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Strahlentherapie Und Onkologie : Organ... Jul 2023We present a case of mild radiation recall dermatitis triggered by cisplatin chemotherapy given simultaneously to re-irradiation. The dermatitis area correlated to skin...
We present a case of mild radiation recall dermatitis triggered by cisplatin chemotherapy given simultaneously to re-irradiation. The dermatitis area correlated to skin exposure of the previous radiation therapy, characterizing the reaction clearly as a recall. Cisplatin has not yet been recognized as a potential trigger for recall reactions. Although it was part of several reported multidrug trigger combinations, all review works referred to cisplatin as not suspicious, suggesting the combination partner as the effector. We performed a focused systematic literature review aiming to re-evaluate the real role of cisplatin as a (co-)triggering factor. In total, 30 reported cases were found, 90% triggered by multidrug combinations. The latter tended to cause more severe symptoms. Besides findings supporting the 20 Gy-threshold theory, no correlation between radiation dose and severity or prevalence was found. Recognition of cisplatin as a trigger of the recall phenomenon and its supportive management may prevent unnecessary cessation of systemic chemotherapy. Systematic reporting of recall events as a secondary endpoint of prospective clinical trials applying radiation therapy could support understanding the recall phenomenon.
Topics: Humans; Cisplatin; Prospective Studies; Radiodermatitis
PubMed: 36920507
DOI: 10.1007/s00066-023-02059-9 -
International Ophthalmology Jun 2023Orbital lymphoma is one of the most common adult orbital malignancies, accounting for approximately 10% of all orbital tumors. This study aimed to analyze the effects of...
OBJECTIVES
Orbital lymphoma is one of the most common adult orbital malignancies, accounting for approximately 10% of all orbital tumors. This study aimed to analyze the effects of surgical resection and orbital iodine-125 brachytherapy implantation for orbital lymphoma.
PATIENTS AND METHODS
This was a retrospective study. Clinical data of 10 patients were collected from October 2016 to November 2018 and followed up to March 2022. Patients underwent the primary surgery for maximal safe removal of the tumor. After a pathologic diagnosis of a primary orbital lymphoma was established, iodine-125 seed tubes were designed based on the tumor size and invasion range, and direct vision was placed into the nasolacrimal canal or/and under the orbital periosteum around the resection cavity during the secondary surgery. Then, follow-up data, including the general situation, ocular condition, and tumor recurrence, were recorded.
RESULTS
Of the 10 patients, the pathologic diagnoses included extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (6 cases), small lymphocytic lymphoma (1 case), mantle cell lymphoma (2 cases), and diffuse large B-cell lymphoma (1 case). The number of seeds implanted ranged from 16 to 40. The follow-up period ranged between 40 and 65 months. All patients in this study were alive and well had tumors that were completely controlled. No tumor recurrences or metastases occurred. Three patients had dry eye syndrome and two patients had abnormal facial sensation. No patient had radiodermatitis involving the skin around the eye, and no patient had radiation-related ophthalmopathy.
CONCLUSIONS
Based on preliminary observations, iodine-125 brachytherapy implantation appeared to be a reasonable alternative to external irradiation for orbital lymphoma.
Topics: Adult; Humans; Orbital Neoplasms; Brachytherapy; Retrospective Studies; Neoplasm Recurrence, Local; Lymphoma, B-Cell, Marginal Zone
PubMed: 36906873
DOI: 10.1007/s10792-022-02594-x -
Physiological Reports Mar 2023Radiodermatitis (RD) occurs in 95% of cancer patients undergoing radiation therapy. At present, there is no effective treatment for the management of this complication... (Review)
Review
Radiodermatitis (RD) occurs in 95% of cancer patients undergoing radiation therapy. At present, there is no effective treatment for the management of this complication of radiotherapy. Turmeric (Curcuma longa) is a polyphenolic and biologically active natural compound with various pharmacological functions. The aim of this systematic review was to determine the efficacy of curcumin supplementation for reducing RD severity. This review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive literature search was conducted in Cochrane library, PubMed, Scopus, Web of Science, and MEDLINE databases. A total of seven studies comprising 473 cases and 552 controls were included in this review. Four studies demonstrated that curcumin supplementation had a beneficial effect on RD intensity. These data provide evidence for the potential clinical use of curcumin in supportive cancer care. Further large prospective and well-designed trials are warranted to exactly determine the "real effective extract, supplemental form and dose of curcumin" for RD prevention and treatment of patients receiving radiotherapy.
Topics: Humans; Radiodermatitis; Curcuma; Curcumin; Prospective Studies; Databases, Factual
PubMed: 36872842
DOI: 10.14814/phy2.15624 -
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 -
Plastic and Reconstructive Surgery.... Feb 2023Approximately 80% of patients submitted to radiotherapy develop radiodermatitis. Photobiomodulation based on light-emitted diode (LED) is one of the therapeutic...
