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Oncology Letters May 2016Currently in Japan, breast-conserving therapy, consisting of breast-conserving surgery and post-operative radiation therapy, is performed frequently for the treatment of...
Currently in Japan, breast-conserving therapy, consisting of breast-conserving surgery and post-operative radiation therapy, is performed frequently for the treatment of invasive breast cancer. It has been demonstrated that radiation therapy not only prevents recurrence in the preserved breast, but that it also contributes to improved patient survival. The present study describes the case of a 37-year-old woman with radiation recall dermatitis that occurred 6 years and 4 months after breast-conserving surgery. Erythema with a relatively distinct border was observed at the irradiated site on the left breast; eczema was diagnosed by a dermatologist. Inflammatory breast cancer was ruled out, since chest X-ray, abdominal ultrasound and bone scintigraphy were negative. Following ~1 month of topical corticosteroid application and oral second generation antihistamine treatment, the erythema was alleviated and the subjective symptoms also disappeared. Only a few cases of radiation recall dermatitis have been described in the fields of radiology and dermatology, but not yet in the surgical field. In the future, the incidence of radiation recall dermatitis is predicted to increase due to the increasing number of patients undergoing breast-conserving therapy. Whether in the surgical, radiological or dermatological field, if erythema is detected at the irradiated site during post-operative follow-up, routine care should be provided, keeping in mind the possibility of radiation recall dermatitis and inflammatory breast cancer.
PubMed: 27123065
DOI: 10.3892/ol.2016.4346 -
International Journal of Radiation... Jul 2022Radiation dermatitis (RD) is a common, unpleasant side effect of patients receiving radiation therapy. In clinical practice, the severity of RD is graded manually...
PURPOSE
Radiation dermatitis (RD) is a common, unpleasant side effect of patients receiving radiation therapy. In clinical practice, the severity of RD is graded manually through visual inspection, which is labor intensive and often leads to large interrater variations. To overcome these shortcomings, this study aimed to develop an automatic RD assessment based on deep learning (DL) techniques that could efficiently assist the RD severity classification in clinical application.
METHODS AND MATERIALS
A total of 1205 photographs of the head and neck region were collected from patients with nasopharyngeal carcinoma (NPC) undergoing radiation therapy. The severity of RD in these photographs was graded by 5 qualified assessors based on the Radiation Therapy Oncology Group 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 classifier (DenseNet-121) was applied to RD severity classification. Dice similarity coefficient 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 dice similarity coefficients 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 = .683).
CONCLUSIONS
We have successfully demonstrated a DL-based method for automatic assessment of RD severity in patients with NPC. This method holds great potential for efficient and effective assessing and monitoring of RD in patients with NPC.
Topics: Deep Learning; Humans; Image Processing, Computer-Assisted; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Organs at Risk; Radiodermatitis; Tomography, X-Ray Computed
PubMed: 35304306
DOI: 10.1016/j.ijrobp.2022.03.011 -
Cancer Treatment and Research... 2021Radiation dermatitis (RD) is a side effect that frequently arises during radiotherapy (RT) in breast cancer patients. The present study investigates possible predictive...
PURPOSE
Radiation dermatitis (RD) is a side effect that frequently arises during radiotherapy (RT) in breast cancer patients. The present study investigates possible predictive factors of RD, as well as the use of skin treatments to manage symptoms.
METHODS
Demographic and treatment characteristics were collected retrospectively, while skin symptoms and treatments were collected prospectively for patients who received adjuvant RT between December 2013 and November 2015. Patients were seen weekly by clinicians throughout treatment, during which a clinician-reported survey was completed on RD symptoms and skin treatments. Possible predictive factors were correlated with skin outcomes through a univariate ordinal logistic regression analysis.
RESULTS
A total of 1093 patients were included in this analysis. Predictive factors for erythema included dose fractionation (p<0.0001), tissue volume irradiated by tangential fields (p = 0.01), and administration of a boost (p = 0.005). High BMI (≥30 kg/m) (p = 0.0004) and boost (p = 0.02) were predictive of edema. A dose of 50 Gy/25 (p<0.0001) and a high irradiated tissue volume (p = 0.0001) were predictive of desquamation. A dose of 50 Gy/25 (p = 0.0005) and high BMI (p = 0.02) were predictors of pain. Bolus use was the only factor associated with bleeding (p = 0.02). Patients who developed desquamation were likely to receive corticosteroids/antihistamines (p<0.0001), topical antibiotics/antifungals (p<0.001), and dressings (p<0.0001).
