-
Current Oncology (Toronto, Ont.) Aug 2010Radiation recall is a well-known phenomenon that involves the "recall" of an acute inflammatory reaction in a previously irradiated region after administration of...
Radiation recall is a well-known phenomenon that involves the "recall" of an acute inflammatory reaction in a previously irradiated region after administration of certain drugs. The most common type of radiation recall is radiation recall dermatitis, which involves the reoccurrence of an acute inflammatory skin reaction in previously irradiated skin. Most radiation recall reactions are attributable to chemotherapeutic agents. One previously reported case of radiation recall dermatitis occurred after administration of an antibiotic. The present case report is the second of radiation recall dermatitis involving an antibiotic: azithromycin.
PubMed: 20697522
DOI: 10.3747/co.v17i4.488 -
Dermatology and Therapy Jun 2016Ionizing radiation is an important treatment modality for a variety of malignant conditions. However, development of radiation-induced skin changes is a significant... (Review)
Review
Ionizing radiation is an important treatment modality for a variety of malignant conditions. However, development of radiation-induced skin changes is a significant adverse effect of radiation therapy (RT). Cutaneous repercussions of RT vary considerably in severity, course, and prognosis. When they do occur, cutaneous changes to RT are commonly graded as acute, consequential-late, or chronic. Acute reactions can have severe sequelae that impact quality of life as well as cancer treatment. Thus, dermatologists should be informed about these adverse reactions, know how to assess their severity and be able to determine course of management. The majority of measures currently available to prevent these acute reactions are proper skin hygiene and topical steroids, which limit the severity and decrease symptoms. Once acute cutaneous reactions develop, they are treated according to their severity. Treatments are similar to those used in prevention, but incorporate wound care management that maintains a moist environment to hasten recovery. Chronic changes are a unique subset of adverse reactions to RT that may develop months to years following treatment. Chronic radiation dermatitis is often permanent, progressive, and potentially irreversible with substantial impact on quality of life. Here, we also review the etiology, clinical manifestations, pathogenesis, prevention, and management of late-stage cutaneous reactions to radiotherapy, including chronic radiation dermatitis and radiation-induced fibrosis.
PubMed: 27250839
DOI: 10.1007/s13555-016-0120-y -
Ecancermedicalscience 2020Radiation recall (RR) is a fairly uncommon and unpredictable phenomenon caused by an acute inflammatory reaction in a previously irradiated area. Several antineoplastic...
BACKGROUND
Radiation recall (RR) is a fairly uncommon and unpredictable phenomenon caused by an acute inflammatory reaction in a previously irradiated area. Several antineoplastic drugs have been previously associated with RR reactions including anthracyclines and taxanes like docetaxel, paclitaxel or antimetabolites.
CASE PRESENTATION
Here we report for the first time a case of a recall reaction to Eribulin mesylate, a novel chemotherapeutic compound that affects microtubule polymerisation, approved for the treatment of metastatic or locally advanced breast cancers (BCs). We present the case of a 61-year-old female BC patient originally diagnosed with bilateral BC with metastatic disease that went through several lines of chemotherapy and radiation therapy (RT); RR reaction was observed following Eribulin treatment and sequential palliative RT.
CONCLUSION
This case report raises awareness about these fairly rare phenomena when prescribing Eribulin, or any new chemotherapeutic after RT to prevent and treat as early as possible to avoid further patient complications.
PubMed: 32104208
DOI: 10.3332/ecancer.2020.1006 -
Clinical Oncology (Royal College of... Jan 2023Objective evaluation of radiation dermatitis is important for analysing the correlation between the severity of radiation dermatitis and dose distribution in clinical...
AIMS
Objective evaluation of radiation dermatitis is important for analysing the correlation between the severity of radiation dermatitis and dose distribution in clinical practice and for reliable reporting in clinical trials. We developed a novel radiation dermatitis segmentation system based on convolutional neural networks (CNNs) to consistently evaluate radiation dermatitis.