UNLABELLED
Approximately 80% of patients submitted to radiotherapy develop radiodermatitis. Photobiomodulation based on light-emitted diode (LED) is one of the therapeutic strategies for treating inflammation. This study aimed to investigate the effect of the photobiomodulation with two wavelengths, in an acute radiodermatitis animal model.
METHODS
Twenty rats were submitted to one radiotherapy session. After 15 days, the rats that developed radiodermatitis were divided into control groups, LED-630 nm, LED-850 nm, and LED-630 + 850 nm. The treatment regimen was one session lasting 10 minutes on alternate days for 21 days. We analyzed macroscopy aspects (RTOG scale), vascular density, dermal appendages, VEGF-a, TNF-alpha, MMP-9, and MMP-9 genic expression level.
RESULTS
All LED groups revealed a two-point reduction on the radiodermatitis severity grade compared with the baseline classification. Dermal appendage and vascular analysis showed a higher counting in all LED groups compared to control. This study showed dermal appendages twice in the 630/850 nm group compared with the control group. The 630/850 nm group showed six times more arterioles than the control group. Regarding genic expression, this study showed a 10-fold decrease between LED-630 nm versus LED-630 + 850 nm ( = 0.02) interleukin-10 expression and a 12-fold decrease between control versus LED-630 nm ( = 0.006) and LED-850 nm ( = 0.002) in TNF-alpha.
CONCLUSION
LED (630 nm, 850 nm, and 630 nm + 850 nm) showed benefit in the treatment of radiodermatitis, and the association of the 630 nm + 850 nm and 630 nm parameters demonstrated the best macroscopic and microscopic results.
PubMed: 36751505
DOI: 10.1097/GOX.0000000000004809 -
Flap application in reconstructive surgery to manage severe radiation-induced ulcers: a case series.Wounds : a Compendium of Clinical... Jan 2023Radiation-induced ulceration is a late-stage skin reaction after RT for cancer treatment.
INTRODUCTION
Radiation-induced ulceration is a late-stage skin reaction after RT for cancer treatment.
OBJECTIVE
The present study examined the use of a single-stage reconstructive procedure to manage radiation-related wounds.
MATERIALS AND METHODS
Nine patients with radiation-induced chronic ulcer with accompanying severe complications were admitted to the Plastic, Reconstructive, and Regenerative Center of Viet Nam National Burn Hospital between October 2015 and September 2019. The patients ranged in age from 49 to 77 years. Complications included exposed cheekbone (n = 1), exposed trachea (n = 1), exposed carotid artery (n = 2), exposed axillary artery (n = 2), exposed pleura (n = 1), and exposed pericardium (n = 2). Flap type used to achieve defect coverage after debridement was individualized to each patient and included ALT, LD, SCA, and DIEP flaps. Additionally, a high-density polyethylene was used to reconstruct the trachea to recover breathing function in the patient with exposed trachea.
RESULTS
Complete survival of all flaps was achieved. Most vital organs (the trachea, axillary artery, and carotid artery) were covered. Hospital length of stay ranged from 15 to 120 days.
CONCLUSIONS
The successful management of patients with severe complications suggests that immediate single-stage reconstruction may be a valuable option for managing radiation-induced ulcers.
Topics: Humans; Middle Aged; Aged; Plastic Surgery Procedures; Ulcer; Surgery, Plastic; Debridement; Surgical Flaps; Skin Ulcer; Radiodermatitis; Treatment Outcome
PubMed: 36749991
DOI: 10.25270/wnds/21090 -
Journal of Lasers in Medical Sciences 2022Radiodermatitis (RD) is the most common side-effect of radiation therapy, yet its prevention and treatment through photobiomodulation therapy (PBMT) have demonstrated... (Review)
Review
Radiodermatitis (RD) is the most common side-effect of radiation therapy, yet its prevention and treatment through photobiomodulation therapy (PBMT) have demonstrated promising results. This study aimed to synthesize the evidence concerning the use of PBMT in managing RD among breast cancer patients undergoing radiation therapy. This is a systematic review with no time restrictions, based on the methodology proposed by the Joanna Briggs Institute (JBI), including such databases as PubMed, Cochrane, Web of Science, Scopus, and CINAHL. The studies were selected based on the following inclusion criteria: female participants over 18 years of age and females having breast cancer and undergoing radiation therapy using a three-dimensional technique or an intensity-modulated radiation therapy (IMRT) technique. Two reviewers assessed the methodological quality using the JBI Critical Appraisal Checklist, and the report was described based on PRISMA guidelines. Red and infrared wavelengths were used. Device power ranged from 1.1 W to 0.08 W for continuous modes and 25 W for pulsed mode, resulting in a 3 and 4 J/cm fluence, applied throughout radiation therapy, leading to a reduced severity in cutaneous reactions. PBMT can reduce the severity of RD. New clinical trials are required to standardize protocols, given the scarcity of studies for the adopted site and methodological diversity.
