malignancy. It isimportant to be familiar with the presenting signs andsymptoms of this entity so that affected patients canreceive timely and appropriate therapy.

Skin Response to Single and Fractionated Irradiation: Dynamic Modeling Approach

A biologically motivated mathematical model of the dynamics of swine skin epidermis after single acute irradiation () is extended to describe the effects of fractionated irradiation on this vital body system. The extended model, as the initial one, is a system of nonlinear ordinary differential equations whose variables and parameters have clear biological meaning. The performed studies of the model reveal a correlation between the dynamics of the dimensionless concentration of corneal cells of the upper skin layer and the dynamics of the fraction of the area of swine skin epidermis without moist desquamation under fractionated irradiation similar to that after single acute irradiation (). On the basis of these results, the formula, which allows computation of the dynamics of the moist desquamation in irradiated skin proceeding from the respective dynamics of skin epidermal cells, is proposed. It is demonstrated that the modeling predictions of the moist reaction in swine skin under fractionated irradiation in the wide range of total doses agree, on qualitative and quantitative levels, with the respective experimental data. All this bears witness to the validity of employment of the developed model, after appropriate identification, in the investigation and prediction of the effects of fractionated irradiation on skin epidermis in humans.

A novel Nrf2 activator from microbial transformation inhibits radiation-induced dermatitis in mice

Nuclear factor erythroid 2-related factor 2 (Nrf2) is a transcriptional factor that regulates many antioxidants, and we have recently succeeded in obtaining a novel Nrf2 activator, RS9, from microbial transformation. RS9 is categorized as a triterpenoid, and well-known triterpenoids such as RTA 402 (bardoxolone methyl) and RTA 408 have been tested in clinical trials. RTA 408 lotion is currently being tested in patients at risk for radiation dermatitis. This prompted us to study the profiles of RS9 in the skin. All the above triterpenoids increased the level of an Nrf2-targeted gene, NADPH:quinone oxidoreductase-1, in normal human epidermal keratinocytes. Among them, the activity of RS9 was prominent; furthermore, the cellular toxicity was less compared with RTA compounds. BALB/c mice were irradiated with 30 Gy/day on Day 0, and compounds were topically applied on the back once daily from Day 1 to Day 30. Dermatitis scores peaked on Day 18, with a score of 2.6 in vehicle-treated mice, and topical applications of 0.1% RTA 402, RTA 408 and RS9 reduced the scores to 1.8, 2.0 and 1.4, respectively. Moreover, the percentage of animals with scores ≥2 was analyzed, and 0.1% RS9 suppressed the percentage from 100% to 47%. These results imply that RS9 has potential efficacy for treating radiation dermatitis.

Fluoroscopy-induced radionecrosis

Complications from radiation exposure during fluoroscopic guidance of cardiac catheterization may occur. With repeated procedures, the risk for cutaneous injuries increases. Herein, we describe a 59-year-old man with extensive coronary artery disease, who had undergone multiple revascularization procedures and developed a non-healing ulcer on his left inferior scapula. The patient's medical history, physical exam findings, and histopathology gave clues to a case of radiation-induced dermatitis and necrosis.

Use of a Polylactide-based Copolymer as a Temporary Skin Substitute for a Patient With Moist Desquamation Due to Radiation

Skin reactions are known adverse effects of radiation therapy. Despite advances in skin care products, there is still a demand for optimal skin care products to improve the therapy of these lesions. The authors report the use of a polylactide-based copolymer (Suprathel, PolyMedics Innovations GmbH, Denkendorf, Germany) as a temporary skin substitute for covering the skin defects of a patient with moist desquamation due to radiation.

Pemphigus foliaceus exacerbated by radiation, in association with myasthenia gravis

Pemphigus foliaceus (PF) is a sporadic autoimmune blistering disease of unknown etiology. The production of immunoglobulin G4 antibodies against desmoglein-1 is responsible for the clinical manifestation of PF. We present a case of a woman with a recent diagnosis of myasthenia gravis (MG), who was also recently treated with radiation therapy for breast cancer. The clinical exam, supported by biopsy and direct immunofluorescence, were consistent with PF. We present this case to increase the awareness of the potential exacerbation or induction of PF with radiation, and of the association of PF and myasthenia gravis. Only five prior cases of radiation-exacerbated or radiation-induced PF have been reported in the literature to date. Furthermore, the co-existence of the autoimmune entities of myasthenia gravis and PF has been reported in the literature in only 9 cases and was also noted in this patient.

