Corticoides sistémicos en el tratamiento de la radiodermitis grave: una serie de casos / Systemic corticoids in the treatment of severe radiodermitis: a series of cases

Introducción: la radiodermitis es uno de los efectos secundarios más frecuentes de la radioterapia y afecta aproximadamente al 95% de los pacientes que la reciben. La radiodermitis aguda se presenta dentro de los 90 días posteriores al inicio del tratamiento, tiene un profundo impacto en la calidad de vida de los pacientes y puede ser la causa de la interrupción prematura de la radioterapia. Su tratamiento es complejo y el papel de los corticoides sistémicos en él aún no ha sido evaluado. Materiales y métodos: estudio descriptivo de 6 pacientes mayores de 18 años con radiodermitis grave, tratados con corticoides sistémicos al no responder a la terapia tópica inicial. Hubo un seguimiento de 6 meses, entre el 1 de junio de 2019 y el 30 de mayo de 2020, en el Servicio de Dermatología de un hospital de alta complejidad. Resultados: se indicó tratamiento con corticoides sistémicos en dosis de meprednisona 40 mg/día o equivalentes, durante 5 días, con resolución completa del cuadro en un período máximo de 15 días. Discusión: en la bibliografía no hemos encontrado trabajos científicos que comuniquen o evalúen la utilidad de los corticoides sistémicos en la radiodermitis grave. Proponemos, entonces, demostrar su utilidad en esta patología. Conclusión: el objetivo de este trabajo es comunicar nuestra experiencia en pacientes con radiodermitis aguda grave, con gran repercusión en el estado general, que evolucionaron con una rápida resolución del cuadro y un adecuado manejo sintomático, mediante el uso de corticoides sistémicos. (AU)

Introduction: radiodermitis is one of the most frequent side effects of radiotherapy and affects approximately 95% of the patients who receive it. Acute radiodermitis occurs within 90 days after the start of treatment, has a profound impact on the quality of life of patients and may be the cause of premature discontinuation of radiotherapy. Its treatment is complex and the role of systemic corticosteroids in it has not yet been evaluated. Materials and methods: descriptive study of 6 patients older than 18 years with severe radiodermatitis, treated with systemic corticosteroids when they did not respond to initial topical therapy. With a 6-month follow-up, between June 1, 2019 and May 30, 2020 at the Dermatology Service of a high complexity hospital. Results: treatment with systemic corticosteroids was indicated at a dose of meprednisone 40 mg/day or equivalent, for 5 days, with complete resolution of the symptoms in a maximum period of 15 days. Discussion: in the literature, we have not found scientific papers that report or evaluate the usefulness of systemic corticosteroids in severe radiodermatitis. We propose to demonstrate their usefulness in this pathology. Conclusion: the objective of this work is to communicate our experience in patients with severe acute radiodermatitis, with great repercussions on the general state, who evolved with rapid resolution of the symptoms and adequate symptomatic management, with the use of systemic corticosteroids. (AU)

Clinical Observation of Huhuang Burn Liniment on the Prevention and Treatment of Radiation Dermatitis of Nasopharyngeal Carcinoma Patients / 中国药房

