Computational model based on optical coherence tomography (OCT) skin scanning to identify and quantify acute radiation dermatitis (ARD): a prospective diagnostic study.

BACKGROUND: acute radiation dermatitis (ARD) is the most widely reported radiotherapy-induced adverse event. Currently, there is no objective or reliable method to measure ARD. OBJECTIVE: our main objective was to identify and quantify the effects of radiotherapy with a computational model using optical coherence tomography (OCT) skin scanning. Secondary objectives included determining the ARD impact of different radiotherapeutic schemes and adjuvant topical therapies. METHODS: we conducted a prospective, single-center case series study in a tertiary referral center of patients with breast cancer who were eligible for whole breast radiotherapy (WBRT). RESULTS: a total of 39 women were included and distributed according to the radiotherapeutic schemes (15, 20, and 25 fractions). A computational model was designed to quantitatively analyze OCT findings. After radiotherapy, OCT scanning was more sensitive revealing vascularization changes in 84.6% of the patients (vs 69.2% of the patients with ARD by clinical examination). OCT quantified an increased vascularization at the end of WBRT (P < .05) and a decrease after 3 months (P = .032). Erythematous skin changes by OCT were more pronounced in the 25-fraction regime. CONCLUSION: an OCT computational model allowed for the identification and quantification of vascularization changes on irradiated skin, even in the absence of clinical ARD. This may allow the design of standardized protocols for ARD beyond the skin color of the patients involved.

Effectiveness of glutamine for the treatment of radiodermatitis in cancer patients: a meta-analysis of randomized controlled trials.

BACKGROUND: After receiving radiation therapy, 60%-95% of patients with cancer develop radiodermatitis, which causes pain, wound infection, and poor quality of life. Glutamine is a popular nutritional supplement for patients with cancer. Several studies examined the usefulness of glutamine for reducing radiodermatitis. However, there is still no consolidated evidence for clinical use. METHODS: We searched PubMed, Embase, Cochrane Library, CINAHL PLUS, and the China Knowledge Resource Integrated Database for the relevant literature published up to March 2023, without language restrictions. Two reviewers screened, filtered, and appraised these articles independently, and their data were pooled using a random-effects model. RESULTS: Five randomized controlled trials (RCTs) with 218 participants were analyzed. The incidence of radiodermatitis in the glutamine group (89/110) was significantly lower than in the placebo group (99/108; risk ratio [RR], 0.90; 95% CI, 0.81-1.00; p = 0.05; I2 = 7%). The incidence of moderate to severe radiodermatitis was significantly lower in the glutamine group than in the placebo group (RR, 0.49; 95% CI, 0.32-0.76; p = 0.001; I2 = 52%). Moreover, subgroup analysis demonstrated heterogeneity (I2 = 52%) for moderate to severe radiodermatitis, the risk of which might be significantly reduced by a glutamine dose of 20-30 g/day (RR, 0.60; 95% CI, 0.41-0.87; I2 = 0%). CONCLUSION: The meta-analysis indicate that glutamine might lead to a lower incidence of radiodermatitis, and that a glutamine dose of 20-30 g/day might decrease the incidence of moderate to severe dermatitis. Thus, the serious impact of radiodermatitis on treatment follow-up makes the clinical use of glutamine even more important. PROSPERO number: CRD42021254394.

Deciphering the fibrotic process: mechanism of chronic radiation skin injury fibrosis.

This review explores the mechanisms of chronic radiation-induced skin injury fibrosis, focusing on the transition from acute radiation damage to a chronic fibrotic state. It reviewed the cellular and molecular responses of the skin to radiation, highlighting the role of myofibroblasts and the significant impact of Transforming Growth Factor-beta (TGF-ß) in promoting fibroblast-to-myofibroblast transformation. The review delves into the epigenetic regulation of fibrotic gene expression, the contribution of extracellular matrix proteins to the fibrotic microenvironment, and the regulation of the immune system in the context of fibrosis. Additionally, it discusses the potential of biomaterials and artificial intelligence in medical research to advance the understanding and treatment of radiation-induced skin fibrosis, suggesting future directions involving bioinformatics and personalized therapeutic strategies to enhance patient quality of life.

