Radiation Dermatitis Research Articles

Correlation of CTCAE and patient-reported breast radiation dermatitis symptom scores

Correlation of CTCAE and patient-reported breast radiation dermatitis symptom scores

Microorganisms isolated from thermoplastic masks and storage racks in head and neck cancer patients with radiation dermatitis.

Healthcare-associated infections (HAIs) remain a critical public health issue, as they contribute to prolonged treatment duration, increased healthcare costs, and heightened risks of morbidity and mortality. In head and neck cancer patients undergoing radiotherapy, thermoplastic masks (TMs), which come into direct contact with the skin, represent a potential vector for infection. Additionally, the storage racks where these masks are kept may also facilitate microorganism transmission. Our study aimed to isolate and identify microorganisms from infective skin lesions secondary to radiation dermatitis in head and neck cancer patients, as well as from the TMs and storage racks, and to evaluate the antibiotic resistance profiles of the isolated microorganisms. The study included 71 locally advanced head and neck cancer patients who underwent radiotherapy between August 2022 and November 2023. Patients were monitored daily, and their skin evaluations were made according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Grade 2 and 3 radiodermatitis was observed in 29 of these 71 patients. Samples were collected using sterile swabs from the skin lesions on the head and neck area, the inner surfaces of the TM, and the storage rack from 29 patients. Samples were inoculated into enrichment and selective media. After the growing microorganisms were identified, antimicrobial susceptibility was evaluated using conventional methods and automated systems according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. At least one type of microorganism was isolated from the skin samples of infected patients, and double growth was detected in two patients. Among the samples, 2 were methicillin-resistant coagulase-negative Staphylococcus (MRCNS), 1 was methicillin-resistant Staphylococcus aureus (MRSA), 1 was Candida albicans (C. albicans), 15 were methicillin-sensitive coagulase-negative Staphylococcus (MSCNS), 1 was methicillin-sensitive Staphylococcus aureus (MSSA), 1 was Bacillus subspecies (Bacillus spp.) and 3 were Corynebacterium diphtheriae (C. diphtheriae). Coagulase-negative Staphylococcus strains were isolated from the skin of 14 of 19 patients with grade 2 radiation dermatitis, whereas CNS strains were isolated from only 2 of 10 patients with grade 3 radiation dermatitis. Among the gram-negative bacteria, 3 Pseudomonas aeruginosa (P. aeruginosa), 2 Enterobacter cloacae (E. cloacae), 1 Klebsiella pneumoniae (K. pneumoniae) and 1 Moraxella catarrhalis (M. catarrhalis) strain were isolated. Sixteen (55.1%) of the TMs used in 29 patients and 20 (68.9%) of the storage racks harbored microorganisms, including HAI agents and flora bacteria. Bacteria colonize TMs and storage racks where they are risk factors for secondary skin infections in radiation dermatitis lesions that develop on the skin of head and neck cancer patients. Decontamination procedures should be meticulously applied to surfaces such as TMs and their storage racks during the course of radiotherapy.

Increasing the effectiveness of total-skin electron beam therapy by reducing the manifestations of radiation dermatitis in patients with primary lymphomas. A comparative randomized prospective study

