Skip to main content

Advertisement

Log in

Looking for complementary alternatives to CTCAE for skin toxicity in radiotherapy: quantitative determinations

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Introduction

Radiotherapy (RT) is an essential part of the patient’s treatment diagnosed with cancer. Determination of the most common RT secondary effect, the cutaneous toxicity, is usually based on visual rating scales, like Common Terminology Criteria for Adverse Events with an inherent subjectivity. The aim of this work is to perform an objective method to evaluate the radiodermatitis using a non-invasive imaging technique based on laser Doppler flowmetry (LDF).

Materials and methods

A prospective study was performed analysing 1,824 measurements. A LDF was used to measure the cutaneous microcirculation in real time. A basal measurement was taken prior to radiotherapy treatment. To be able to observe the microcirculation changes related to the delivered dose, several sets of measurements were taken in the irradiated area along the RT treatment and in the contralateral non-irradiated area.

Results

A relative increase in blood flow at all measured points was found in the irradiated area. This relative increase in blood flow increases with the dose administered. In the non-irradiated contralateral area, the relative increase in blood flow is not significant and is independent of the dose administered. After treatment, a decrease in blood flow was detected with a trend towards returning to the baseline measurements.

Conclusions

LDF is an objective technique that assesses early radiodermatitis. This method is useful to develop strategies to prevent onset of radiation dermatitis in patients irradiated, such as the modification and individualization of fractionation parameters of the RT. This allows the reduction of radiation morbidities and maintains patient quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bentzen SM, Dorr W, Anscher MS, Denham JW, Hauer-Jensen M, Marks LB, et al. Normal tissue effects: reporting and analysis. Semin Radiat Oncol. 2003;13:189–202.

    Article  PubMed  Google Scholar 

  2. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6.

    Article  PubMed  CAS  Google Scholar 

  3. Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute (NCI). Common Terminology Criteria for Adverse Events (CTCAE): version 4.0. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Bethesda: Maryland; 2009. v4.02: 2009.

  4. Freedman GM, Anderson PR, Li J, Eisenberg DF, Hanlon AL, Wang L, et al. Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer. Am J Clin Oncol. 2006;29:66–70.

    Article  PubMed  Google Scholar 

  5. Formenti S, Gidea-Addeo D, Goldberg J, Roses D, Guth A, Rosenstein B, et al. Phase I–II trial of prone accelerated intensity modulated radiation therapy to the breast to optimally spare normal tissue. J Clin Oncol. 2007;25:2236–42.

    Article  PubMed  Google Scholar 

  6. Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol. 2004;22:1447–53.

    Article  PubMed  CAS  Google Scholar 

  7. Mukesh M, Harris E, Jena R, Coles Ch. Relationship between irradiated breast volume and late normal tissue complications. A systematic review. Radiother Oncol. 2012;104:1–10.

    Article  PubMed  Google Scholar 

  8. Pigno J, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008;26:2085–92.

    Article  Google Scholar 

  9. Bonner RF, Clem TR, Bowen PD. Laser Doppler continuous real-time monitor of pulsatile and mean blood flow in tissue microcirculation. In: Chen SH, Chu B, Nossal R, editors. Scattering techniques applied to supramolecular and non-equilibrium systems. New York: Plenum Press; 1981. p. 685–701.

    Chapter  Google Scholar 

  10. Bonner R, Nossal R. Model for laser Doppler measurements of blood flow in tissue. Appl Opt. 1981;20:2097–107.

    Article  PubMed  CAS  Google Scholar 

  11. Saumet JL, Dittmar A, Leftheriotis G. Non-invasive measurement of skin blood flow: comparison between plethysmography, laser Doppler flowmeter and heat thermal clearance method. Int J Microcirc Clin Exp. 1986;5:73–83.

    PubMed  CAS  Google Scholar 

  12. Fagrell B. Advances in microcirculation network evaluation: an update. Int J Microcirc Clin Exp. 1995;15(Suppl 1):34–40.

    Article  PubMed  Google Scholar 

  13. Chufa HE, Cherry GW. Blood flow in patients with leg ulcers. In: Mani R, Falanga V, Shearman CP, Sandeman D, editors. Chronic wound healing. Clinical measurement and basic science. London: W.B. Saunders; 2000.

    Google Scholar 

  14. Romanelli M, Falanga V. Measurement of transcutaneous oxygen tension in chronic wounds. In: Mani R, Falanga V, Shearman CP, Sandeman D, editors. Chronic wound healing. Clinical measurement and basic science. London: W.B. Saunders; 2000.

    Google Scholar 

  15. Bland JM, Altman DG. Statistical methods for assessing agreement between measurement. Biochim Clin. 1987;11:399–404.

    Google Scholar 

  16. Evaluation of measurement data—guide to the expression of uncertainty in measurement. JCGM. 2008;100.

  17. Schnur JB, Love B, Scheckner BL, Green S, Wernicke AG, Montgomery GH. A systematic review of patient-rated measures of radiodermatitis in breast cancer radiotherapy. Am J Clin Oncol. 2011;34:529–36.

    PubMed  PubMed Central  Google Scholar 

  18. Feight D, Baney T, Bruce S, McQuestion M. Evidence-based interventions for radiation dermatitis. Clin J Oncol Nurs. 2011;15(5):481–92.

    Article  PubMed  Google Scholar 

  19. Archambeau JO, Pezner R, Wasserman T. Pathophysiology of irradiated skin and breast. Int J Radiat Oncol Biol Phys. 1995;31:1171–85.

    Article  PubMed  CAS  Google Scholar 

  20. Chren MM, Lasek RJ, Sahay AP, Sands L. Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases. J Cutan Med Surg. 2001;5(2):105–10.

    Article  PubMed  CAS  Google Scholar 

  21. Atherton PJ, Burger KN, Loprinzi CL, Neben Wittich MA, Miller RC, Jatoi A, et al. Using the Skindex-16 and Common Terminology Criteria for Adverse Events to assess rash symptoms: results of a pooled analysis (N0993). Support Care Cancer. 2012;20(8):1729–35.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lim CC, Devi MK, Ang E. Anxiety in women with breast cancer undergoing treatment: a systematic review. Int J Evid Based Healthc. 2011;9(3):215–35.

    PubMed  Google Scholar 

  23. Bostrom 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;59:257–65.

    Article  PubMed  CAS  Google Scholar 

  24. Dornfeld K, Gessert CE, Renier CM, McNaney DD, Urias RE, Knowles DM, et al. Differences in breast tissue oxygenation following radiotherapy. Radiother Oncol. 2011;100:289–92.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Any actual or potential conflicts of interest do not exist. The authors have no financial and personal relationship with other persons or organizations that could inappropriately influence their work.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. González-Sanchís.

Rights and permissions

Reprints and permissions

About this article

Cite this article

González-Sanchís, A., Vicedo-González, A., Brualla-González, L. et al. Looking for complementary alternatives to CTCAE for skin toxicity in radiotherapy: quantitative determinations. Clin Transl Oncol 16, 892–897 (2014). https://doi.org/10.1007/s12094-014-1163-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-014-1163-0

Keywords

Navigation