CONCLUSION
The findings of this study provide evidence of potential predictors of RD and methods of symptom management based on symptom severity. Prevention of RD is needed among high-risk groups, such as patients with a high BMI or receiving a standard fractionation, boost, or bolus.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Female; Humans; Middle Aged; Radiodermatitis; Radiotherapy, Adjuvant
PubMed: 34082363
DOI: 10.1016/j.ctarc.2021.100403 -
Radiation Oncology Journal Dec 2014Tamoxifen and radiotherapy are used in breast cancer treatment worldwide. Radiation recall dermatitis (RRD), induced by tamoxifen, has been rarely reported. Herein, we...
Tamoxifen and radiotherapy are used in breast cancer treatment worldwide. Radiation recall dermatitis (RRD), induced by tamoxifen, has been rarely reported. Herein, we report a RRD case induced by tamoxifen. A 47-year-old woman had a right quadrantectomy and an axillary lymph node dissection due to breast cancer. The tumor was staged pT2N0; it was hormone receptor positive, and human epidermal growth factor receptor 2 negative. The patient received adjuvant chemotherapy followed by tamoxifen and radiotherapy. After 22 months of tamoxifen, the patient developed a localized heating sensation, tenderness, edema, and redness at the irradiated area of the right breast. The symptoms improved within 1 week without treatment. Three weeks later, however, the patient developed similar symptoms in the same area of the breast. She continued tamoxifen before and during dermatitis, and symptoms resolved within 1 week.
PubMed: 25568855
DOI: 10.3857/roj.2014.32.4.262 -
Radiation Oncology Journal Dec 2023Radiation recall presents as an acute inflammatory reaction triggered by systemic therapy, usually chemotherapy, and is typically limited to an area that was previously...
Radiation recall presents as an acute inflammatory reaction triggered by systemic therapy, usually chemotherapy, and is typically limited to an area that was previously irradiated. Radiation recall reactions are generally self-limiting and most commonly occur in the skin. Many systemic agents have been described to elicit a radiation recall reaction, but the exact pathogenesis is largely unknown. Here, we describe the first reported case of radiation recall dermatitis following cetuximab. While cetuximab is associated with other skin reactions, oncologists should not exclude radiation recall dermatitis as a potential complication of cetuximab infusion in patients with prior radiation, and special attention should be paid to the pattern of skin changes both in terms of location and chronology.
PubMed: 38185934
DOI: 10.3857/roj.2023.00577 -
PloS One 2023We applied a radiomics approach to skin surface images to objectively assess acute radiation dermatitis in patients undergoing radiotherapy for breast cancer.
PURPOSE
We applied a radiomics approach to skin surface images to objectively assess acute radiation dermatitis in patients undergoing radiotherapy for breast cancer.
METHODS
A prospective cohort study of 20 patients was conducted. Skin surface images in normal, polarized, and ultraviolet (UV) modes were acquired using a skin analysis device before starting radiotherapy ('Before RT'), approximately 7 days after the first treatment ('RT D7'), on 'RT D14', and approximately 10 days after the radiotherapy ended ('After RT D10'). Eighteen types of radiomic feature ratios were calculated based on the values acquired 'Before RT'. We measured skin doses in ipsilateral breasts using optically stimulated luminescent dosimeters on the first day of radiotherapy. Clinical evaluation of acute radiation dermatitis was performed using the Radiation Therapy Oncology Group scoring criteria on 'RT D14' and 'After RT D10'. Several statistical analysis methods were used in this study to test the performance of radiomic features as indicators of radiodermatitis evaluation.
RESULTS
As the skin was damaged by radiation, the energy for normal mode and sum variance for polarized and UV modes decreased significantly for ipsilateral breasts, whereas contralateral breasts exhibited a smaller decrease with statistical significance. The radiomic feature ratios at 'RT D7' had strong correlations to skin doses and those at 'RT D14' and 'after RT D10' with statistical significance.