Background. One of the main adverse events that significantly reduce the quality of life of patients and limit the total focal dose is radiation-induced skin reactions (RISR). Their timely diagnosis, prevention, and treatment remain urgent tasks of modern radiotherapy. Aim. To improve the effectiveness of total skin irradiation (TSI) in patients with primary skin lymphomas by reducing the clinical manifestations of RISR by using additional therapy with a hydrogel containing active components with vasoprotective and anti-inflammatory action. Materials and methods. A comparative randomized prospective study was conducted, including data from 52 patients who received electron TSI by conventional fractionation at a total focal dose of 14 to 30 Gy for primary cutaneous lymphomas at the Granov Russian Research Center of Radiology and Surgical Technologies from September 2021 to January 2024. Before the first TSI session, during treatment and 2 weeks after the end of radiation therapy, all patients underwent assessment for RISR, quantitative assessment of various degrees of severity of radiodermatitis using instrumental methods and assessment scales; for the observation group, a therapeutic regimen for the prevention and treatment of RISR was used, including a hydrogel with troxerutin (2%) and trolamine (0.07%), and in the control group, basic skin care using moisturizers. Results. Analysis of the physiological parameters of the skin showed statistically significant differences between the study groups: patients of the study group (group I; 30 subjects receiving the above-mentioned therapeutic regimen) compared with the control group (group II; 28 subjects who did not receive specific treatment for radiodermatitis) reported significantly lower rates of erythema (386±12.3 and 572±14.4; p=0.005), transepidermal water loss (25±0.3 and 38±0.4 g/m2/h; p0.001) and a decrease in peak endothelial-dependent vasodilation of microvasculature and blood flow in the skin. A lower proportion of severe radiodermatitis (86.3 and 73.3%; p0.05) and a statistically significant difference in the subjective quality of life scores by the 29-point Skindex-29 scale by an average of 22.2% were also found. Conclusion. A comparative analysis of the quantitative indicators of radiodermatitis in the study group and the control group showed that the topical application of the hydrocolloid gel containing troxerutin and trolamine reduces the clinical manifestations of RISR concerning objectively measured physiological parameters of the skin and blood flow parameters of the microvasculature measured by high-frequency ultrasound, thus improving the quality of life of patients during and after the course of radiation therapy.

Efficacy and safety of tyrosine kinase inhibitors with thoracic radiotherapy for patients with oncogene-mutated non-small cell lung cancer: a meta-analysis.

Tyrosine Kinase Inhibitors (TKIs) is an important therapy for patients with oncogene-mutated Non-Small Cell Lung Cancer (NSCLC). However, acquired resistance remains a major challenge. The efficacy of TKIs plus thoracic radiotherapy (RT) in oncogene-mutated NSCLC patients is uncertain. Therefore, we performed a meta-analysis to comprehensively evaluate the efficacy and safety of thoracic RT plus TKIs in oncogene-mutated NSCLC patients. The following databases were searched for relevant studies: PubMed, EMBASE, and Cochrane Library. Studies comparing the efficacy and safety of TKIs plus RT with TKIs alone in oncogene-mutated NSCLC patients were included in this analysis. Outcomes were median progression-free survival (mPFS), median overall survival (mOS), and incidence of adverse events (AEs). This analysis performed a subgroup analysis of the efficacy of first-line TKIs in combination with RT. This meta-analysis included 12 studies with 2936 patients (n = 823 patients with TKIs plus thoracic RT, n = 2113 patients with TKIs alone). The results showed that patients who received treatment with TKIs plus thoracic RT were associated with superior mPFS and mOS than those who were treated with TKIs alone (hazard ratio [HR]: 0.42, 95% CI 0.30-0.59, p < 0.00001; HR: 0.56, 95% CI 0.41-0.70, p < 0.00001, respectively). Subgroup analyses showed that TKIs plus thoracic RT as first-line treatment was associated with better mPFS and OS (HR: 0.37, 95% CI 0.26-0.52, p < 0.00001; HR: 0.47, 95% CI 0.31-0.70, p = 0.0002, respectively). Although the combination of TKIs with thoracic RT was associated with an increased risk of total AEs (odds ratio [OR]: 1.17, 95% CI 1.06-1.29, P = 0.002), there was no significant difference in serious AEs (grade ≥ 3) (OR: 1.06, 95% CI 0.58-1.92, P = 0.86). The most frequently occurring radiation-related AEs were radiation pneumonitis, radiation esophagitis, and radiation dermatitis, with overall rates of 41.3%, 15.4%, and 11.1%, respectively. The incidence of severe radiation pneumonitis and radiation esophagitis was 4.5% and 6.2%, respectively. In comparison to TKIs alone, TKIs plus thoracic RT are associated with survival benefits, especially as a first-line treatment option. Although TKIs plus thoracic RT may increase the risk of total AEs, it did not increase the risk of severe AEs. Therefore, TKIs plus thoracic RT may be a promising therapeutic regimen for oncogene-mutated NSCLC patients.

