Effect of corticosteroid ointment on radiation induced dermatitis in head and neck cancer patients: A prospective study.

BACKGROUND: Almost all the patients receiving curative radiotherapy for head and neck cancer develop radiation dermatitis, which many a times leads to treatment interruption and reduce patient compliance. In this study, we evaluated the effect of potent topical steroid (Betamethasone Valerate 0.1%) cream on acute radiation dermatitis in head and neck cancer patients receiving curative radiotherapy. METHODS: A total 106 patients of head and neck cancers were randomly divided into arm A (52 patients) and arm B (54 patients). The patient in study arm A were treated with topical betamethasone 0.1% twice daily during radiotherapy/chemo-radiotherapy and arm B was kept as control. The radiation reaction in both the groups was monitored weekly according to Radiation Therapy Oncology Group (RTOG) acute radiation dermatitis grading. RESULTS: Out of 106 patients, 85 (80.2%) patients completed treatment. Patient in control arm had earlier onset of grade 1 reaction (5.7% in arm A vs 16.7 % in arm B at 2nd week, P value 0.157 and 28.8% in arm A vs 50% in arm B at 3rd week, P value 0.028) and progression of radiation dermatitis. In 7th week patient in arm A had higher grade 1 reaction (17.3% in arm A vs 0% in arm B), while arm B had higher grade 2 reaction (66.7% arm B vs 55.8% in arm A). There was no difference in incidence of grade 3 and 4 reaction. No difference was observed in time taken for reaction to heal. CONCLUSION: Topical Betamethasone can delay the onset and progression of radiation dermatitis in head and neck cancer, without significant delay in wound healing.

Determination of Optimal Clinical Target Volume to Planning Target Volume Margins for Conformal Radiotherapy Planning using Image Guidance System in Rectal Cancer in Prone Position.

CONTEXT: In advanced radiotherapy techniques such as three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), geometrical uncertainties are very crucial as they may lead to under dosing of tumor and over dosing of the nearby critical structures and hence, it is important to determine planning target volume (PTV) margins which are specific for every center. AIMS: The aim of this study is to determine adequate clinical target volume (CTV) to PTV margins specific to our radiotherapy center. SETTINGS AND DESIGN: To calculate CTV to PTV margins for rectal cancer patients in prone position using kV cone beam CBCT data sets. MATERIALS AND METHODS: With the Patient immobilized in prone position using thermoplastic mask, a CT simulation was done and a comprehensive 3DCRT plan was generated. Daily kV CBCT was done to check the patient setup error. Daily setup errors were recorded and evaluated retrospectively. RESULTS: CTV-PTV margin calculated for pelvis in the prone position was calculated using van Herk Formula and were found to be 0.5, 1.8, 0.7 cm in the lateral, longitudinal, and vertical directions, respectively. CONCLUSIONS: Image guidance is an effective method to evaluate patient setup errors. Good quality immobilization devices and stringent patient setup policies can help to reduce PTV margins further.