MATERIALS AND METHODS
The radiation dermatitis segmentation system is designed to segment the radiation dermatitis occurrence area using skin photographs and skin-dose distribution. A CNN architecture with a dilated convolution layer and skip connection was designed to estimate the radiation dermatitis area. Seventy-three skin photographs obtained from patients undergoing radiotherapy were collected for training and testing. The ground truth of radiation dermatitis segmentation is manually delineated from the skin photograph by an experienced radiation oncologist and medical physicist. We converted the skin photographs to RGB (red-green-blue) and CIELAB (lightness (L), red-green (a) and blue-yellow (b)) colour information and trained the network to segment faint and severe radiation dermatitis using three different input combinations: RGB, RGB + CIELAB (RGBLAB) and RGB + CIELAB + skin-dose distribution (RGBLAB_D). The proposed system was evaluated using the Dice similarity coefficient (DSC), sensitivity, specificity and normalised Matthews correlation coefficient (nMCC). A paired t-test was used to compare the results of different segmentation performances.
RESULTS
Optimal data composition was observed in the network trained for radiation dermatitis segmentation using skin photographs and skin-dose distribution. The average DSC, sensitivity, specificity and nMCC values of RGBLAB_D were 0.62, 0.61, 0.91 and 0.77, respectively, in faint radiation dermatitis, and 0.69, 0.78, 0.96 and 0.83, respectively, in severe radiation dermatitis.
CONCLUSION
Our study showed that CNN-based radiation dermatitis segmentation in skin photographs of patients undergoing radiotherapy can describe radiation dermatitis severity and pattern. Our study could aid in objectifying the radiation dermatitis grading and analysing the reliable correlation between dosimetric factors and the morphology of radiation dermatitis.
Topics: Humans; Deep Learning; Image Processing, Computer-Assisted; Neural Networks, Computer; Radiodermatitis; Radiotherapy Planning, Computer-Assisted
PubMed: 35918275
DOI: 10.1016/j.clon.2022.07.001 -
Diagnostic and Interventional Imaging Nov 2019A variety of dermatologic complications can occur after interventional radiology procedures, including fluoroscopy-induced radiation dermatitis, thermal skin injury from... (Review)
Review
A variety of dermatologic complications can occur after interventional radiology procedures, including fluoroscopy-induced radiation dermatitis, thermal skin injury from tumor ablation, non-target embolization to the skin, allergic reactions related to interventional radiology procedures, and dermatitis and infections at catheter sites. Yet, interventional radiologists typically lack training in dermatology. This review focuses on recognition of dermatologic complications and introduces basic principles for management of these complications. By taking a more active role in the diagnosis, management, and follow-up of dermatologic complications, interventional radiologists can improve the care for patients suffering iatrogenic skin inury.
Topics: Adult; Aged; Burns; Catheter-Related Infections; Child; Child, Preschool; Cryosurgery; Drug Hypersensitivity; Embolization, Therapeutic; Female; Fluoroscopy; Humans; Ischemia; Male; Middle Aged; Photography; Radiation Injuries; Radiodermatitis; Radiography, Interventional
PubMed: 31302074
DOI: 10.1016/j.diii.2019.06.007 -
Radiation dose and radiation protection for patients and physicians during interventional procedure.Journal of Radiation Research 2010Although the wide acceptance of interventional radiology (IVR) procedures has led to increasing numbers of interventions being performed, the radiation doses from IVR... (Review)
Review
Although the wide acceptance of interventional radiology (IVR) procedures has led to increasing numbers of interventions being performed, the radiation doses from IVR are higher. Increasing numbers of case reports of patient radiation injury resulting from IVR are being published. Therefore, radiation protection during IVR poses a very important problem. To protect against radiation injury, the evaluation of radiation dose is essential. The radiation dose must be evaluated for each IVR x-ray machine and each laboratory, because it varies greatly. To obtain this information easily, and to ensure practical use of the radiation information, good relationships between interventionists and medical physicists are essential.