Assessment of Pattern of Acute Radiation Dermatitis and its Influencing Factor in Breast Cancer Patients Undergoing Radiation Therapy

Assessment of Pattern of Acute Radiation Dermatitis and its Influencing Factor in Breast Cancer Patients Undergoing Radiation Therapy

Concordance of patient- and clinician-reported outcomes of acute radiation dermatitis in breast cancer.

The study evaluated the concordance between patient-reported outcomes (PRO) and clinician-reported outcomes (CRO) of acute radiation dermatitis (RD) symptoms following adjuvant radiotherapy for early-stage and locally advanced breast cancer. This is a secondary analysis of a multi-center randomized phase 3 trial (376 patients). Ordinal logistic regression analysis was used to compare the Skin Symptom Assessment (SSA) independently reported by both patients and clinicians. Concordance between patient- and clinician-reported SSAs for RD symptoms was measured by percent concordance, concordance index (C-statistic), and Cohen's Kappa. Analyses were performed across all patients in the original modified intention-to-treat analysis and those with only grade 2-3 (CTCAE) RD. PROs were significantly more severe than CROs across all RD symptoms (Odds Ratio [OR] > 1; p < 0.0001). Pigmentation (OR 5.4), blistering/peeling (OR 4.0), and pain/soreness (OR 3.9) were the most differentially reported symptoms. Poor-to-low concordance was noted between patient- and clinician-reported SSAs for all RD symptoms for the entire cohort (percent concordance < 50%, C-statistic 0.52-0.63, Cohen's Kappa 13.9-23.4%) and those with grade 2-3 RD (percent concordance < 50%, C-statistic 0.56-0.66, Cohen's Kappa 2.0-24.5%). Similarly, poor-to-low concordance was noted in both Mepitel film and standard-of-care arms. PROs and CROs have poor concordance in breast RD, and patients report worse outcomes than clinicians, regardless of RD severity or prophylaxis. PROs must be further integrated into routine clinical practice and clinical trial design to reduce the risk of underreporting symptoms.

Radiation dermatitis in the hairless mouse model mimics human radiation dermatitis

Over half of all people diagnosed with cancer receive radiation therapy. Moderate to severe radiation dermatitis occurs in most human radiation patients, causing pain, aesthetic distress, and a negative impact on tumor control. No effective prevention or treatment for radiation dermatitis exists. The lack of well-characterized, clinically relevant animal models of human radiation dermatitis contributes to the absence of strategies to mitigate radiation dermatitis. Here, we establish and characterize a hairless SKH-1 mouse model of human radiation dermatitis by correlating temporal stages of clinical and pathological skin injury. We demonstrate that a single ionizing radiation treatment of 30 Gy using 6 MeV electrons induces severe clinical grade 3 peak toxicity at 12 days, defined by marked erythema, desquamation and partial ulceration, with resolution occurring by 25 days. Histopathology reveals that radiation-induced skin injury features temporally unique inflammatory changes. Upregulation of epidermal and dermal TGF-ß1 and COX-2 protein expression occurs at peak dermatitis, with sustained epidermal TGF-ß1 expression beyond resolution. Specific histopathological variables that remain substantially high at peak toxicity and early clinical resolution, including epidermal thickening, hyperkeratosis and dermal fibroplasia/fibrosis, serve as specific measurable parameters for in vivo interventional preclinical studies that seek to mitigate radiation-induced skin injury.

Immunomodulatory hydrogel patches loaded with curcumin and tannic acid assembled nanoparticles for radiation dermatitis repair and radioprotection

Radiation dermatitis, as a major side effect of radiotherapy, is a form of skin injury linked to the production of reactive oxygen species (ROS). Development of functional patches with excellent ROS scavenging ability and biosafety is crucial for radioactive dermatitis repair. Herein, we present a nanohybrid hydrogel patch composed with natural-derived substances. The patch possesses dual functionalities of chemically scavenging ROS and physically absorbing radiation, thereby alleviating radiation damage. Curcumin@tannic acid (Cur@TA) nanoparticles are synthesized through spontaneous coordination of TA and iron ions (Fe3+), enabling the encapsulation of Cur. The nanoparticles are then loaded into gelatin methacryloyl (GelMA) hydrogel patches, which endow the hydrogel with tissue adhesion as well as photothermal properties. Simultaneously, the patch exhibits powerful ROS scavenging capability and promotes M2 polarization of macrophages. Additionally, the high-water content of the GelMA hydrogel enables physical absorption of low-energy X-rays, providing radiation shielding. Based on these characteristics, we have demonstrated the augmented therapeutic efficacy of the hydrogel patch loaded with Cur@TA nanoparticles in the mouse model of radiation dermatitis. Our findings introduce a novel therapeutic approach for radiation protection and treatment, with potential clinical applications.

