[Topical Calendula and Betamethasone Valerate in the prevention of acute radiation dermatitis: a randomized prospective trial]

Acute radiation dermatitis is a very common side effect of radiation therapy for many cancers, including breast cancer. Despite the high prevalence of acute radiation dermatitis as well as wet desquamation, only a few trials studying the prophylaxis of this complication using topical treatment have been conducted. In spite of these studies, some controversy still exists about regarding treatments for acute radiation dermatitis, as does some concern about their long-term complications. For this reason, we conducted a clinical trial for a new treatment with the same effectiveness as corticosteroids, but fewer complications. This trial included 60 patients with pathologic diagnoses of breast cancer for whom radiotherapy had been planned. Patients were 30-73 years old. Patients with radical mastectomy received 5000 cGy over five weeks, and those with conservative surgery received 6000 cGy over six weeks divided in 200 cGy fractions. Patients were divided randomly into two groups: one group received a moderately-potent glucocorticoid steroid, 0.1% betamethasone ointment [30], and the other received the new treatment, 0.1% calendula ointment [30]. All patients applied their respective drugs twice daily within the tangential field from the first day of radiation treatment until one month after treatment was completed. Starting one week after radiation therapy commenced, patients were monitored weekly for symptoms of dermatitis and the degree of severity as well as possible adverse drug effects, in addition to such monitoring on the days of their appointments. Four weeks after termination of therapy, patients were again examined, at which time they completed a questionnaire about dermatologic complications. The mean time to develop dermatitis was 3.7 weeks for the betamethasone group and 3.87 weeks for the calendula group. Maximal dermatitis intensity during treatment in the betamethasone group was: 0, 6.7%; I, 73.3%; II, 16.7%; III, 0%; IV, 3.3%. Dermatitis intensity in the calendula group was: 0, 13.3%; I, 67%; II, 16.7%; III, 0%; IV, 3.3%. No significant differences were observed in the incidence of symptoms such as burning, pruritus and pain between the two groups [p=0.762]. Calendula ointment is as effective as betamethasone in reducing acute radiation dermatitis

Hematological toxicities and treatment interruption due to craniospinal irradiation

To assess the frequency and severity of myelosuppression due to cranio-spinal irradiation to identify patients at high risk of haematological toxicity who may require supportive therapy. Between 1998 and 2002, 45 patients received craniospinal axis radiotherapy as part of the treatment of primary CNS tumours at departement of radiotherapeutic oncology of cancer Institute. The dose to the whole brain ranged from 30 to 40 Gy in 1.5-1.85 Gy/f. The usual dose to the posterior fossa or to the site of primary disease was 50- 55 Gy in 6-8 weeks for adults and was reduced to 45-50 Gy in 6-7 weeks for children aged, 3 years. Complete blood counts [CBC] were obtained during radiation therapy. Any interruption in treatment due hematologic toxicity [G3-4] lasting 2 days was defined as a significant treatment interruption. In 45 patients who received craniospinal irradiation [CSI] 19 patients had treatment interruption more than 2 days. The median dose at interruption was 21.6 +/- 8.7 Gy and the the frequency of grade 3,4 hematologic toxicity occurred with peack incidence in fourth week of CSI[median day of interruption was day 23,range 8-38]. The median WBC count was 1900[range 100-2140].The mean of interruption period was 7 +/- 8 days [one patient died from neutropenic fever then he didn't finish his treatment. In 19 patients who had treatment interruption,13 of them were under 12 years while 5 patients were greater than 12 years .With Mann-Whitney U test the median age of patients with treatment interruption was lower; 10.2 years and 16.2 years respectively[P=.059].].In 24 patients with dose/fraction =<1.6 Gy 12 patients [50%] had treatment interruption but in 21 patients with dose/fraction >1.6 Gy 7 [33%] had treatment interruption[P=.2] but interruption period was longer in patients with dose/ fraction >1.6 Gy .From 12 patients who had dose/fraction <=1.6Gy,7 patients had interruption period less than 5 days while in group with dose/fraction >1.6 Gy all patients had treatment interruption period more than 5 days[P=.016,CI 95% for interruption period difference =1.2-4.7]. In summary, in our study 42% of patients undergoing CSI had treatment interruption. The risk was higher in children and in patients who received higher spinal dose fraction the treatment interruption was longer, but the overall treatment-related morbidity was low. In a population at risk of hematological toxicity where further studies of HGFs should be targeted