Topics: Algorithms; Angioplasty, Balloon, Coronary; Catheter Ablation; Dose-Response Relationship, Radiation; Humans; Patients; Physicians; Protective Clothing; Radiation Dosage; Radiation Injuries; Radiation Protection; Radiodermatitis; Radiology, Interventional; Radiometry; Scattering, Radiation
PubMed: 20339253
DOI: 10.1269/jrr.09112 -
Treatment outcomes after definitive radio(chemo)therapy for 17 lacrimal sac squamous cell carcinoma.The British Journal of Radiology Nov 2020Tumors of the lacrimal sac are rare and life-threatening. Because of their rarity, no extensive clinical data on their management and prognosis exist. We investigated... (Review)
Review
OBJECTIVES
Tumors of the lacrimal sac are rare and life-threatening. Because of their rarity, no extensive clinical data on their management and prognosis exist. We investigated the application of definitive radiation therapy and its outcome in patients with lacrimal sac squamous cell carcinoma (LSSCC).
METHODS
We retrospectively studied 17 patients with LSSCC at a single institution between 2003 and 2017. All the patients were treated with definitive radiotherapy, and 11 patients were delivered with cisplatin-based chemotherapy. The patients' clinical records were reviewed for symptoms, pathological types, the volume and dosimetry of the tumors and their adjacent structures, radiation coverage of lymph node drainage areas, treatment outcomes, and complications from definitive radiotherapy.
RESULTS
Median follow-up was 38.9 months, and age at diagnosis was 48 years.The 2-year and 5-year overall survival, progression-free survival, locoregional control, and disease metastasis-free survival rates were 94.1 and 84.7%, 88.2 and 73.5%, 93.8%, 94.1, and 78.4%, respectively. A total dose of 6600-7000 cGy was prescribed to the tumor. Levels Ⅰb, Ⅶa, Ⅷ, and Ⅸ were covered with the clinical target volume regardless of lymph involvement. Acute Grade 3 radiation dermatitis occurred in seven patients (17.6%), but no acute Grade 4 or Grade 5 toxicity of any type occurred. Seven (41.2%, 7/17) of the treated eyes had moderated vision impairments; 17.6% (3/17) of patients developed cataracts, and glaucoma and radiation retinopathy were found in 5.9% (1/17) of patients.
CONCLUSIONS
Definitive radiotherapy could be a treatment option for those who refuse surgery or have unresectable LSSCC.
ADVANCES IN KNOWLEDGE
Radiation alone is a treatment option for LSSCC.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Cataract; Chemoradiotherapy; Disease-Free Survival; Eye Neoplasms; Female; Glaucoma; Humans; Male; Middle Aged; Nasolacrimal Duct; Progression-Free Survival; Radiation Injuries; Radiodermatitis; Radiotherapy Dosage; Radiotherapy, Conformal; Retrospective Studies; Treatment Outcome; Vision Disorders; Young Adult
PubMed: 32970475
DOI: 10.1259/bjr.20190633 -
Radiation Oncology (London, England) Sep 2006Modern radiotherapy (RT) reduces the side effects at organ at risk. However, skin toxicity is still a major problem in many entities, especially head and neck cancer.... (Review)
Review
BACKGROUND
Modern radiotherapy (RT) reduces the side effects at organ at risk. However, skin toxicity is still a major problem in many entities, especially head and neck cancer. Some substances like chemotherapy provide a risk of increased side effects or can induce a "recall phenomenon" imitating acute RT-reactions months after RT. Moreover, some phototoxic drugs seem to enhance side effects of radiotherapy while others do not. We report a case of "radiation recall dermatitis" (RRD) one year after RT as a result of taking hypericin (St. John's wort).