OBJECTIVE：To observe therapeutic efficacy and safe ty of Huhuang burn liniment on the prevention and treatment of radiation dermatitis patients with nasopharyngeal carcinoma （NPC）. METHODS ：Totally 129 NPC patients were collected from our hospital during Aug. 2018-Feb. 2020. They were numbered according to the order of radiotherapy ，the ones with odd number were included into observation group （65 cases）and the ones with even number into control group （64 cases）. Both groups received routine radiotherapy and skin nursing. Control group were evenly smeared with Shirun shaoshang cream in the radiation field during radiotherapy ，and observation group were smeared with Huhuang burn liniment. The smearing area should be 1 cm beyond the edge of radiation field ，3 times a day until the end of stage 1 radiotherapy（33-38 times in total ）. The skin lesions of the two groups were observed ；the appearance time and healing time of skin lesion ，RTOG score and NRS score were recorded. The levels of serum cytokines （TNF-α，IL-6，IL-8 and IL- 10）were detected in 2 groups at 0，15th and 30th time of radiotherapy. The occurrence of ADR was recorded in 2 groups during treatment. RESULTS ：The appearance time of skin lesion in observation group was significantly longer than control group ；the healing time of skin lesion in observation group was significantly shorter than control group （P＜0.01）. RTOG grading of radiodermatitis in the two groups was mainly grade 1，but no grade 3 or 4 was found. There was no significant difference in the proportion of patients with differen RTOG grades （P＞0.05）. The highest NRS score of control group and observation group were 3 and 2 points respectively ，and the proportions of patients with 0-3 points in the two groups were statistically significant （P＜0.05）. There was no significant difference in serum cytokine levels between @qq.com 2 groups at 0 time of radiotherapy （P＞0.05）. The serum cytokine levels of 2 groups were increased significantly at 15th @qq.com time of radiotherapy ， but t he observation group was significantly lower than control group at the same period （P＜0.05 or P＜0.01）. At 30th time of radiotherapy ，the cytokine levels of 2 groups decreased significantly ，compared with 15th time of radiotherapy ，the observation group was significantly lower than the control group at the same period （P＜0.05 or P＜0.01）；the levels of TNF-α，IL-6 and IL- 10 in control group as well as the level of IL- 6 in observation group were significantly higher than the same group at 0 time of radiotherapy （P＜0.05 or P＜0.01）. There was no ADR such as allergy ，rash，smear site infection in the two groups during the treatment. CONCLUSIONS ：Huhuang burn liniment has a good effect of preventing and treating radiation dermatitis of NPC patients ，delays the occurrence of skin lesion，shortens the healing time of skin lesion ，relieves pain and reduces the level of serum cytokines with good safety.

Meta-analysis of the Effectiveness of Trolamine for Preventing and Treating Radiation Dermatitis and Quality Evaluation of GRADE Evidence / 中国药房

OBJECTIVE： To evaluate the effectiveness of trolamine for preventing and treating radiation dermatitis （RD） and evidence quality， and to provide reference for clinical use. METHODS： Retrieved from PubMed， Cochrane library， Embase， CNKI， Wanfang and VIP database， randomized controlled trials （RCTs） about trolamine （trial group） versus usual care （control group） for preventing and treating RD were collected. After data extraction， Cochrane bias risk assessment tool 5.0.2 was used to assess the bias risk， and Rev Man 5.3 statistical software was used to perform the Meta-analysis. GRADE evidence quality grading system was used to evaluate the evidence quality of outcome indexes. RESULTS： Seven RCTs were included， involving 782 patients. Results of Meta-analysis showed that there was no statistical significance in total incidence of RD [OR＝0.50， 95％CI （0.23， 1.11）， P＝0.09]， and the incidence of grade Ⅰ RD [OR＝1.32， 95％CI（0.96，1.81）， P＝0.09]， grade Ⅱ RD [OR＝1.07， 95％CI（0.80，1.42）， P＝0.66]， grade Ⅲ RD [OR＝0.69， 95％CI（0.45，1.04）， P＝0.07] or grade Ⅳ RD [OR＝0.43， 95％CI（0.17，1.05）， P＝0.07] between 2 groups. Results of Grade evidence quality evaluation showed that total incidence of RD， and the incidence of grade Ⅱ RD and grade Ⅳ RD were recommended by moderate-level evidence in 2 groups， while the incidence of grade Ⅰ and grade Ⅲ RD were recommended by low-level evidence. CONCLUSIONS： Trolamine is not effective in preventing and treating RD， and can not reduce the incidence of RD.