Effect of Film Dressing on Acute Radiation Dermatitis Secondary to Proton Beam Therapy

PURPOSE

Acute radiation dermatitis (ARD) is one of the most common adverse events of proton beam therapy (PBT), and there is currently no effective method to manage ARD. The purpose of this study was to examine the prophylactic effect of a film dressing using Airwall on PBT-induced ARD compared with standard skin managements.

METHODS AND MATERIALS

A total of 271 patients with prostate cancer who were scheduled for PBT at our center were divided into 2 groups based on their own requests: 145 patients (53%) chose Airwall (group A) and 126 patients (47%) received standard treatments (group B). We evaluated irradiated skin every other day during PBT and followed up once a week for a month after completion of PBT.

RESULTS

Grade 0, 1, 2, and 3 dermatitis were seen in 2, 122, 21, and 0 and 0, 65, 57, and 4 patients in groups A and B, respectively (P<.001). Numbers of days to grades 1 and 2 ARD development were 34.9 ± 14.3 and 54.7 ± 10.3 and 31.8 ± 11.3 and 54.4 ± 11.6 in groups A and B, respectively. There were no significant differences between the 2 groups. Eighteen patients (12%) in group A who experienced problems in the region covered with Airwall switched to standard skin care after peeling the film off.

CONCLUSIONS

Film dressing using Airwall reduced the severity of ARD without delaying the response time of the skin to proton beam irradiation compared with standard skin management. Hence, film dressing is considered a promising measure for preventing ARD secondary to PBT.

New model for long-term investigations of cutaneous microcirculatory and inflammatory changes following irradiation

Radiotherapy is used for curative and palliative treatment. However, its negative effect on normal tissue is a limiting factor for the deliverable dose. Microcirculatory breakdown and prolonged inflammation in particular are major features of late side effects. The purpose of this study was to develop a reliable animal model that will allow a long-term in vivo analysis of microcirculation and inflammation following irradiation. A single dose of 90 Gy was delivered to the ears of hairless mice (n = 15). Intravital fluorescent microscopy was used to assess microcirculatory parameters and leukocyte behaviour. Values for the identical (control) areas were obtained before as well as during the following days, weeks and months following irradiation. The arteriolar and venular diameter increased up to Day 14, decreased during the following months, and increased again after one year. The red blood cell velocity increased up to 145% on Day 3, decreased on Day 7 to 115%, and stayed above baseline value the whole year. The integrity loss of the endothelium increased up to Day 7 and continued up to Day 75 after radiation. After one year, the oedema was at the baseline level. Leukocytes showed their maximal activity at one year after trauma. An increase was measured up to Day 25; the lowest values were measured at Day 40 post-irradiation, followed by a repeated increase. The present model allows a certain visualization of microcirculatory disturbances and inflammation over a period of months. This permits the possibility of long-term investigations of the underlying pathophysiology following irradiation, including possible drug interactions.

Protective effect of inhalation of hydrogen gas on radiation-induced dermatitis and skin injury in rats

The effect of inhalation of hydrogen-containing gas (1.3% hydrogen + 20.8% oxygen + 77.9% nitrogen) (HCG) on radiation-induced dermatitis and on the healing of healing-impaired skin wounds in rats was examined using a rat model of radiation-induced skin injury. An X-ray dose of 20 Gy was irradiated onto the lower part of the back through two holes in a lead shield. Irradiation was performed before or after inhalation of HCG for 2 h. Inhalation of HCG significantly reduced the severity of radiodermatitis and accelerated healing-impaired wound repair. Staining with terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) and 8-hydroxy-2(')-deoxyguanosine (8-OHdG) showed that the proportion of apoptotic keratinocytes and the level of staining in the X-irradiated skin of rats that pre-inhaled HCG were significantly lower than that of rats which did not pre-inhale HCG. Cutaneous full-thickness wounds were then created in the X-irradiated area to examine the time-course of wound healing. X-irradiation significantly increased the time required for wound healing, but the inhalation of HCG prior to the irradiation significantly decreased the delay in wound healing compared with the control and post-inhalation of HCG groups. Therefore, radiation-induced skin injury can potentially be alleviated by the pre-inhalation of HCG.

