Abstract
BackgroundRecent improvement of machinery evaluation for the skin changes in various therapies enabled us to evaluate fine changes quantitatively. In this study, we performed evaluation of the changes in radiation dermatitis (RD) using quantitative and qualitative methods, and verified the validity of the conventional qualitative assessment for clinical use.MethodsForty-three breast cancer patients received conventional fractionated radiotherapy to whole breast after breast-conserving surgery. Erythema, pigmentation and skin dryness were evaluated qualitatively, and biophysical parameters of RD were measured using a Multi-Display Device MDD4 with a Corneometer for capacitance, a Tewameter for transepidermal water loss (TEWL), a Mexameter for erythema index and melanin index. Measurements were performed periodically until 1 year.ResultsThe quantitative manifestations developed serially from skin erythema followed by dryness and pigmentation. Quantitative measurements detected the effects of irradiation earlier than that of qualitative indices. However, the grades of the domains in RD by qualitative and quantitative assessment showed similar time courses and peak periods. However, no significant correlation was observed between the skin dryness grade and skin barrier function. In contrast to serial increase in pigmentation grades, melanin index showed initial decrease followed by marked increase with significant correlation with pigmentation grades.ConclusionSubjectively and objectively measured results of RD were almost similar course and peak points through the study. Therefore, validity of the conventional qualitative scoring for RD is confirmed by the present quantitative assessments. Instrumental evaluations revealed the presence of modest inflammatory changes before radiotherapy and long-lasting skin dryness, suggesting indication of intervention for RD.
Highlights
The skin reactions and effects induced by radiation depend on several factors, including the irradiation area, fractionation dose, number of fractions, and total radiation time
The peak reaction time of Common Terminology Criteria for Adverse Events (CTCAE) and erythema grade were at the end of radiotherapy: week 5, but those of dryness and pigmentation were two weeks after end of radiotherapy
When changes in the CTCAE grade were compared with symptom-specific criteria, a moderate correlation was observed between the erythema grade (Table 1)
Summary
The skin reactions and effects induced by radiation depend on several factors, including the irradiation area (target volume), fractionation dose, number of fractions, and total radiation time. The most widely used qualitative grading scales are (1) the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 for the classification of acute radiation dermatitis, (2) the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) scale, or (3) the Late Effects Normal Tissue Task Force/Subjective, Objective, Management, and Analysis (LENT/SOMA) scale for the classification of chronic dermatitis [13,14,15] Both the CTCAE and RTOG/EORTC scale assess acute radiation effects on a scale from 0 to 4 in increments of 1. These scales enable finer classification and grading of radiation-induced skin toxicities, their reliability and validity remain largely unsupported by data because these increments require linear regression and accurate observations These evaluations have served as the basis for various recommendations regarding the timing and frequency of skin cooling and/or topical corticosteroid application as a method of reducing skin reactions [8,9,10]. Instrumental evaluations revealed the presence of modest inflammatory changes before radiotherapy and long-lasting skin dryness, suggesting indication of intervention for RD
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