CONCLUSIONS
The energy for normal mode and sum variance for polarized and UV modes demonstrated the potential to evaluate and predict acute radiation, which assists in its appropriate management.
Topics: Humans; Female; Radiodermatitis; Breast Neoplasms; Prospective Studies; Breast; Skin
PubMed: 37883380
DOI: 10.1371/journal.pone.0293071 -
Strahlentherapie Und Onkologie : Organ... May 2016Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin, mainly subsequent to the administration of certain... (Review)
Review
BACKGROUND
Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin, mainly subsequent to the administration of certain chemotherapeutics. Here we present a rare case of RRD induced by the oral multikinase inhibitor sorafenib.
CASE REPORT
A 77-year-old male with hepatocellular carcinoma was irradiated at ten different sites for bone metastases with 20-36 Gray in 5-12 fractions from January to March 2015. Sorafenib 400 mg was administered twice daily from mid-March. One week later the patient presented with fever and erythematous lesions on the right upper arm, mandible, and trunk. All skin symptoms were confined to previously irradiated areas. After RRD was diagnosed by exclusion of other causes and skin biopsy, sorafenib was paused. With the administration of topical corticosteroids and oral antihistamines, the skin reaction subsided within several days. Sorafenib was readministered after 3 weeks, which did not lead to recurrence of RRD but did cause fluctuating fever.
DISCUSSION
Only four other such cases have been reported in the literature and WHO pharmacovigilance database on individual case safety reports. The current report is the first to show a potential relationship between the severity of sorafenib-induced RRD and radiation dose, histopathological features, and simultaneous acute radiation dermatitis and mucositis.
CONCLUSION
RRD induced by sorafenib is a rare phenomenon, but should be considered in patients showing erythematous skin lesions 1-2 weeks after initiation of the drug, predominantly in areas where skin has been irradiated with an equivalent dose ≥ 30 Gy. Discontinuation of sorafenib with possible readministration should be evaluated with respect to the clinical situation and severity of reaction.
Topics: Aged; Antineoplastic Agents; Bone Neoplasms; Humans; Male; Niacinamide; Phenylurea Compounds; Protein Kinase Inhibitors; Radiodermatitis; Radiotherapy, Conformal; Sorafenib; Treatment Outcome
PubMed: 26907093
DOI: 10.1007/s00066-016-0950-7 -
Journal of Cancer Research and... 2022Radiation-induced mucositis and dermatitis are severe side effects and compromise the health of the head-and-neck cancer patient undergoing treatment. Zinc...
BACKGROUND
Radiation-induced mucositis and dermatitis are severe side effects and compromise the health of the head-and-neck cancer patient undergoing treatment. Zinc supplementation during the course of the treatment is shown to have protective effects against both radiation-induced mucositis and dermatitis. The aim of this study was to understand whether the level of serum zinc has an effect on the development of mucositis and dermatitis.
MATERIALS AND METHODS
This was noninterventional study where the levels of serum zinc were ascertained before the start of treatment by spectrophotometric methods. The patients were treated every day with no more than one fraction of 2 Gy per day, five times a week without any intended gaps for a planned target dose of 60-70 Gy (6-7 consecutive weeks). The patients were assessed for radiation-induced dermatitis and mucositis in accordance with the standard guidelines. The association between the levels of serum zinc with the development of different grades of mucositis and dermatitis (on the day of development) was ascertained using the Pearson correlation coefficient (r). A statistical value of P < 0.05 was considered to be statistically significant.
RESULTS
A total of 52 consecutive patients satisfying the inclusion criteria were enrolled. The results indicate that serum zinc levels showed a significant correlation (r = 0.29; P < 0.038) for Grade 1, while it was insignificant for Grades 2 and 3. For dermatitis, a significant correlation for all the grades (Grade 1 [r = 0.28; P < 0.043]; Grade 2 [r = 0.39; P < 0.006]; and Grade 3 [r = 0.49; P < 0.047]) was observed.
CONCLUSIONS
For the first time, the results of this pilot study indicate that the serum level of zinc had an inverse association with the early development of mucositis and dermatitis, with better effects seen in dermatitis where it was also effective in Grades 2 and 3.