Herbal preparation extract for skin after radiotherapy treatment. Part One--Preclinical tests

Naran R is a herbal composition made of Plantago lanceolate folium, Malvae arboreae flos, Calendulae flos, Chamomillae inflorescentia, Lamii albi flos to prepare compresses or to wash skin with inflammations. The extract of this preparation is mixed to be applied as an ointment on patients' skin after radiotherapy. Experiments performed in vitro are part of pre-clinical tests with Naran R ointment. This study examined the impact of the plant composition for ethanol-water extract on human skin fibroblasts (HSF) culture. Samples of extract, prepared from patented amounts of herbs, were in the range of 25-225 μg/mL. Six methods were applied: standard spectrophotometric 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, neutral red (NR) uptake assay, DPPH free radical scavenging test, labeling of cytoskeleton F-actin, staining of argyrophilic nucleolar organizer regions (AgNORs) and trypan blue coloration. The extract concentration 75 μg/mL was established as safe for application on human skin. In labeling of F-actin with rhodamine-phalloidin dye at this concentration the cytoskeleton was stable. The extract did not influence the membrane stability and had positive influence on the proliferation activity. It was confirmed in AgNOR test during incubation with extract, which led to formation of larger amount of smaller nucleolins. In DPPH scavenging activity test, the extract revealed over 8% higher free-radical scavenging activity in comparison to control. After trypan blue staining, the extract in concentration 125 μg/mL significantly lowered the cell viability. When the cytotoxic and anti-proliferative activity of the extracts were analyzed, MTT and Neutral Red (NR) methods were used. The cells' viability was maintained on a constant level (80-110%) after 24, 48 and 72 h of incubation. During all time of NR test (72 h) and even when 225 μg/mL of extract was applied, the viability of cells was in range 80-110% of control. Positive influence of the extract on investigated cells structure and proliferation, lack of toxicity and increasing anti-oxidant activity enable to consider this preparation as a natural remedy with potential application in skin therapy after radiation.

In vivo analysis of THz wave irradiation induced acute inflammatory response in skin by laser-scanning confocal microscopy

The recent development of THz sources in a wide range of THz frequencies and power levels has led to greatly increased interest in potential biomedical applications such as cancer and burn wound diagnosis. However, despite its importance in realizing THz wave based applications, our knowledge of how THz wave irradiation can affect a live tissue at the cellular level is very limited. In this study, an acute inflammatory response caused by pulsed THz wave irradiation on the skin of a live mouse was analyzed at the cellular level using intravital laser-scanning confocal microscopy. Pulsed THz wave (2.7 THz, 4 μs pulsewidth, 61.4 μJ per pulse, 3Hz repetition), generated using compact FEL, was used to irradiate an anesthetized mouse's ear skin with an average power of 260 mW/cm(2) for 30 minutes using a high-precision focused THz wave irradiation setup. In contrast to in vitro analysis using cultured cells at similar power levels of CW THz wave irradiation, no temperature change at the surface of the ear skin was observed when skin was examined with an IR camera. To monitor any potential inflammatory response, resident neutrophils in the same area of ear skin were repeatedly visualized before and after THz wave irradiation using a custom-built laser-scanning confocal microscopy system optimized for in vivo visualization. While non-irradiated control skin area showed no changes in the number of resident neutrophils, a massive recruitment of newly infiltrated neutrophils was observed in the THz wave irradiated skin area after 6 hours, which suggests an induction of acute inflammatory response by the pulsed THz wave irradiation on the skin via a non-thermal process.

Fluoroscopy-associated radiation dermatitis

We present a 67-year-old man with an ulcerated, indurated plaque on the right mid back with a presumed diagnosis of morphea that was complicated by an allergic contact dermatitis. Further clinical and histopathologic data elucidated the diagnosis of fluoroscopy-induced radiation dermatitis. We present a brief review of the common locations, clinical characteristics, pathophysiology, and management options for fluoroscopy-induced radiation dermatitis.