Incidence of radiodermatitis and factors associated with its severity in women with breast cancer: a cohort study

Abstract Background: One of the main adverse reactions of adjuvant radiotherapy for breast cancer is radiodermatitis. Objective: To assess the incidence of radiodermatitis in women with breast cancer, identify factors associated with its severity and determine the time at which this event occurs. Methods: Prospective cohort study in 113 women with breast cancer who were evaluated before radiotherapy and at every fifth session until the end of treatment. Logistic regression and Cox proportional regression model were used for the assessment of risk factors; P values < 0.05 were considered significant. Results: The incidence rate of radiodermatitis was 98.2% and it was demonstrated that for each additional point of the Body Mass Index (BMI), the chance of occurrence of grades II to IV radiodermatitis increases by 14% (OR = 1.14 [95% CI 1.04-1.26]; p = 0.004) and statin use increases the risk of more severe skin lesions by four-fold (OR = 4.27 [95% CI 1.11-16.42]; p = 0.035). The exclusive use of hydrogel for skin hydration was an independent factor in delaying the onset of radiodermatitis (HR = 0.55 [95% CI 0.36-0.82]; p = 0.004). Study limitations: The main limitation of this study was its external validity. The identified factors should be considered for services and populations similar to those in this study. Conclusions: There was a high incidence of radiodermatitis and its severity was related to higher BMI, statin use; there was a protective effect of hydrogel use.

Radiation therapy dose escalation achieves high rates of local control with tolerable toxicity profile in pediatric and young adult patients with Ewing sarcoma.

BACKGROUND: Local control for patients with Ewing sarcoma (EWS) who present with large tumors are suboptimal when treated with standard radiation therapy (RT) doses of 54-55.8 Gy. The purpose of this study is to determine local control and toxicity of dose-escalated RT for tumors ≥8 cm (greatest diameter at diagnosis) in pediatric and young adult patients with EWS. METHODS: Eligible patients ≤30 years old with newly diagnosed EWS ≥8 cm treated with definitive conformal or intensity modulated photon, or proton radiation therapy techniques were included. All patients in the study received dose-escalated RT doses. Outcomes included overall survival (OS), event-free survival (EFS), local failure rates, and toxicity. RESULTS: Thirty-two patients were included, 20 patients presented with metastatic disease and 12 patients with localized disease. The median RT dose was 64.8 Gy (range, 59.4-69.4 Gy) with variability of doses to protect normal surrounding tissues. All patients received systemic chemotherapy. The 5-year OS and EFS for the cohort was 64.2% and 42%, respectively. The 5-year cumulative incidence of local failure was 6.6%. There were two combined local and distant failures with no isolated local failures. Twenty-nine patients experienced short term toxicity, 90% of those being radiation dermatitis. Twenty-seven patients experienced long-term toxicity, with only one experiencing grade 4 toxicity, a secondary malignancy after therapy. CONCLUSION: This study demonstrates that definitive RT for pediatric and young adult patients with EWS ≥8 cm provides high rates of local control, while maintaining a tolerable toxicity profile.

Incidence of radiodermatitis and factors associated with its severity in women with breast cancer: a cohort study.

BACKGROUND: One of the main adverse reactions of adjuvant radiotherapy for breast cancer is radiodermatitis. OBJECTIVE: To assess the incidence of radiodermatitis in women with breast cancer, identify factors associated with its severity and determine the time at which this event occurs. METHODS: Prospective cohort study in 113 women with breast cancer who were evaluated before radiotherapy and at every fifth session until the end of treatment. Logistic regression and Cox proportional regression model were used for the assessment of risk factors; P values < 0.05 were considered significant. RESULTS: The incidence rate of radiodermatitis was 98.2% and it was demonstrated that for each additional point of the Body Mass Index (BMI), the chance of occurrence of grades II to IV radiodermatitis increases by 14% (OR=1.14 [95% CI 1.04-1.26]; p=0.004) and statin use increases the risk of more severe skin lesions by four-fold (OR=4.27 [95% CI 1.11-16.42]; p=0.035). The exclusive use of hydrogel for skin hydration was an independent factor in delaying the onset of radiodermatitis (HR=0.55 [95% CI 0.36-0.82]; p=0.004). STUDY LIMITATIONS: The main limitation of this study was its external validity. The identified factors should be considered for services and populations similar to those in this study. CONCLUSIONS: There was a high incidence of radiodermatitis and its severity was related to higher BMI, statin use; there was a protective effect of hydrogel use.