Effects of photobiomodulation therapy for acute radiation dermatitis in patients with cancer: A systematic review and meta‑analysis of real-world evidence

PurposeTo examine the effectiveness of photobiomodulation therapy (PBMT) for acute radiation dermatitis (ARD) in patients with cancer. Materials and methodsPubMed, Embase, Cochrane Library, and CINAHL were searched for articles published between database inception until July 2024. Randomized controlled trials (RCTs) and non-RCTs examining the effects of PBMT against ARD in patients with cancer were included for analysis. A random-effects model was used to conduct meta-analyses and sensitivity analyses. Subgroup analyses were conducted for cancer types and PBMT goals (prevention or treatment of ARD) with stratification for different grades of ARD. ResultsEight studies (five RCTs and three non-RCTs) were included in this meta-analysis. Compared with the control group, the PBMT group exhibited significantly lower ARD incidence at grades 2 and 3 (risk difference = − 0.36, 95 % confidence interval = − 0.53 to − 0.19, I2 = 85 %, P = < 0.00001). Subgroup analyses revealed that, compared with the control group, PBMT had a significant effect on both breast cancer and head and neck cancer. In addition, PBMT significantly reduced grades 2 and 3 ARD incidence in the PBMT group for both prevention and treatment subgroups. ConclusionPBMT may have beneficial effects on the prevention and treatment of higher-grade ARD in patients with breast cancer and head and neck cancer. Nevertheless, the studies included in this meta-analysis exhibited high heterogeneity. Therefore, the results must be interpreted with caution.

Multimodal Photoacoustic/Elastography Imaging for the Detection of Acute Radiation Dermatitis in Breast Radiation Therapy

Purpose: This study evaluates whether photoacoustic (PA), sound touch elastography (STE), and viscoelasticity (VE) can distinguish between normal and abnormal post-radiotherapy breast skin and compare these methods with RTOG criteria at a 20 Gy threshold. Methods: Patients meeting inclusion and exclusion criteria underwent PA, STE, and VE on the same day. Collected data included radiation dose, molecular type, RTOG, Fitzpatrick skin type, pathology, neoadjuvant chemotherapy status, TNM classification, surgical procedures, primary breast cancer location, BMI, and age. A sample of 41 patients was determined using a two-sample t-test. Statistical tools like T-tests, variance analysis, rank sum tests, and chi-square tests, along with random forest analysis and ROC curves, were used to evaluate the radiation dose effects. Results: Data from 66 patients showed significant differences in parameters such as dermis and subcutaneous tissue oxygen saturation, dermal thickness, and skin elasticity (p-values < 0.05). However, minimum values of oxygen saturation and some photoacoustic measures were not significantly different. Notably, at a 20 Gy radiation threshold, significant variations in oxygen saturation, abnormal dermal thickness, and skin STE and VE were observed, proving more accurate than RTOG grading. Conclusion: The study confirms the effectiveness of PA and elastography imaging in differentiating normal from abnormal breast tissue and assessing radiation-induced changes, highlighting the potential of these imaging techniques.

The Histopathology of Chronic "Radiation Conjunctivitis" Shows Diagnostic Features Similar to Those Seen in Radiation Dermatitis, Including Radiation Fibroblasts.