Topical hypochlorite ameliorates NF-κB-mediated skin diseases in mice

Nuclear factor-κB (NF-κB) regulates cellular responses to inflammation and aging, and alterations in NF-κB signaling underlie the pathogenesis of multiple human diseases. Effective clinical therapeutics targeting this pathway remain unavailable. In primary human keratinocytes, we found that hypochlorite (HOCl) reversibly inhibited the expression of CCL2 and SOD2, two NF-κB-dependent genes. In cultured cells, HOCl inhibited the activity of inhibitor of NF-κB kinase (IKK), a key regulator of NF-κB activation, by oxidizing cysteine residues Cys114 and Cys115. In NF-κB reporter mice, topical HOCl reduced LPS-induced NF-κB signaling in skin. We further evaluated topical HOCl use in two mouse models of NF-κB-driven epidermal disease. For mice with acute radiation dermatitis, topical HOCl inhibited the expression of NF-κB-dependent genes, decreased disease severity, and prevented skin ulceration. In aged mice, topical HOCl attenuated age-dependent production of p16INK4a and expression of the DNA repair gene Rad50. Additionally, skin of aged HOCl-treated mice acquired enhanced epidermal thickness and proliferation, comparable to skin in juvenile animals. These data suggest that topical HOCl reduces NF-κB-mediated epidermal pathology in radiation dermatitis and skin aging through IKK modulation and motivate the exploration of HOCl use for clinical aims.

Photoprotective effects of Romanian propolis on skin of mice exposed to UVB irradiation

We aimed at investigating the antioxidant, antiinflamatory, antiapoptotic and antigenotoxic effects of a Romanian Propolis (RP) extract in two concentrations (RP1 3 mg, respectively RP2 1.5 mg polyphenols/cm(2)), topically administered, either prior to or after UVB exposure, in a Swiss mouse model. Our results showed that both concentrations of RP extract, independent of the time of administration, significantly attenuated the malondialdehyde (MDA) formation and restored glutathione peroxidase (GPx) activity. However, the 8-hydroxy-2-deoxy-guanosine (8-oxo-dG), nitric oxide (NO) and glutathione (GSH) levels were not influenced by UVB exposure and RP treatment. Interleukin (IL)-6 levels were significantly decreased by RP treatment, both before and after UVB-exposure. RP2 extract, in both regimens, significantly reduced the epidermal hyperplasia and dermal inflammation, whereas RP1 pre-treatment diminished only the dermal inflammation. The effect of our RP extract in terms of reduction of sunburn cell formation and of activated caspase-3 and TUNEL-positive cells was observed in both subsets of the experiment, RP2 having a slightly better protective effect as compared to RP1. The antigenotoxic effect of RP was demonstrated by significantly reduced cyclobutane pyrimidine dimers (CPDs) formation. Our results suggest that RP extract might be a potential chemopreventive candidate by modulation of multiple UVB-induced signaling pathways in skin.

Development of a porcine skin injury model and characterization of the dose-dependent response to high-dose radiation

A porcine skin model was developed to characterize the dose-dependent response to high-dose radiation. The dorsal skin of a mini pig was divided into four paraspinal sections, with 11 small irradiation fields (2 cm × 2 cm) in each section, and a single fraction of 15, 30, 50 or 75 Gy was delivered to each section using a 6 MeV electron beam. A spectrophotometer measured gross skin changes, and a biopsy for each radiation dose was performed in the 1st, 2nd, 4th, 6th and 9th weeks for histology, immunostaining with anti-CD31, and western blotting with IL-6 and TGF-β1 to determine the degree of skin damage. After a 4-week latency period, erythema and dry desquamation, moist desquamation, and ulceration appeared at 4, 6 and 9 weeks, respectively. Gross skin toxicity was more pronounced, occurred early and continued to progress with irradiation >50 Gy, whereas complete healing was observed 12 weeks after 15 Gy. Spectrophotometry showed erythema indices rapidly increased during the first 4 weeks after irradiation. The number of eosinophils began rising sharply at 4 weeks and normalized after reaching peaks at 7-8 weeks. Microvessel density showed a biphasic pattern with a transient peak at 1 week, a nadir at 4-6 weeks, and maximum recovery at 9 weeks. Increase in the levels of IL-6 and TGF-β1 was detected soon after irradiation. Most of these parameters indicated complete healing of the skin 12 weeks after 15 Gy. Our porcine skin model provides an effective platform for studying high-dose radiation-induced skin injury, in particular histologic and molecular changes, during the early latency period.