Evaluation of the effect of herbal agents as management of radiodermatitis in breast cancer patients: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of herbal agents in the prevention and therapy of radiodermatitis in breast cancer patients. METHODS: Randomized controlled trials were searched from databases such as PubMed, Web of Science, Embase, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI) to assess the effectiveness of herbal agents compared to a standard medication or placebo in prevention or treatment of radiodermatitis in breast cancer. RESULTS: Data from 16 studies involving 1994 patients were included. This meta-analysis included 10 clinical trials of 562 breast cancer patients treated with calendula, silymarin, or aloe vera for the prevention of radiodermatitis. Silymarin showed positive effects in ameliorating the damage of radiodermatitis, whereas the efficacy of calendula and aloe vera in the treatment of radiodermatitis lacks sufficient evidence. CONCLUSIONS: Herbal medicine may show therapeutic effects on radiodermatitis in breast cancer, but more comprehensive investigations and clinical trials are required in the future.

Factors associated with the quality of life of women undergoing radiotherapy / Factores asociados a la calidad de vida de mujeres en radioterapia / Fatores associados à qualidade de vida de mulheres submetidas à radioterapia

ABSTRACT 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.

RESUMEN Objetivo: Evaluar las características de la piel y la calidad de vida de pacientes con cáncer de mama en tratamiento con radioterapia. Método: Estudio transversal con 60 mujeres. Se aplicaron la escala de clasificación de alteraciones cutáneas por exposición a radiaciones ionizantes (RTOG) y las versiones validadas en portugués de las que clasificaban tipos de piel (Fitzpatrick), síntomas (RISRAS) y calidad de vida (DLQI) en el período comprendido entre diciembre 2021 y octubre de 2022. Para el análisis de los datos se utilizaron el Test Exacto de Fisher, Chi-Cuadrado y el Test de Independencia General Asintótica. Resultados: El 100% de los pacientes evaluados sobre la piel. A medida que avanzaba el tratamiento y aparecía o empeoraba la radiodermatitis, hubo tendencia a aumentar la intensidad de los signos y síntomas, tales como: sensibilidad, malestar o dolor, visualización, ardor y calor, descamación seca y húmeda, que pudieron haber tenido una impacto en la calidad de vida y reflejado en otros aspectos, como: actividades de compra o salidas (p=0,0020), actividades sociales o de ocio (p=0,0420). Conclusión: La radiodermatitis es una afección común que afecta a mujeres con cáncer de mama, sometidas a radioterapia, las características de la piel y la calidad de vida de las pacientes afectadas durante este tratamiento.

RESUMO Objetivo: Avaliar as características da pele e a qualidade de vida de pacientes com câncer de mama submetidas à radioterapia. Método: Estudo transversal com 60 mulheres. Foram aplicadas as escalas de classificação das alterações cutâneas decorrentes da exposição à radiação ionizante (RTOG) e as versões validadas em português das que classificaram os tipos de pele (Fitzpatrick), os sintomas (RISRAS) e a qualidade de vida (DLQI), no período entre dezembro de 2021 e outubro de 2022. Para a análise de dados, foram utilizados os Testes Exato de Fisher, Qui-Quadrado e Teste de Independência Geral Assintótica. Resultados: 100% das pacientes apresentaram irritação na pele. À medida que o tratamento avançou e que a radiodermatite surgiu ou se agravou, houve maior tendência de intensidade de sinais e sintomas, como: sensibilidade, desconforto ou dor, coceira, queimação e calor, descamação seca e úmida, o que pode ter impactado na qualidade de vida e refletido em outros aspectos, como: atividades de compras ou passeios (p=0,0020), programação social ou atividade de lazer (p=0,0420). Conclusão: A radiodermatite é uma condição comum que afeta as mulheres com câncer de mama submetidas à radioterapia, as características da pele e a qualidade de vida das pacientes são afetadas durante esse tratamento.