Fluoroscopy-induced chronic radiation dermatitis masquerading as morphea: A diagnostic pitfall

Chronic radiodermatitis is a rare complication of fluoroscopy-guided procedures. The diagnosis of fluoroscopy-induced chronic radiation dermatitis is challenging because of its rarity, late insidious onset, and close clinicopathological resemblance to morphea. We report two cases of fluoroscopy-induced chronic radiodermatitis following cardiac procedures to highlight the clinicopathological features. The diagnosis relies on recognizing the characteristic clinical presentation of well-demarcated, rectangular- or square-shaped indurated plaque with depigmentation, telangiectasia, and ulceration located on the scapula, back, or axilla; supported by the histological identification of radiation fibroblasts in a sclerotic dermis.

Chronic Radiation Dermatitis Induced by Endoscopic Retrograde Cholangiopancreatoscopy (ERCP) / 대한피부과학회지

Skin has long been known to be a very radiosensitive organ. Furthermore, the damaging effects of radiation exposure induced by fluoroscopic procedures have been recognized for some time. However, accurate diagnosis of fluoroscopy-induced chronic radiation dermatitis (FICRD) can be very challenging, since the provided clinical history regarding radiation exposure may not be accurate and the signs of cutaneous radiation injury may develop months to years after radiation exposure. Recognition of FICRD is important to avoid unnecessary treatment and interventions and also guarantees appropriate surveillance for radiation-induced malignancy. We herein report a case of a 65-year-old woman who was diagnosed with radiation dermatitis after endoscopic retrograde cholangiopancreatoscopy (ERCP).

Two Cases of Radiation Dermatitis Treated with Shiunko / 日本東洋医学雑誌

Shiunko, topical herbal ointment, has been used in Japan for hemorrhoid and skin wound such as scratch, incision and burn. We report two cases of radiation dermatitis with erosion, which have a good outcome after treatment with shiunko. Case 1 was 72-year-old man with radiation dermatitis of bilateral inguinal region caused by postoperative irradiation for bilateral inguinal lymph node metastases from penile cancer. Re-epithelization was observed in erosion on the 10th day after applying shiunko. It showed earlier recovery from radiation dermatitis than the cases treated with topical external medicine of azulene and/or steroid. Case 2 was 60-year-old man with the perianal radiation dermatitis with pain caused by pelvic radiotherapy for recurrence of advanced rectal cancer after chemotherapy. Shiunko gave rapid relief from anal pain and the patients felt no pain on the day subsequent to applying shiunko. Shiunko hastens analgesic effectiveness and improvement of wound caused by radiotherapy.

Treatment of acute radiation dermatitis induced by radiotherapy in nasopharyngeal carcinoma patients treated with hydrogen / 中国生化药物杂志

Objective To investigate the clinical effect of the treatment of acute radiation dermatitis caused by radiotherapy in nasopharyngeal carcinoma patients treated with hydrogen. Methods Selected from January 2014 to January 2016 for nasopharyngeal carcinoma in the first hospital of Ningbo radiotherapy lead to acute radiation dermatitis patients were studied, by drawing lots method were divided into treatment group and control group with 40 cases in each. The patients in the control group were given conventional treatment, iodine inunction, treatment group given routine treatment, hydrogen card grease rubbed. Comparison of two groups of treatment effect. Results After 10 days of treatment, the treatment group the score RISRAS significantly lower than the control group (P < 0.05). Conclusion Combination of hydrogen and conventional therapy in the treatment of acute radiation dermatitis induced by radiotherapy in nasopharyngeal carcinoma patients, can significantly shorten the treatment time.