CASE REPORT
A 65 year old man with completely resected squamous cell carcinoma of the epiglottis received an adjuvant locoregional RT up to a dose of 64.8 Gy. The patient took hypericin during and months after RT without informing the physician. During radiotherapy the patient developed unusual intensive skin reactions. Five months after RT the skin was completely bland at the first follow up. However, half a year later the patient presented erythema, but only within the area of previously irradiated skin. After local application of a steroid cream the symptoms diminished but returned after the end of steroid therapy. The anamnesis disclosed that the patient took hypericin because of depressive mood. We recommended to discontinue hypericin and the symptoms disappeared afterward.
CONCLUSION
Several drugs are able to enhance skin toxicity of RT. Furthermore, the effect of RRD is well known especially for chemotherapy agents such as taxans. However, the underlying mechanisms are not known in detail so far. Moreover, it is unknown whether photosensitising drugs can also be considered to increase radiation sensitivity and whether a recall phenomenon is possible. The first report of a hypericin induced RRD and review of the literature are presented. In clinical practise many interactions between drugs and radiotherapy were not noticed and if registered not published. We recommend to ask especially for complementary or alternative drugs because patients tend to conceal such medication as harmless.
Topics: Aged; Anthracenes; Carcinoma, Squamous Cell; Humans; Lung Neoplasms; Male; Perylene; Phytotherapy; Radiation Tolerance; Radiation-Sensitizing Agents; Radiodermatitis; Radiotherapy
PubMed: 16948841
DOI: 10.1186/1748-717X-1-32 -
Supportive Care in Cancer : Official... Jul 2020Although topical agents are often provided during radiation therapy, there is limited consensus and evidence for their use prophylactically to prevent or reduce... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Although topical agents are often provided during radiation therapy, there is limited consensus and evidence for their use prophylactically to prevent or reduce radiation dermatitis.
METHODS
This was a multi-site, randomized, placebo-controlled, blinded study of 191 breast cancer patients to compare the prophylactic effectiveness of three topical agents (Curcumin, HPR Plus™, and Placebo) for reducing radiation dermatitis and associated pain. Patients applied the topical agent to their skin in the radiation area site three times daily starting the first day of radiation therapy (RT) until 1 week after RT completion.
RESULTS
Of the 191 randomized patients, 171 patients were included in the final analyses (87.5% white females, mean age = 58 (range = 36-88)). Mean radiation dermatitis severity (RDS) scores did not significantly differ between study arms (Curcumin = 2.68 [2.49, 2.86]; HPR Plus™ = 2.64 [2.45, 2.82]; Placebo = 2.63 [2.44, 2.83]; p = 0.929). Logistic regression analyses showed that increased breast field separation positively correlated with increased radiation dermatitis severity (p = 0.018). In patients with high breast field separation (≥ 25 cm), RDS scores (Curcumin = 2.70 [2.21, 3.19]; HPR Plus™ = 3.57 [3.16, 4.00]; Placebo = 2.95 [2.60, 3.30]; p = 0.024) and pain scores (Curcumin = 0.52 [- 0.28, 1.33]; HPR Plus™ = 0.55 [- 0.19, 1.30]; Placebo = 1.73 [0.97, 2.50]; p = 0.046) significantly differed at the end of RT.
CONCLUSIONS
Although there were no significant effects of the treatment groups on the overall population, our exploratory subgroup analysis suggests that prophylactic treatment with topical curcumin may be effective for minimizing skin reactions and pain for patients with high breast separation (≥ 25 cm) who may have the worst skin reactions.
Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Female; Humans; Middle Aged; Pain; Radiodermatitis
PubMed: 31758326
DOI: 10.1007/s00520-019-05166-5 -
JAMA Oncology Jul 2023Pathogenesis of acute radiation dermatitis (ARD) is not completely understood. Pro-inflammatory cutaneous bacteria may contribute to cutaneous inflammation after...
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.
Topics: Humans; Female; Male; Staphylococcus aureus; Prospective Studies; Cohort Studies; Radiodermatitis; Head and Neck Neoplasms
PubMed: 37140927
DOI: 10.1001/jamaoncol.2023.0454