Factors associated with the quality of life of women undergoing radiotherapy.

OBJECTIVE: To evaluate the skin characteristics and quality of life of patients with breast cancer undergoing radiotherapy. METHOD: Cross-sectional study conducted with 60 women. The classification scales of skin changes resulting from exposure to ionizing radiation (RTOG) and the validated versions in Portuguese of those that classified skin types (Fitzpatrick), symptoms (RISRAS) and quality of life (DLQI) were applied. in the period between December 2021 and October 2022. For data analysis, Fisher's Exact Test, Chi-Square and Asymptotic General Independence Test were used. RESULTS: 100% of patients had skin irritation. As the treatment progressed and the radiodermatitis appeared or worsened, there was a tendency for the intensity of signs and symptoms to increase, such as: sensitivity, discomfort or pain, itching, burning and heat, dry and wet desquamation, which may have impacted the quality of life and reflected in other aspects, such as: shopping activities or outings (p=0.0020), social activities or leisure activities (p=0.0420). CONCLUSION: Radiodermatitis is a common condition that affects women with breast cancer undergoing radiotherapy, skin characteristics and quality of life of patients affected during this treatment.

Radiodermatites: Análise dos Fatores Preditivos em Pacientes com Câncer de Mama / Radiodermatitis: Analysis of Predictive Factors in Breast Cancer Patients / Radiodermatitis: Análisis de Factores Predictivos en Pacientes con Cáncer de Mama

Introdução: A radioterapia é uma das modalidades terapêuticas de escolha para os tratamentos adjuvante e neoadjuvante, em pacientes com câncer de mama. Tal modalidade provoca reação de pele dolorosa conhecida como radiodermatite. Objetivo: Avaliar os fatores associados com o aparecimento de radiodermite após radioterapia e a sua associação com o maior grau de toxicidade nesses pacientes. Método: Estudo retrospectivo, com 117 pacientes com de câncer de mama submetidos à radioterapia conformacional 3D, entre 2016 a 2018, em doses variáveis. Dados pessoais foram coletados a partir de prontuário, e o grau de radiodermite estabelecido segundo os critérios do grupo de oncologia radioterápica. O total de 15 potenciais preditivos foram elencados e analisados por estatísticas univariada e multivariada. Resultados: A população do estudo apresentou uma média de 50 anos, 47% relataram alguma comorbidade, 59,83% realizaram cirurgia radical e 81,19% desenvolveram radiodermite. Observou-se, em análise multivariada, associação do desenvolvimento de radiodermite com maiores doses da radiação (p=0,011) e com uso de bólus diário (p=0,009). Conclusão: As principais variáveis que culminaram em maiores graus de radiodermite foram a dose da radiação e o uso de bólus diário. Categorizando os fatores preditivos, identificam-se o paciente com maior risco de lesões graves e a possibilidade da criação de protocolos mais eficazes na prevenção das radiodermatites.

Introduction: Radiotherapy is one of the therapeutic modalities chosen for adjuvant and neoadjuvant treatment in patients with breast cancer. This modality causes a painful skin reaction known as radiodermatitis. Objective:To evaluate the factors related with the appearance of radiodermatitis after radiotherapy and their relationship with the highest degree of toxicity in patients with breast cancer. Method: Retrospective study, with 117 patients with breast cancer submitted to 3D conformational radiotherapy between 2016 and 2018, at variable doses. Personal data were collected from medical records, and the degree of radiodermatitis established according to the criteria of the Radiation Oncology Group. The total of 15 predictive factors in potential were listed and later analyzed by univariate and multivariate statistics. Results: The study population presented an average of 50 years, 47% reported some comorbidities, 59.83% underwent radical surgery and 81.19% developed radiodermatitis. In a multivariate analysis, there was an association between development of radiodermatitis and higher doses of radiation (p=0.011) and daily bolus use (p=0.009). Conclusion:The main elements that culminated in higher degrees of radiodermatitis were the dose of radiation and the use of daily bolus. By categorizing the predictive factors, we can identify the patient with the highest risk of severe skin lesions and enables the creation of more effective protocols for the prevention of radiodermatitis.

Introducción: La radioterapia es una modalidad terapéutica para tratamiento adyuvante y neoadyuvante, en pacientes con cáncer de mama. Tal modalidad provoca reacción de piel dolorosa conocida como radiodermatitis. Objetivo: Evaluar factores conexos con la aparición de radiodermatitis tras la radioterapia y su asociación con el mayor grado de toxicidad. Método: Estudio retrospectivo, con 117 pacientes con cáncer de mama sometidos a la Radioterapia Conformacional 3D entre 2016 a 2018. Los datos personales fueron recolectados a partir de prontuario, así como el grado de radiodermatitis establecido según los criterios del grupo de oncología radioterápica. El total de 15 potencial predictivos fueron enumerados y posteriormente analizados por estadística univariana y multivariada. Resultados: La población del estudio presentó un promedio de 50 años, el 47% informó de algunas comorbilidades, el 59,83% se sometió a cirugía radical y el 81,19% desarrolló radiodermatitis. En un análisis multivariado, hubo una asociación entre el desarrollo de radiodermatitis y dosis más altas de radiación (p=0.011) y el uso diario de bolos (p=0.009). Conclusión: Las principales variables que culminaron en mayores grados de radiodermatitis fueron la dosis de radiación y el uso de bolos diarios. Al categorizar los factores predictivos, podemos identificar al paciente con el mayor riesgo de lesiones cutáneas graves y permitir la creación de protocolos más efectivos para la prevención de la radiodermatitis.