A unique case of subacute radiodermatitis

Subacute radiodermatitis is a rare cutaneous disease induced by ionizing radiation. It often is mistaken for contact dermatitis, fixed drug eruption, or connective-tissue disease. Routine use of fluoroscopy has flourished in many types of medical procedures. We present a case of subacute radiodermatitis stemming from prolonged fluoroscopic exposure during angiography; the lesion appeared only at the site of contact for the ground plate, remote from the field of radiation.

A synthetic superoxide dismutase/catalase mimetic EUK-207 mitigates radiation dermatitis and promotes wound healing in irradiated rat skin

In the event of a radionuclear attack or nuclear accident, the skin would be the first barrier exposed to radiation, though skin injury can progress over days to years following exposure. Chronic oxidative stress has been implicated as being a potential contributor to the progression of delayed radiation-induced injury to skin and other organs. To examine the causative role of oxidative stress in delayed radiation-induced skin injury, including impaired wound healing, we tested a synthetic superoxide dismutase (SOD)/catalase mimetic, EUK-207, in a rat model of combined skin irradiation and wound injury. Administered systemically, beginning 48 hours after irradiation, EUK-207 mitigated radiation dermatitis, suppressed indicators of tissue oxidative stress, and enhanced wound healing. Evaluation of gene expression in irradiated skin at 30 days after exposure revealed a significant upregulation of several key genes involved in detoxication of reactive oxygen and nitrogen species. This gene expression pattern was primarily reversed by EUK-207 therapy. These results demonstrate that oxidative stress has a critical role in the progression of radiation-induced skin injury, and that the injury can be mitigated by appropriate antioxidant compounds administered 48 hours after exposure.

Fluoroscopy-induced chronic radiation dermatitis

A 62-year-old man with a history of 2 previous cardiac catheterizations presented with an itchy, nontender skin lesion over his right scapula. The skin lesion had been present for >5 years. Review of the medical records found evidence of a prolonged and complicated cardiac catheterization 8 years previously. Physical examination revealed an 8 × 6 cm, well-demarcated, erythematous reticulated atrophic plaque with telangiectasias and ulceration. Biopsy confirmed histologic changes consistent with radiation dermatitis. In conclusion, the characteristic histologic findings of radiation dermatitis, along with the location over the right scapula and the history of prolonged fluoroscopic exposure during cardiac catheterization, led to the clinical diagnosis of fluoroscopy-induced chronic radiation dermatitis.

A phase 2 trial of once-weekly hypofractionated breast irradiation: first report of acute toxicity, feasibility, and patient satisfaction

PURPOSE

To report on early results of a single-institution phase 2 trial of a 5-fraction, once-weekly radiation therapy regimen for patients undergoing breast-conserving surgery (BCS).

METHODS AND MATERIALS

Patients who underwent BCS for American Joint Committee on Cancer stage 0, I, or II breast cancer with negative surgical margins were eligible to receive whole breast radiation therapy to a dose of 30 Gy in 5 weekly fractions of 6 Gy with or without an additional boost. Elective nodal irradiation was not permitted. There were no restrictions on breast size or the use of cytotoxic chemotherapy for otherwise eligible patients. Patients were assessed at baseline, treatment completion, and at first posttreatment follow-up to assess acute toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and quality of life (European Organization for Research and Treatment of Cancer QLQ-BR23).

RESULTS

Between January and September 2011, 42 eligible patients underwent weekly hypofractionated breast irradiation immediately following BCS (69.0%) or at the conclusion of cytotoxic chemotherapy (31.0%). The rates of grade ≥2 radiation-induced dermatitis, pain, fatigue, and breast edema were 19.0%, 11.9%, 9.5%, and 2.4%, respectively. Only 1 grade 3 toxicity-pain requiring a course of narcotic analgesics-was observed. One patient developed a superficial cellulitis (grade 2), which resolved with the use of oral antibiotics. Patient-reported moderate-to-major breast symptoms (pain, swelling, and skin problems), all decreased from baseline through 1 month, whereas breast sensitivity remained stable over the study period.