Heijiangdan ointment relieves oxidative stress from radiation dermatitis induced by (60)Co γ-ray in mice / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the effects of Heijiangdan Ointment ( HJD) on oxidative stress in (60)Co γ-ray radiation-induced dermatitis in mice.</p><p><b>METHODS</b>Female Wistar mice with grade 4 radiation dermatitis induced by (60)Co γ-rays were randomly divided into four groups (n=12 per group); the HJD-treated, recombinant human epidermal growth factor (rhEGF)-treated, Trolox-treated, and untreated groups, along with a negative control group. On the 11th and 21st days after treatment, 6 mice in each group were chosen for evaluation. The levels of superoxide dismutase (SOD), malondialdehyde (MDA), and lactate dehydrogenase (LDH) were detected using spectrophotometric methods. The fibroblast mitochondria were observed by transmission electron microscopy (TEM). The expressions of fibroblast growth factor 2 (FGF-2) and transforming growth factor β1 (TGF-β1) were analyzed by western blot.</p><p><b>RESULTS</b>Compared with the untreated group, the levels of SOD, MDA and LDH, on the 11th and 21st days after treatment showed significant difference (P<0.05). TEM analysis indicated that fibroblast mitochondria in the untreated group exhibited swelling and the cristae appeared fractured, while in the HJD group, the swelling of mitochondria was limited and the rough endoplasmic reticulum appeared more relaxed. The expressions of FGF-2 and TGF-β1 increased in the untreated group compared with the negative control group (P<0.05). After treatment, the expression of FGF-2, rhEGF and Trolox in the HJD group were significantly increased compared with the untreated group (P<0.05), or compared with the negative control group (P<0.05). The expression of TGF-β1 showed significant difference between untreated and negative control groups (P<0.05). HJD and Trolox increased the level of TGF-β1 and the difference was marked as compared with the untreated and negative control groups (P<0.05).</p><p><b>CONCLUSION</b>HJD relieves oxidative stress-induced injury, increases the antioxidant activity, mitigates the fibroblast mitochondrial damage, up-regulates the expression of growth factor, and promotes mitochondrial repair in mice.</p>

Clinical research of trolamine cream in the prevention and treatment of radioactive dermatitis in patients with breast cancer after modified radical mastectomy / 肿瘤研究与临床

Objective To evaluate the efficacy of trolamine cream in the prevention and treatment of acute radioactive dermatitis in patients with breast cancer after modified radical mastectomy.Methods 80 breast cancer patients who received postmastectomy chest-wall irradiation by 6-MeV electron beam were included.40 cases in the treatment group were given trolamine cream combined with the conventional nursing care during radiotherapy,while another 40 cases in the control group were treated with the conventional nursing care.Results In the treatment group,the rates of radiation dermatitis of grade 1,2 and 3 were 70.0 ％ (28/40),22.5 ％(9/40),and 7.5 ％ (3/40),respectively,while they were 52.5 ％ (21/40),32.5 ％ (13/40) and 15.0 ％ (6/40),respectively,in control group (P ＜ 0.05).Grade 1,2 and 3 radiation dermatitis appeared in treatment group when the radiation doses were (21.91±4.39) Gy,(37.43±6.50) Gy and (46.14±6.50)Gy,respectively,while in the control group,it was (12.67±2.16) Gy,(22.61±3.51) Gy,(42.71±8.11) Gy (P ＜ 0.05),respectively.With cumulative doses of 10 Gy and 25 Gy,the rates of radiation dermatitis in the treatment group were 22.5 ％ (9/40) and 47.5 ％ (19/40),respectively,while they were 40.0 ％ (16/40) and 62.5 ％ (25/40),respectively,in the control group (P ＜ 0.05).Conclusions Trolamine cream effectively alleviates radiation skin damage in breast cancer patients after modified mastectomy,thus it is suitable for use in patients with postoperative chest wall radiotherapy.

Fluoroscopy-induced Chronic Radiation Dermatitis / 대한피부과학회지

Fluoroscopy-induced chronic radiation dermatitis (FICRD) is a cutaneous disorder that results from prolonged exposure to ionizing radiation during interventional procedures. With the expanded use of interventional procedures, there is increased fluoroscopic exposure. However, diagnosis and treatment of such disorder remain difficult. Herein, we report on a case of FICRD that occurred in the right subscapular area.

