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ACUTE RADIOTHERAPY-INDUCED SKIN REACTIONS: THREE MONTHS CLINICAL OBSERVATION AT A SINGLE INSTITUTE IN KURDISTAN–IRAQ
ACUTE RADIOTHERAPY-INDUCED SKIN REACTIONS: THREE MONTHS CLINICAL OBSERVATION AT A SINGLE INSTITUTE IN KURDISTAN–IRAQ
Ranjdar Akram Kareem a, Mohammed Yousif Saeed b, and Layth Mula-Hussain c
Ranjdar Akram Kareem a, Mohammed Yousif Saeed b, and Layth Mula-Hussain c
a KBMS Trainee of Dermatology, Dermatology Teaching Center, Sulaimaniyah/Iraq.
b Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
c Cross Cancer Institute,University of Alberta, Edmonton, Canada.
Submitted: 8/1/2019; Accepted: 3/5/2019; Published: 21/6/2019
DOI Link: https://doi.org/10.17656/jsmc.10194
ABSTRACT
Background
Radiotherapy Induced Skin Reactions (RISR) are common side effects of external-beam radiotherapy (EBRT). They can be acute or chronic and may require special attention by the care givers. It is not yet studied in our region.
Objectives
To observe the clinical manifestations of randomly collected patients, whom will take RT in a single radiation oncology center, over a period of three months post the first RT fraction.
Methods
Fifty patients with different types of cancers participated, whom have been treated with EBRT for different intentions. Ten sessions of clinical observation applied, started before the 1st EBRT dose and extended to 12th week, using Skin Toxicity Assessment Tool (STAT).
Results
It involved 35 females and 15 males. Full assessment was amenable for 49 patients. Breast cancer patients were half of the cohort. Seventy percent of participants received a total dose of 4001-6000 centyGray (cGy). Ninety four percent got at least one of RISRs ranging from faint erythema 94%, itching 82%, hyperpigmentation 78%, dry desquamation 74%, burning 66%, bright erythema 62%, wet desquamation 58%, tenderness 30%, and ulceration 6%.
Conclusion
Acute RISR is a very common side effect of EBRT in our population. Erythema was the most frequent, while ulceration was the lowest. Total dose was directly proportional to the severity of damage.
KEYWORDS
Cancer, Radiotherapy Induced Skin Reactions, Kurdistan, Iraq.
References
1- Panizzon R, Seegenschmiedt M. Radiation Treatment and Radiation Reactions in Dermatology. 2nd ed. Berlin: Springer; 2015. p. 1-2.
2- Beyzadeoglu M, Gokhan O, Cuneyt E. Basic Radiation Oncology. Berlin; London: Springer, 2010. p. 145.
3- Sharon RH, Eric AS, Caroline F. Radiation dermatitis: Clinical presentation, pathophysiology, and treatment. J Am Acad Dermatol. 2006;54(1):28-46.
4- Atun R, Jaffray D, Barton M, Bray F, Baumann M, Vikram B et al. Expanding global access to radiotherapy. The Lancet Oncology. 2015;16 (10):1153-1186
5- David JK, Daniel GH, Cornelis J. H. van de Velde. Oxford text book of oncology. 3rd ed. London: Oxford;2016.
6- Singh M, Alavi A, Wong R, Akita S. Radiodermatitis: A Review of Our Current Understanding. American Journal of Clinical Dermatology. 2016;17(3):277-292.
7- Siegel R, Desantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62(4):220–41.
8- Gunderson LLT, Joel E. Clinical Radiation Oncology, 3rd edn. Philadelphia: Elsevier, 2011.
9- Barton MB, Jacob S, Shafiq J, Wong K, Thompson SR, Hanna TP, et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol 2014;112(1):140–44.
10- Zubizarreta EH, Fidarova E, Healy B, Rosenblatt E. Need for radiotherapy in low and middle income countries—the silent crisis continues. Clin Oncol (R Coll Radiol) 2015;27(2):107–14.
11- Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86.
12-Butof R, Dubrovska A, Baumann M. Clinical perspectives of cancer stem cell research in radiation oncology. Radiotherapy and Oncology. 2013; 108(3):388–396.
13- Hall E, Giaccia A. Radiobiology for the Radiologist. 7th edn Philadelphia: Lippincott Williams & Wilkins; 2012. p. 331-332.
14- Mendelsohn FA, Divino CM, Reis ED, Kerstein MD. Wound care after radiation therapy. Adv. Skin Wound Care. 2002;15(5):216–224.
15- Ryan JL. Ionizing radiation: the good, the bad, and the ugly. J Invest Dermatol. 2012; 132(3 Pt 2):985–93.
16- Cox JD, Ang K. Radiation Oncology: Rationale, Technique, Results. 9th edn. Philadelphia, PA: Mosby Elsevier; 2010. p. 15-16.
17- Brown KR, Rzucidlo E. Acute and chronic radiation injury. J Vasc Surg. 2011; 53(1 Suppl):15S-21S.