Radiation therapy is a treatment modality for various ocular and ocular adnexal tumors. The histopathology of chronic radiation dermatitis has been well-described. The authors present two cases demonstrating and characterizing "chronic radiation conjunctivitis" which has not been histopathologically illustrated in detail. Retrospective case review of two patients who received proton beam irradiation for an anterior uveal melanoma and external beam radiation for conjunctival lymphoma, and developed leukoplakia and/or thickening of the eyelid margin and symblepharon. Hematoxylin and eosin-stained sections of eyelid margin and conjunctival biopsies as well as clinical histories were reviewed. Conjunctival biopsies in both cases revealed squamous epithelial metaplasia, chronic inflammation and bizarre-appearing stromal cells with hyperchromatic nuclei in a fibrotic/sclerotic stroma, consistent with chronic radiation conjunctivitis. These stromal cells are believed to be the same "radiation fibroblasts" described in chronic radiation dermatitis. The radiation fibroblast is characteristic for the diagnosis of chronic radiation conjunctivitis, as it is in radiation dermatitis. Features of squamous metaplasia of conjunctival epithelium, keratinization, subepithelial fibrosis/sclerosis and chronic inflammation are frequently found but not specific. A detailed history and other ancillary tests help differentiate cicatrizing conjunctival conditions, and biopsy should be performed in the setting of suspicion for a secondary malignancy.

Development and Validation of a Nomogram Prediction Model for Moderate-to-Severe Acute Radiation Dermatitis in Patients with Breast Cancer: A Retrospective Study.

Aims/Background Acute radiation dermatitis is the most common complication of radiotherapy in patients with breast cancer, with mild severity relieved by symptomatic treatment and moderate-to-severe severity leading to compromised skin integrity and affecting the patient's quality of life. Therefore, this study aims to develop a prediction model for moderate-to-severe acute radiation dermatitis in patients with breast cancer to reduce its severity. Methods A retrospective analysis of 713 patients receiving radiotherapy for breast cancer at the Affiliated Cancer Hospital of Xinjiang Medical University from January 2019 to December 2023 was conducted, with January 2019 to December 2021 serving as the training group (497 patients) and January 2022 to December 2023 serving as the validation group (216 patients). Patients in the training group were classified as having mild (383 patients) or moderately severe (114 patients) acute radiation dermatitis. Binary logistic regression was used to analyze the independent effects on moderately severe acute radiation dermatitis in patients with breast cancer, and a predictive model of the bar-folding plot was constructed and validated. Results Univariable analysis revealed that age, body mass index, targeted therapy, oral tamoxifen use, hyperlipidemia, diabetes, positive regional lymph node metastasis, value-added index, and triple-negative breast cancer were factors influencing moderate-to-severe acute radiation dermatitis in patients with breast cancer. Multivariate analysis showed that body mass index, hyperlipidemia, diabetes, positive regional lymph node metastasis, and value-added index were independent influencing factors for moderate-to-severe acute radiation dermatitis in patients with breast cancer. A nomogram prediction model was constructed, and the area under the receiver operating characteristic curve of the model was 0.814 and 0.743 for internal and external validation, respectively. The calibration curve showed that the model predicted moderate-to-severe acute radiation dermatitis better, and the decision curve analysis curve showed that the model had a high clinical benefit. Conclusion This risk prediction model can predict moderate-to-severe acute radiation dermatitis in patients with breast cancer, and help clinical providers screen high-risk patients and reduce acute radiation dermatitis severity.

Joker Sign After Drooling Radioactive Saliva.

A 28-year-old man underwent high-dose radioactive iodine therapy after total thyroidectomy due to papillary thyroid carcinomas. After 2 weeks, a linear reddish line was observed extending from the right corner of the mouth to the cheek, resembling the appearance of the Joker. Through a detailed interview, it was determined that the patient had developed radiation dermatitis because of radioactive saliva drooling while sleeping on one side. Although this is expected to be infrequent, educating patients on avoiding saliva contact with the skin during and after radioactive iodine therapy is crucial due to the potential skin damage and cancer risk.

Radiation recall reaction induced by gemcitabine/docetaxel in children: A retrospective study on risk factors and outcomes.