CONCLUSIONS

The tolerance of weekly hypofractionated breast irradiation compares well with recent reports of daily hypofractionated whole-breast irradiation schedules. The regimen appears feasible and cost-effective. Additional follow-up with continued accrual is needed to assess late toxicity, cosmesis, and disease-specific outcomes.

Radiation port erythema multiforme: erythema multiforme localized to the radiation port in a patient with non-small cell lung cancer

A 75-year-old man was treated with stereotactic radiation to 50 gray units in 4 fractions for stage IB non-small cell lung cancer. Radiotherapy was directed at the right lower lobe segment of the lung and lasted 4 days. He developed radiodermatitis, which completely resolved within a few weeks after radiotherapy was finished. Three months after completing radiation therapy, he developed a pruritic red lesion within his radiation port on his right mid back with the formation of blisters a week later. Two weeks after the onset of the patient's blisters, cutaneous examination showed individual and convergent erythematous papules and plaques with superficial scaling at sites of resolving vesicles located within the radiated area (Figures 1 and 2). The patient had neither symptoms of mycoplasma pneumoniae, nor lesions or history of present or past herpetic infection. Also, he had not recently been placed on any new medications, and he did not have any other erythema multiforme-associated risk factors. A biopsy from the erythematous lesions showed a band-like infiltrate of lymphocytes in the dermis. The overlying epidermis contained necrotic keratinocytes and there was alteration of the basal layer. Correlation of the clinical presentation and pathologic changes established a diagnosis of erythema multiforme localized to the radiation port. The patient was treated with topical triamcinolone acetonide 0.1% cream twice daily for 10 days and once daily for 4 days. His lesions resolved and there was mild hyperpigmentation of the affected area.

[The current potential of forensic medical expertise of a local radiation injury]

The present review concerns radiation injury, a most challenging problem facing modern forensic medical expertise. It is shown that its successful solution requires the combined application of all currently available relevant methods including radio- and biodosimetry, forensic histological examination, etc.

Protective effect of prostaglandin E₁ on radiation-induced proliferative inhibition and apoptosis in keratinocytes and healing of radiation-induced skin injury in rats

We examined the effects of prostaglandin E₁ (PGE₁) on radiation-induced proliferation inhibition and apoptosis in keratinocytes and healing of radiation-induced skin injury in a rat model. PGE₁ had a protective effect on radiation-induced growth inhibition in keratinocytes in vitro, but not in fibroblasts. Varying concentrations of PGE₁ were subcutaneously administered into the posterior neck region. X-irradiation at a dose of 20 Gy was administrated to the lower part of the back using a lead sheet with two holes 30 min to 1 h before or after the administration of PGE₁. Although X-irradiation induced epilation, minor erosions, or skin ulcers in almost all rats, PGE₁ administration prior to irradiation reduced these irradiation injuries. Staining with terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling showed that proportions of apoptotic keratinocytes in the X-irradiated skin of PGE₁-administered rats were significantly lower than for those in the skin of rats which did not receive PGE₁. Cutaneous full-thickness defective wounds were then formed in X-irradiated areas to examine the time course of wound healing. Wound healing was significantly delayed because of X-irradiation, but PGE₁ administration prior to irradiation led to a significantly shorter delay in wound healing compared with controls. Decreasing delay in wound healing was correlated with concentration of PGE₁ administrated. Thus, PGE₁-administration may potentially alleviate the radiation-induced skin injury.

Experience with carbon ion radiotherapy for WHO Grade 2 diffuse astrocytomas

PURPOSE

To assess outcomes of carbon ion radiotherapy for diffuse astrocytomas in adults.

METHODS AND MATERIALS

Between October 1994 and February 2002, 14 patients with diffuse astrocytoma, identified as eligible for carbon ion radiotherapy, were enrolled in a phase I/II clinical trial. Carbon ion radiotherapy was administered in 24 fractions over 6 weeks. The normal tissue morbidity was monitored carefully, and the carbon ion dose was escalated from 50.4 Gy equivalent (GyE) to 55.2 GyE. Patients were divided into two groups according to their carbon ion doses: a low-dose group in which 2 patients were irradiated with 46.2 GyE and 7 patients were irradiated with 50.4 GyE, and a high-dose group in which 5 patients were irradiated with 55.2 GyE.

