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Photobiomodulation therapy for the management of radiation-induced dermatitis

A single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery

Photobiomodulationstherapie zur Behandlung strahlentherapieassoziierter Dermatitis

Eine Single-Institut-Beobachtung zur adjuvanten Radiotherapie bei Brustkrebspatientinnen nach brusterhaltender Operation

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Abstract

Background

Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT.

Patients and methods

Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a “matched” group (n = 25) was generated from the control group based on propensity for potentially confounding variables.

Results

In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5.

Conclusion

PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery.

Zusammenfassung

Hintergrund

Radiotherapie (RT) ist integrativer Bestandteil der multimodalen Therapie beim Mammakarzinom. Strahlentherapieinduzierte Hauttoxizität ist dabei das häufigste unerwünschte Ereignis; dennoch sind Prävention und Management der Radiodermatitis (RD) weiterhin trivial. Klinische Studien ergaben, dass die Photobiomodulation (PBM) mit Leuchtdioden (LED) die Wundheilung fördern und entzündungshemmend wirken kann. Diese Single-Institut-Studie untersucht die Wertigkeit der PBM-LED zur Prävention und Linderung der RD während der adjuvanten Brustkrebs-RT.

Patienten und Methoden

Von insgesamt 70 konsekutiv behandelten Patienten wurden 25 Patienten nach brusterhaltender Operation 2‑mal wöchentlich mit PBM-LED vor adjuvanter 3D-RT behandelt. RD wurde nach den Common Toxicity Criteria Version 4.0 dokumentiert und RD-assoziierte Schmerzen mit der visuellen Analogskala (VAS) erfasst. Die Kontrollgruppe (n = 45) erhielt keine PBM-LED vor RT. Zusätzlich wurde eine „gematchte“ Gruppe (n = 25) aus der Kontrollgruppe basierend auf der Neigung für potenzielle Störvariablen gebildet.

Ergebnisse

In der PBM-Gruppe präsentierten 22 Patienten (88 %) eine Grad-1-RD und 3 (12 %) eine Grad-2-RD. In der Kontrollgruppe zeigten 25 Patienten (55,6 %) eine Hauttoxizität vom Grad 1, 18 (40 %) vom Grad 2 und 2 (4,4 %) eine Grad-3-RD. Hinsichtlich der Schmerzintensität hatten 15 Patienten (60 %) der PBM-Gruppe keine Schmerzen, 5 (20 %) VAS 2 und 5 (20 %) VAS 3. In der Kontrollgruppe hatten 13 Patienten (28,9 %) keine Schmerzen, 2 (4,4 %) VAS 1, 7 (15,6 %) VAS 2, 9 (20 %) VAS 3, 12 (26,7 %) VAS 4 und 2 (4,4 %) Patienten VAS 5.

Schlussfolgerung

PBM-LED-Therapie vor adjuvanter RT könnte die Inzidenz und Ausprägung von RD bei Brustkrebspatientinnen nach brusterhaltender Operation verringern.

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Acknowledgements

We thank THOR Photomedicine Ltd who kindly provided the light-emitting diode photobiomodulation device. This study has no funding.

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Authors and Affiliations

  1. Department of Radiation Oncology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany

    Iosif Strouthos, Georgios Chatzikonstantinou, Nikolaos Tselis, Efstratios Karagiannis, Eleni Zoga, Konstantinos Ferentinos, Julia Maximenko, Vassiliki Nikolettou-Fischer & Nikolaos Zamboglou

  2. Department of Radiotherapy and Oncology, Medical Center – Albert Ludwigs University of Freiburg, Robert Koch 3, 79106, Freiburg, Germany

    Iosif Strouthos

  3. Department of Radiotherapy and Oncology, J. W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Georgios Chatzikonstantinou & Nikolaos Tselis

  4. Institute of Biostatistics and Mathematical Modelling, J. W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Dimitra Bon

  5. Department of Radiation Oncology, Otto von Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany

    Efstratios Karagiannis

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  1. Iosif Strouthos
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Correspondence to Iosif Strouthos.

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Conflict of interest

I. Strouthos, G. Chatzikonstantinou, N. Tselis, D Bon, E. Karagiannis, E. Zoga, K. Ferentinos, J. Maximenko, V. Nikolettou-Fischer, and Nikolaos Zamboglou declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Strouthos, I., Chatzikonstantinou, G., Tselis, N. et al. Photobiomodulation therapy for the management of radiation-induced dermatitis. Strahlenther Onkol 193, 491–498 (2017). https://doi.org/10.1007/s00066-017-1117-x

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