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

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.

[Cutaneous radiation syndrome: clinical features, diagnosis and therapy]. / Das kutane Strahlensyndrom. Klinik, Diagnostik und Therapie.

Accidental exposure to ionizing radiation may occur during such catastrophic events as the Chernobyl accident in 1986 or over days to weeks as in Goiania in 1987 and in the military camp during the training of soldiers in Lilo/Georgia in 1997, as well as in medical institutions. The cutaneous symptoms after radiation exposure are based on a combination of inflammatory processes and alteration of cellular proliferation as a result of a specific pattern of transcriptionally activated proinflammatory cytokines and growth factors. They follow a time course consisting of prodromal erythema, latency period, acute stage, chronic stage and late stage. The entire complex is referred to as cutaneous radiation syndrome. The time course depends on several factors such as the radiation dose, radiation quality, individual radiation sensitivity, the extent of contamination and absorption and amount of skin exposed. For the diagnosis of the cutaneous radiation syndrome the following procedures are used: 7.5 MHz to 20 MHz-B-scan sonography, thermography, capillary microscopy, profilometry, nuclear magnetic resonance imaging, bone scintigraphy and histology. Based on the results of experimental and clinical research, today treatment may include topical or systemic corticosteroids, gamma-interferon, pentoxifylline, vitamin E and superoxide dismutase. The treatment depends on the stage of the cutaneous radiation syndrome. Due to the complexity of the clinical manifestations of radiation disease, most patients require interdisciplinary treatment in specialized centres. Dermatologists are essential partners in the life-long follow-up and therapy of such patients.

Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy.

OBJECTIVE: To characterize the epidemiological, clinical, and histopathological features of patients with cancer who develop widespread polymorphic and pruritic skin lesions following radiotherapy. PATIENTS, DESIGN, AND INTERVENTIONS: During phase 1, epidemiological and clinical features of 103 patients with cancer, 83 treated with radiotherapy (71 women and 12 men) and 20 controls who did not undergo radiotherapy (16 women and 4 men), were explored during 3 months (October 1995 to January 1996). During phase 2, in 30 additional patients with cancer who were treated with telecobalt or linear accelerator, 18 with skin lesions (15 women and 3 men) and 12 without lesions (10 women and 2 men), the following were investigated: (1) hematoxylin-eosin-stained sections for routine histopathological examination and direct immunofluorescence, and lymphocytic markers; (2) blood, skin, and primary tumor eosinophilia; and (3) the presence of antiepidermal autoantibodies. Patients were examined during 5 months (February 1996 to June 1996). SETTING: A dermatology department at a university hospital. RESULTS: During phase 1, 14 (17%) of the 83 patients undergoing radiotherapy developed an eruption. Acral excoriations, erythematous papules, vesicles, and bullae were the most frequent lesions. During phase 2, in 18 patients, a superficial and deep lymphocytic perivascular infiltrate with numerous eosinophils, intraepidermal and interstitial eosinophilic infiltrates, eosinophilic panniculitis, IgM and C3 perivascular deposits, and slightly predominant CD4+ cells were observed. No antiepidermal autoantibodies were found. CONCLUSIONS: The clinical, histopathological, and immunopathologic features in patients with cancer undergoing radiotherapy are described. To our knowledge, this condition has not been well characterized. Because of its unique presentation, the denomination "eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy" is suggested.

El método de la microcapilaroscopía y su utilización en el diagnóstico precoz de la radiodermatitis ocupacional / The icrocapilaroscopy method and its usefulness in the early diagnosis of occupational radiodermites

Se describe el método de la microcapilaroscopia y se señala su aplicación como prueba auxiliar en el diagnóstico de una serie de enfermedades de la piel. Se resalta el valor que pudiera tener la utilización de este método en el diagnóstico precoz de las lesiones cutáneas en los dedos, producidas por radiaciones ionizantes en los trabajadores con alto riesgo de efectos no estocásticos. Consideramos que seria beneficioso realizar un estudio exploratorio en individuos de diferentes tipos de piel con el propósito de introducir esta técnica auxiliar de diagnóstico en nuestro país

El método de la microcapilaroscopía y su utilización en el diagnóstico precoz de la radiodermatitis ocupacional / The microcapilaroscopy method and its usefulness in the early diagnosis of occupational radiodermites

Se describe el método de la microcapilaroscopia y se señala su aplicación como prueba auxiliar en el diagnóstico de una serie de enfermedades de la piel. Se resalta el valor que pudiera tener la utilización de este método en el diagnóstico precoz de las lesiones cutáneas en los dedos, producidas por radiaciones ionizantes en los trabajadores con alto riesgo de efectos no estocásticos. Consideramos que seria beneficioso realizar un estudio exploratorio en individuos de diferentes tipos de piel con el propósito de introducir esta técnica auxiliar de diagnóstico en nuestro país