RESULTS

Toxicities were within acceptable limits, and none of the patients developed Grade 3 or higher acute or late reactions. The median progression-free survival (PFS) time was 18 months for the low-dose group and 91 months for the high-dose group (p = 0.0030). The median overall survival (OS) time was 28 months for the low-dose group and not reached for the high-dose group (p = 0.0208).

CONCLUSION

High-dose group patients showed significant improvement in PFS and OS rates compared to those in the low-dose group, and both dose groups showed acceptable toxicity.

A qualitative analysis of acute skin toxicity among breast cancer radiotherapy patients

OBJECTIVES

One of the most common acute side effects of breast cancer radiotherapy is treatment-induced skin changes, referred to as skin toxicity. Yet no research to date has focused expressly on skin toxicity-related quality of life (QOL) in breast cancer radiotherapy patients. Therefore, our aim was to use qualitative approaches to better understand the impact of skin toxicity on QOL.

METHODS

Semistructured interviews were conducted with 20 women (Stage 0-III breast cancer), during their last week of external beam radiotherapy. Each interview was transcribed verbatim, and thematic analysis was performed.

RESULTS

Three themes were identified based on the interview responses: First, skin changes affect multiple dimensions of QOL. They cause physical discomfort, body image disturbance, emotional distress, and impair both day-to-day functioning and satisfaction with radiation treatment. Second, individual differences affect women's experiences. Generally African American women, younger women, women who are not currently in a relationship, women who are being treated during the summer, and women who are more invested in their appearance are more distressed by skin toxicity. Third, women use a variety of symptom management strategies including self-medication, complementary/alternative medicine approaches, and psychological strategies.

CONCLUSIONS

Implications of results are as follows: (1) skin toxicity affects numerous dimensions of QOL, and assessment approaches and psychosocial interventions should address this; (2) individual differences may affect the experience of skin toxicity and should be considered in treatment and education approaches; and (3) participants' own creativity and problem-solving should be used to improve the treatment experience.

[Mesenchymal stem cells transplantation in the treatment of radiation skin lesions]

Transplantation of mesenchymal stem cells, both at early and later stage after local exposure of rats source beta radiation dose, 90Sr/90Y 140 GR, stimulates recovery of damaged skin. Diminution area local radiation injuries and accelerate healing radiation ulcers. Clinically shows the high efficiency of the transplantations autologous mesenchymal stem cells in treatment of deep beam ulcers, intractable standard conservative treatment. Found promising application of mesenchymal stem cells for treatment of severe local radiation injuries and the need to develop the best possible conditions for their use.

Objective and longitudinal assessment of dermatitis after postoperative accelerated partial breast irradiation using high-dose-rate interstitial brachytherapy in patients with breast cancer treated with breast conserving therapy: reduction of moisture deterioration by APBI

PURPOSE

To objectively evaluate the radiation dermatitis caused by accelerated partial breast irradiation (APBI) using high-dose-rate interstitial brachytherapy.

PATIENTS AND METHODS

The skin color and moisture changes were examined using a newly installed spectrophotometer and corneometer in 22 patients who had undergone APBI using open cavity implant high-dose-rate interstitial brachytherapy (36 Gy in six fractions) and compared with the corresponding values for 44 patients in an external beam radiotherapy (EBRT) control group (50-60 Gy in 25-30 fractions within 5-6 weeks) after breast conserving surgery.

RESULTS

All values changed significantly as a result of APBI. The extent of elevation in a∗ (reddish) and reduction in L∗ (black) values caused by APBI were similar to those for EBRT, with slightly delayed recovery for 6-12 months after treatment owing to the surgical procedure. In contrast, only APBI caused a change in the b∗ values, and EBRT did not, demonstrating that the reduction in b∗ values (yellowish) depends largely on the surgical procedure. The changes in moisture were less severe after APBI than after EBRT, and the recovery was more rapid. The toxicity assessment using the Common Toxicity Criteria, version 3, showed that all dermatitis caused by APBI was Grade 2 or less.

CONCLUSION

An objective analysis can quantify the effects of APBI procedures on color and moisture cosmesis. The radiation dermatitis caused by APBI using the present schedule showed an equivalent effect on skin color and a less severe effect on moisture than the effects caused by standard EBRT.