An Analysis of the Incidence and Related Factors for Radiation Dermatitis in Breast Cancer Patients Who Received Radiation Therapy / 대한방사선종양학회지

PURPOSE: We analyzed the incidence and related factors of radiation dermatitis; at first, to recognize whether a decrease in radiation dermatitis is possible or not in breast cancer patients who received radiation therapy. MATERIALS AND METHODS: Of 338 patients, 284 with invasive breast cancer who received breast conservation surgery with radiotherapy at Chonbuk National University Hospital from January 2007 to June 2009 were evaluated. Patients who also underwent bolus, previous contralateral breast irradiation and irradiation on both breasts were excluded. For patients who appeared to have greater than moderate radiation dermatitis, the incidence and relating factors for radiation dermatitis were analyzed retrospectively. RESULTS: A total of 207 and 77 patients appeared to have RTOG grade 0/1 or above RTOG grade 2 radiation dermatitis, respectively. The factors found to be statistically significant for the 77 patients who appeared to have greater than moderate radiation dermatitis include the presence of lymphocele due to the stasis of lymph and lymph edema which affect the healing disturbance of radiation dermatitis (p=0.003, p=0.001). Moreover, an allergic reaction to plaster due to the immune cells of skin and the activation of cytokine and concomitant hormonal therapy were also statistically significant factors (p=0.001, p=0.025). CONCLUSION: Most of the breast cancer patients who received radiation therapy appeared to have a greater than mild case of radiation dermatitis. Lymphocele, lymphedema, an allergy to plaster and concomitant hormonal therapy which affect radiation dermatitis were found to be significant factors. Consequently, we should eliminate lymphocele prior to radiation treatment for patients who appear to have an allergic reaction to plaster. We should also instruct patients of methods to maintain skin moisture if they appear to have a greater than moderate case of radiation dermatitis.

The Clinical Features and Pathophysiology of Acute Radiation Dermatitis in Patients Receiving Tomotherapy

BACKGROUND: Radiation therapy (RT) including tomotherapy has been widely used to treat primary tumors, as well as to alleviate the symptoms of metastatic cancers. OBJECTIVE: The primary purpose of this study was to examine the characteristics of the clinical features and pathophysiological mechanisms associated with acute radiation dermatitis in cancer patients that received tomotherapy, and compare the results to patients treated by conventional radiation therapy. METHODS: The study population consisted of 11 patients that were referred to the dermatology department because of radiation dermatitis after receiving tomotherapy; all patients were evaluated for clinical severity. The patients were assessed and identified using the National Cancer Institute Common Toxicity Criteria version (CTC) 3.0. We performed biopsies of the skin lesions that were examined for apoptosis using the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labelling (TUNEL) assay and stained immunohistochemically with monoclonal antibodies to CD8, CD4 and TGF-beta. As a positive control, patients with radiation dermatitis treated with conventional radiation therapy were also studied. RESULTS: The results of the clinical features of the skin of tomotherapy patients were the following: grade 1 (36%), grade 2 (55%) and other changes (9%). Among the population that had skin lesions due to acute radiation dermatitis, the mean number of positive cells per high power field (HPF) was the following: there were 30.50+/-.50 TUNEL- positive cells, 34.60+/-12.50 CD8+ T cells, 5.19+/-3.17 CD4+T cells and 9.95+/-1.33 TGF-beta positive cells measured per HPF. The mean number of positive cells per HPF for the patients that received conventional radiation therapy was: TUNLEL-positive cells in 7.5+/-1.64, CD8-, CD4- and TGF-beta-positive cells in 12.50+/-3.73, 3.16+/- 1.47, 6.50+/-1.97. CONCLUSION: We found that the number of TUNEL-positive cells and CD8+ T cells were higher in the lesions of patients receiving tomotherapy compared to the lesions of the patients receiving conventional radiation therapy. These findings suggest that tomotherapy without dose modification may cause significantly more severe forms of radiation dermatitis by apoptosis and cytotoxic immune responses than conventional radiation therapy.