Radiation recall reaction (RRR) is a rare inflammatory reaction developing in a previously irradiated field after a triggering agent. In pediatric patients, it is poorly understood and deficiently studied. Gemcitabine-docetaxel (G/D) in childhood cancer is mainly used as a salvage regimen for sarcomas. We aim to describe RRR triggered by G/D in children. Retrospective review of 21 patients receiving G/D along with radiotherapy at two hospitals from 2010 until 2022. RRR was considered as any toxicity occurring after G/D administration in a previously irradiated field. RRR features were described. Fisher's and Mann-Whitney tests were utilized to analyze the risk factors involved. Sixteen episodes of RRR developed in 16 (76.2%) patients. RRR mainly involved deep layers of the skin (58%) and occurred predominantly after two G/D cycles. The mean time between radiotherapy and chemotherapy was 28.5days (0-1359days), and the mean radiation volume 391mL (157-1810mL) for RRR. RRR treatment was mainly systemic steroids, with partial responses in six of 11 (58%) patients. Re-exposure to G/D was associated with a high rate of recurrence in nine of 15 (56.2%), prompting drug discontinuation. The major risk factors for RRR after G/D include, without statistical significance, a larger volume of the irradiated field and a shorter interval between chemotherapy and radiotherapy. The incidence of RRR after G/D in the pediatric population is higher than previously reported. Drug re-exposure is usually followed by recurrence. Higher irradiated volumes and a shorter time to the start of chemotherapy could be related with an increased risk of RRR.

The Relationship Between Breast Radiation Dermatitis and Post-Mastectomy Chronic Pain: A Multicenter Retrospective Study

ObjectiveWith the increasing incidence of breast cancer, radiotherapy has become a crucial component of postoperative treatment to mitigate recurrence and metastasis. However, breast radiation dermatitis (BRD) and post-mastectomy pain syndrome (PMPS) remain significant complications, affecting patients' quality of life. Despite the importance of these issues, there is a lack of comprehensive studies exploring the correlation between BRD and PMPS, as well as effective management strategies for these conditions. MethodsThis multicenter retrospective study included 784 patients who underwent breast cancer surgery followed by radiotherapy between 2017 and 2023. Clinical data were collected from four major hospitals in China. Patients were assessed for BRD and PMPS using questionnaires and clinical records. ResultsBRD incidence was 81.25%, with elderly (average age 50.77 years) and obese patients (26.4% with BMI > 30) showing higher susceptibility. 23.4% of BRD patients developed PMPS, compared to 13.6% in the non-BRD group (P = 0.009). Early onset of BRD during radiotherapy (P =0.004) and larger affected areas (P =0.000) were linked to higher PMPS risk. ConclusionsThis study underscores the significant relationship between BRD and PMPS, emphasizing the need for targeted prevention and management strategies. The findings suggest that early intervention and personalized treatment plans are crucial for managing BRD and preventing PMPS.

Radiation dermatitis: the development of the problem

Radiation dermatitis: the development of the problem

Adipose-derived stem cells apoptosis rejuvenate radiation-impaired skin in mice via remodeling and rearranging dermal collagens matrix

BackgroundChronic radiation dermatitis (CRD) is a late consequence of radiation with high incidence in patients receiving radiotherapy. Conventional therapies often yield unsatisfactory results. Therefore, this study aimed to explore the therapeutic potential and mechanism of adipose-derived stem cells (ADSCs) for CRD, paving the way for novel regenerative therapies in clinical practice.MethodsClinical CRD skin biopsies were analyzed to character the pathological changes of CRD skin and guided the animal modeling scheme. Subsequently, an in vivo analysisusing mouse CRD models was conducted to explore their effects of ADSCs on CRD, monitoring therapeutic impact for up to 8 weeks. Transcriptome sequencing and histologic sections analysis were performed to explore the potential therapeutic mechanism of ADSCs. Following observing extensive apoptosis of transplanted ADSCs, the therapeutic effect of ADSCs were compared with those of apoptosis-inhibited ADSCs. Multiphoton imaging and analysis of collagen morphologic features were employed to explain how translated ADSCs promote collagen remodeling at the microscopic level based on the contrast of morphology of collagen fibers.ResultsFollowing injection into CRD-afflicted skin, ADSCs therapy effectively mitigated symptoms of CRD, including acanthosis of the epidermis, fibrosis, and irregular collagen deposition, consistent with the possible therapeutic mechanism suggested by transcriptome sequencing. Notably, in vivo tracking revealed a significant reduction in ADSCs number due to extensive apoptosis. Inhibiting apoptosis in ADSCs partially tempered their therapeutic effects. Mechanically, analysis of collagen morphologic features indicated that translated ADSCs might promote dermal extracellular matrix remodeling through enlarging, lengthening, crimping, and evening collagen, counteracting the atrophy and rupture caused by irradiation.ConclusionsThis study demonstrated that ADSCs underwent substantial apoptosis upon local skin transplantation, and paradoxically, this apoptosis is essential for their efficacy in promoting the regeneration of late radiation-impaired skin. Mechanically, transplanted ADSCs could promote the remodeling and rearrangement of radiation-damaged dermal collagen matrix.

