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Management of severe bio-radiation dermatitis induced by radiotherapy and cetuximab in patients with head and neck cancer: emphasizing the role of calcium alginate dressings

  • Pierluigi BonomoEmail author
  • Isacco Desideri
  • Mauro Loi
  • Lucia Pia Ciccone
  • Monica Lo Russo
  • Carlotta Becherini
  • Daniela Greto
  • Gabriele Simontacchi
  • Nicola Pimpinelli
  • Lorenzo Livi
Original Article
  • 30 Downloads

Abstract

Purpose

Severe bio-radiation dermatitis may develop in patients treated with concurrent radiotherapy and cetuximab for head and neck squamous cell carcinoma. The aim of our work was to report on the impact of a grade-specific management approach on treatment tolerability.

Methods

Concomitant radiotherapy and cetuximab was prescribed for patients deemed ineligible for cisplatin-based chemoradiation. Since 2014, an advanced wound care nursing team was established in our clinic to implement a standardized policy for skin toxicity. A central role of calcium alginate dressings was defined in our management algorithm. The correlation between patient, disease, and treatment features with severe bio-radiation dermatitis and treatment tolerability was evaluated.

Results

Between 2007 and 2018, 51 patients were treated at our center with radiotherapy and cetuximab. The incidence of G3/G4 bio-radiation dermatitis was 43.1%. Comparing two consecutive cohorts of 26 and 25 patients treated before and after January 2014, respectively, the adoption of a grade-specific dermatitis management allowed to improve treatment tolerability. A mean radiation treatment interruption of 8.42 days (SD, 6.73; 95% CI 5.7–11.1) was reduced to 0.86 days (SD, 2.66; 95% CI − 0.28–2.02) in the more recent group (p < 0.0001). Mean relative dose intensity of cetuximab was also significantly higher (86.3% vs 74.5%, p = 0.0226).

Conclusions

Routine involvement of an advanced wound care management team and early consideration for calcium alginate dressings in case of moist desquamation should be warranted to ensure high compliance to radiotherapy and cetuximab in patients with head and neck cancer.

Keywords

Head and neck cancer Radiotherapy Cetuximab Bio-radiation dermatitis Skin toxicity 

Notes

Acknowledgements

The authors wish to thank the advanced wound care nursing team (Mrs. Vincenza Capalbo, Beatrice Formigli, Flavia Picone, and Susanna Targioni) for the excellent work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

The authors have full control of all primary data and agree to allow the journal to review the data if requested

Supplementary material

520_2018_4606_MOESM1_ESM.docx (20 kb)
Supplementary material : p value: differences reported according to cohort 2014-2018 vs cohort 2007-2013 (t test and log rank test) (DOCX 20 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Pierluigi Bonomo
    • 1
    Email author
  • Isacco Desideri
    • 1
  • Mauro Loi
    • 1
  • Lucia Pia Ciccone
    • 1
  • Monica Lo Russo
    • 1
  • Carlotta Becherini
    • 1
  • Daniela Greto
    • 1
  • Gabriele Simontacchi
    • 1
  • Nicola Pimpinelli
    • 2
  • Lorenzo Livi
    • 1
  1. 1.Radiation OncologyAzienda Ospedaliero – Universitaria Careggi, University of FlorenceFlorenceItaly
  2. 2.Division Dermatology, Department Surgery and Translational MedicineUniversity of FlorenceFlorenceItaly

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