PubMed: 36743146
DOI: 10.34172/jlms.2022.42 -
CMAJ : Canadian Medical Association... Jan 2023
Topics: Humans; Radiodermatitis; Liver Neoplasms
PubMed: 36690366
DOI: 10.1503/cmaj.221122 -
Journal of Cancer Research and... Dec 2022To investigate the incidence and influencing factors of acute radiation dermatitis (ARD) induced by radiotherapy in postoperative patients with breast cancer.
AIMS
To investigate the incidence and influencing factors of acute radiation dermatitis (ARD) induced by radiotherapy in postoperative patients with breast cancer.
METHODS AND MATERIALS
A retrospective analysis was conducted on 598 patients with breast cancer who received postoperative radiotherapy from November 18, 2014 to September 14, 2019. The radiotherapy technology included two-dimensional radiotherapy, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and tomotherapy. The occurrence of ARD in patients was then followed up and recorded. The independent risk factors for radiation-induced dermatitis were analyzed by using an orderly logistic regression model.
RESULTS
Of the 598 patients, 431 had mild skin reactions, including pigmentation and dry desquamation (grade 1), 151 developed wet desquamation and tender erythema (grade 2), and 16 had severe skin reactions, including flaky wet scaling and erosion (grade 3). There were no grade 4 skin reactions. The severity of ARD was independent of the following factors: Age, diabetes, allergy, quadrant, pathological type, the clinical stage, the tumor stage, triple-negative breast cancer, ki-67 expression, adjuvant chemotherapy, endocrine therapy, targeted therapy, radiotherapy area, and boost irradiation. However, it was found to be dependent on the body mass index, surgery type, radiotherapy technique, node stage, and the prophylactic use of topical agents.
CONCLUSIONS
ARD in response to postoperative radiotherapy in patients with breast cancer is common and mild. Clinicians and patients need to cultivate awareness of the potential risk factors involved and then intervene to alleviate skin reactions and improve the quality of life.
Topics: Humans; Female; Radiodermatitis; Breast Neoplasms; Retrospective Studies; Quality of Life; Radiotherapy, Intensity-Modulated; Risk Factors; Radiotherapy, Adjuvant
PubMed: 36647948
DOI: 10.4103/jcrt.jcrt_1203_22 -
Radiation Oncology (London, England) Jan 2023Radiation dermatitis is a major concern in intensity modulated proton therapy (IMPT) for head and neck cancer (HNC) despite its demonstrated superiority over... (Comparative Study)
Comparative Study
Radiation dermatitis is a major concern in intensity modulated proton therapy (IMPT) for head and neck cancer (HNC) despite its demonstrated superiority over contemporary photon radiotherapy. In this study, dose surface histogram data extracted from forty-four patients of HNC treated with IMPT was used to predict the normal tissue complication probability (NTCP) of skin. Grades of NTCP-skin were clustered using the K-means clustering unsupervised machine learning (ML) algorithm. A new skin-sparing IMPT (IMPT-SS) planning strategy was developed with three major changes and prospectively implemented in twenty HNC patients. Across skin surfaces exposed from 10 (S10) to 70 (S70) GyRBE, the skin's NTCP demonstrated the strongest associations with S50 and S40 GyRBE (0.95 and 0.94). The increase in the NTCP of skin per unit GyRBE is 0.568 for skin exposed to 50 GyRBE as compared to 0.418 for 40 GyRBE. Three distinct clusters were formed, with 41% of patients in G1, 32% in G2, and 27% in G3. The average (± SD) generalised equivalent uniform dose for G1, G2, and G3 clusters was 26.54 ± 6.75, 38.73 ± 1.80, and 45.67 ± 2.20 GyRBE. The corresponding NTCP (%) were 4.97 ± 5.12, 48.12 ± 12.72 and 87.28 ± 7.73 respectively. In comparison to IMPT, new IMPT-SS plans significantly (P < 0.01) reduced SX GyRBE, gEUD, and associated NTCP-skin while maintaining identical dose volume indices for target and other organs at risk. The mean NTCP-skin value for IMPT-SS was 34% lower than that of IMPT. The dose to skin in patients treated prospectively for HNC was reduced by including gEUD for an acceptable radiation dermatitis determined from the local patient population using an unsupervised MLA in the spot map optimization of a new IMPT planning technique. However, the clinical finding of acute skin toxicity must also be related to the observed reduction in skin dose.
Topics: Humans; Head and Neck Neoplasms; Organs at Risk; Proton Therapy; Radiodermatitis; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Unsupervised Machine Learning
PubMed: 36639667
DOI: 10.1186/s13014-023-02201-y