Comparison of liposomal gel with and without chamomile to prevent radiation dermatitis in breast cancer patients: arandomized controlled trial.

To compare aliposomal gel with and without chamomile extract for the prevention of radiation dermatitis in breast cancer patients undergoing radiotherapy. This study was adouble-blind randomized clinical trial. Atotal of 100 participants undergoing radiotherapy for breast cancer were recruited. The primary outcome was the occurrence of dry desquamation. Cumulative dose of ionizing radiation at the first occurrence of dry desquamation, occurrence of erythema, moist desquamation, global radiation dermatitis, and any signs and symptoms self-reported by participants were secondary outcomes. Dry desquamation occurred in 6.0% of the participants using chamomile liposomal gel and 12.2% of those using liposomal gel (p = 0.32). The mean cumulative dose of ionizing radiation for the first occurrence of dry desquamation was 45.1 Gy in the chamomile liposomal gel group and 43.7 Gy in the liposomal gel group. There were no differences between the two gels in the occurrence of erythema, dry desquamation, moist desquamation, and radiation dermatitis compared to liposomal gel. There was alower proportion of reported symptoms in the chamomile liposomal gel group compared to liposomal gel group in the first 3weeks of radiation, especially for itching (p = 0.05). No statistically significant differences between the two gels were found in radiation dermatitis occurrence and dose at first occurrence. Comparing to the literature, it seems that both interventions may be effective, which might explain the lack of statistical difference between the groups.

Durable local control with hypofractionated radiation therapy for unresectable or metastatic melanoma

Background and purposeAs patients with advanced melanoma live longer in the context of systemic therapy advancements, better strategies for durable control of bulky tumors are needed. In this study, we evaluated if dose-escalated hypofractionated radiation therapy (HFRT) can provide durable local control and improve tumor-associated symptoms in patients with unresectable or bulky metastatic melanoma for whom stereotactic ablative radiotherapy (RT) approaches are not feasible due to tumor size or location. Materials and methodsWe retrospectively reviewed 49 patients with unresectable or bulky metastatic melanoma who were treated to a total of 53 tumor targets with 12–17 fractions HFRT at our institution between 2015–2022. Clinical scenarios included: unresectable, locoregional only disease (26 %); oligometastatic disease (<3 total sites, 17 %); oligoprogressive disease (<3 sites progressing, 17 %); and aggressive palliation (>5 known sites of disease or with at least 3 sites progressing, 40 %). ResultsOf the 53 HFRT targets, 91 % (n = 48) had radiographic evidence of response as defined by either stabilization (6 %, n = 3), decreased size (74 %, n = 39), or decreased FDG avidity (11 %, n = 6). Of the 43 symptomatic patients, 98 % (n = 42) had symptomatic improvement. One −year local control was 79 %, with 2-year progression-free and overall survival of 33 % and 39 % respectively. The most common acute toxicities were radiation dermatitis (16 %, n = 8) or a pain flare (14 %, n = 7). Late toxicities were uncommon and typically grade 1. ConclusionHFRT provides favorable local control and symptomatic relief with limited toxicity in tumors not amenable to surgical resection or stereotactic ablative RT.

Randomised controlled trials on radiation dose fractionation in breast cancer: systematic review and meta-analysis with emphasis on side effects and cosmesis

ObjectiveTo provide a comprehensive assessment of various fractionation schemes in radiation therapy for breast cancer, with a focus on side effects, cosmesis, quality of life, risks of recurrence, and survival...