18-McQuestion M. Evidence-based skin care management in radiation therapy: clinical update. Semin Oncol Nurs. 2011; 27(2):e1–7
19- Salvo N, Barnes E, van Draanen J, Stacey E, Mitera G, Breen D, et al. Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. Curr Oncol. 2010;17(4):94–112.
20- Hindley A, Zain Z, Wood L, Whitehead A, Sanneh A, Barber D, et al. Mometasone furoate cream reduces acute radiation dermatitis in patients receiving breast radiation therapy: results of a randomized trial. Int J Radiat Oncol Biol Phys. 2014; 90(4):748–55.
21- Eide MJ, Weinstock MA. Association of UV index, latitude, and melanoma incidence in nonwhite populations—US Surveillance, Epidemiology, and End Results (SEER) Program, 1992 to 2001. Arch Dermatol. 2005;141(4):477–81
22- Lopez E, Guerrero R, Nunez MI, del Moral R, Villalobos M, Martínez-Galán J, et al. Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiationinduced DNA damage in lymphocytes. Breast Cancer Res. 2005;7(5):R690–8
23-Bolderston A, Lloyd NS, Wong RK, Holden L, Robb–Blenderman L. The prevention and management of acute skin reactions to radiation therapy: a systematic review and practice guideline. Support Care Cancer 2006;14(8):802–17.
24- Feight D, Baney T, Bruce S, McQuestion M. Putting evidence into practice: evidence-based interventions for radiation dermatitis. Clin J Oncol Nurs. 2011;15(5):481-92.
25- Hopewell JW, Nyman J, Turesson I. Time factor for acute tissue reactions following fractionated irradiation: a balance between repopulation and enhanced radiosensitivity. Int J Radiat Biol 2003;79(7):513-24.
26- Lee N, Chuang C, Quivey JM, Phillips TL, Akazawa P, Verhey LJ, et al. Skin toxicity due to intensity-modulated radiotherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys 2002;53(3):630-7
27-Boström A, Lindman H, Swartling C, Berne B, Bergh J. Potent corticosteroid cream (mometasone furoate) significantly reduces acute radiation dermatitis: results from a double-blind, randomized study. Radiother Oncol 2001;59(3):257–65.
28- Porock D. Factors influencing the severity of radiation skin and oral mucosal reactions: development of a conceptual framework. Eur J Cancer Care 2002;11(1):33-43.
29-Twardella D, Popanda O, Helmbold I, Ebbeler R, Benner A, von Fournier D, et al. Personal characteristics, therapy modalities and individual DNA repair capacity as predictive factors of acute skin toxicity in an unselected cohort of breast cancer patients receiving radiotherapy. Radiother Oncol 2003;69(2):145-53.
30- Wong RKS, Bensadoun RJ, Boers-Doets CB, Bryce J, Chan A, Epstein JB, et al. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer. 2013;21(10):2933–48.
31- Berthelet E, Truong PT, Musso K, Grant V, Kwan W, Moravan V, et al. Preliminary reliability and validity testing of a new Skin Toxicity Assessment Tool (STAT) in breast cancer patients undergoing radiotherapy. Am J Clin Oncol 2004;27(6):626–31
32- Ryan JL, Bole C, Hickok JT, Figueroa-Moseley C, Colman L, Khanna RC, et al. Post-treatment skin reactions reported by cancer patients differ by race, not by treatment or expectations. Br J Cancer. 2007;97(1):14–21
33-Chan RJ, Larsen E, Chan P. Re-examining the evidence in radiation dermatitis management literature: an overview and a critical appraisal of systematic reviews. Int J Radiat Oncol Biol Phys. 2012;84(3):e357–62.
34-Simonen P, Hamilton C, Ferguson S, Ostwald P, O’Brien M, O’Brien P, et al. Do inflammatory processes contribute to radiation-induced erythema observed in the skin of humans? Radiother Oncol. 1998;46(1):73-82.
35-Schmuth M, Sztankay A, Weinlich G, Linder DM, Wimmer MA, Fritsch PO, et al. Permeability barrier function of skin exposed to ionizing radiation. Arch Dermatol 2001;137(8):1019-23.
36- Kupper TS. The activated keratinocyte: a model for inducible cytokine production by non-bone marrow-derived cells in cutaneous inflammatory and immune responses. J Invest Dermatol 1990; 94(6):146S-50S.
37- Glover D, Harmer V. Radiotherapy-induced skin reactions: assessment and management. Br J Nurs. 2014;23(4):S28, S30–5.
38- Vuong T, Franco E, Lehnert S, Lambert C, Portelance L, Nasr E, et al. Silver leaf nylon dressing to prevent radiation dermatitis in patients undergoing chemotherapy and external beam radiotherapy to the perineum. Int J Radiat Oncol Biol Phys. 2004;59(3):809–14.
39-Fisher J, Scott C, Stevens R, Marconi B, Champion L, Freedman GM, et al. Randomized phase III study comparing best supportive care to Biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: Radiation Therapy Oncology Group (RTOG) 97-13. Int J Radiat Oncol Biol Phys 2000;48(5):1307–1310.
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