Topics: Head and Neck Neoplasms; Humans; Mucositis; Pilot Projects; Radiodermatitis; Radiotherapy; Stomatitis; Zinc
PubMed: 35381760
DOI: 10.4103/jcrt.JCRT_344_20 -
Scientific Reports Aug 2023To evaluate the safety and effectiveness of epigallocatechin-3-gallate (EGCG) solution treating the acute severe dermatitis in patients receiving radiotherapy. This...
To evaluate the safety and effectiveness of epigallocatechin-3-gallate (EGCG) solution treating the acute severe dermatitis in patients receiving radiotherapy. This phase I research enrolled patients with thoracic cancer receiving radiotherapy at Shandong Cancer Hospital and Institute in Shandong, China. EGCG solution was sprayed to the radiation field when grade III radiation-induced dermatitis (RID) first appearance. EGCG concentration escalated from 660 to 2574 μmol/L using modified-Fibonacci dose-escalation. RID and related symptoms were followed up every day. Between March 2021 and November 2021, 19 patients were enrolled in this phase I research. The median dose of grade III RID first observation was 44 Gy (30.6-52 Gy). As the EGCG treatment was performed continuously, all these grade III RID reactions were significantly decreased to grade I or grade II RID at three days after use of EGCG (p < 0.001). Significant relief can be observed in burning sensation (p < 0.001), tractive sensation (p < 0.001), tenderness (p < 0.001), erythema (p < 0.001), itching (p < 0.001) and pain (p < 0.001) after 15 days of EGCG treatment. No radiation therapy delay or interruption for all 19 patients. No adverse events were observed and reported associated with EGCG. The highest dose of this Phase I trial (2574 μmol/L) was recommended for continuous Phase II trial for further evaluation. In this phase I clinical research, use of EGCG solution is safe and can significantly relief grade III RID in patients receiving radiotherapy. Thus, EGCG might be a new choice for acute sever RID.Trial Registration: ClinicalTrials.gov Identifier: NCT02580279 (Full date of first registration: 12/2014).
Topics: Humans; Neoplasms; Dermatitis; Catechin; Radiodermatitis; Acute Disease
PubMed: 37620508
DOI: 10.1038/s41598-023-40881-4 -
International Wound Journal Aug 2023Ulcer in radiation-damaged tissue is a dilemma with limited treatment strategies. The study aimed to evaluate the safety and efficacy of regional flaps for patients with...
Ulcer in radiation-damaged tissue is a dilemma with limited treatment strategies. The study aimed to evaluate the safety and efficacy of regional flaps for patients with post-radiation ulcers through a 10-year experience. A retrospective study of consecutive patients with post-radiation ulcers at a single institute from 2012 to 2022 was conducted. Reconstruction included complete excision of irradiated tissue and coverage with well-vascularised tissue, including local flaps, regional flaps and free flaps. Study outcomes included complications, reoperation rates, overall flap success and recurrence rates. Thirteen patients (six males and seven females; mean age, 56.85 ± 13.87 years) with a mean 10-month history of post-radiation ulcers were enrolled. Ulcers are predominantly located in the chest (n = 3, 23.1%), head (n = 2, 15.4%) and neck (n = 2, 15.4%), with a mean size of 33.1 cm (range from 1 cm to 120 cm ). Eleven patients underwent reconstruction with 15 regional flaps and three local flaps, one patient received a free anterolateral thigh fasciocutaneous flap and one patient underwent amputation. Among these 15 regional flaps, one (6.7%) had wound dehiscence and four (26.7%) had localised necrosis requiring reoperation. In addition, one patient with a non-healing sinus tract underwent reoperation. The overall success rate of the regional flap was 100% and no recurrence was observed with a mean follow-up of 23.3 months. Regional flaps seem a safe and effective reconstructive method for post-radiation ulcers.
Topics: Male; Female; Humans; Adult; Middle Aged; Aged; Ulcer; Plastic Surgery Procedures; Retrospective Studies; Skin Ulcer; Free Tissue Flaps; Radiodermatitis; Treatment Outcome
PubMed: 36751857
DOI: 10.1111/iwj.14103