Head and neck cancer patients under radiotherapy undergoing skin application of hydrogel dressing or hyaluronic acid: results from a prospective, randomized study.

PURPOSE: Acute radiodermatitis (ARD) is a frequent side effect of radiotherapy, a therapeutic option for head and neck squamous cell carcinoma (HNSCC). It is responsible for pain, quality of life (QoL) impairment, and increased risk of treatment discontinuation, which may compromise the prognosis for patients. Local therapies to prevent or alleviate ARD have been proposed without providing any high level of evidence to establish recommendations. METHODS: We implemented a prospective multicenter randomized study on patients with HNSCC treated with definitive radiotherapy to assess the impact on ear, nose, and throat (ENT) pain of the application of a hydrogel-based skin dressing (HydroTac®) compared with the application of hyaluronic acid (Ialuset®) during radiotherapy. RESULTS: Out of 130 enrolled patients, 48 patients per group were assessable for the main endpoint. No difference between groups was found: a worsening of ENT pain of 3 points or more on a visual analog scale from the initiation to 1 month after the end of the radiotherapy was observed for 8 patients (16.7%) who received HydroTac® compared to 13 patients (27%) who received Ialuset® (p = 0.342). The proportion of patients who experienced ARD and grades of ARD (CTCAE v4.0 criteria) were similar between groups. Patient compliance with radiodermatitis treatment was poor, with 56.1% of patients in the HydroTac® group having their treatment temporarily stopped. CONCLUSION: The application of a hydrogel dressing to prevent ARD during radiotherapy for HNSCC patients has failed to demonstrate a benefit. These results may be limited by the difficulties of applying the dressing.

Aloe vera como estratégia de cuidado de enfermagem para tratamento de pessoas com radiodermatites / Aloe vera as a nursing care strategy for treating people with radiodermatitis

Descrever como acontece a utilização de Aloe vera como estratégia de cuidado de enfermagem para o tratamento de pessoas com radiodermatites. Metodologia: caráter retrospectivo e descritivo com a técnica da entrevista semiestruturada com as enfermeiras prescritoras de Aloe. Resultados: estruturação de conhecimentos sobre o Aloe vera como conduta de enfermagem nas radiodermatites que no Hospital Solidariedade resulta na efetiva prevenção de radiodermatites, principalmente de suas formas mais graves. Salienta-se que a babosa consegue prevenir a radiodermatite através do aumento da oxigenação da lesão e da diminuição da quantidade local de tecidos mortos. O estudo, também, proporciona uma maior compreensão sobre a função do enfermeiro na radioterapia e na reabilitação da pele. Conclusão: o Aloe vera tem um papel determinante na prevenção das radiodermatites, sendo um agente terapêutico inovador na área da enfermagem dermatológica e oncológica.(AU)

To describe how Aloe vera is used as a nursing care strategy to treat people with radiodermatitis. Methodology: retrospective and descriptive, using semi-structured interviews with nurses who prescribe Aloe vera. Results: structuring of knowledge about Aloe vera as a nursing approach to radiodermatitis at Solidarity Hospital resulted in the effective prevention of radiodermatitis, especially its more severe forms. It should be noted that aloe vera can prevent radiodermatitis by increasing oxygenation of the lesion and reducing the local amount of dead tissue. The study also provides a greater understanding of the role of nurses in radiotherapy and skin rehabilitation. Conclusion: Aloe vera plays a decisive role in the prevention of radiodermatitis and is an innovative therapeutic agent in the field of dermatology and oncology nursing.(AU)

Describir cómo se utiliza el Aloe vera como estrategia de cuidados de enfermería para tratar a personas con radiodermitis. Metodología: retrospectiva y descriptiva, mediante entrevistas semiestructuradas a enfermeros que prescriben Aloe vera. Resultados: la estructuración del conocimiento sobre el Aloe vera como abordaje de enfermería para la radiodermitis en el Hospital de la Solidaridad resultó en la prevención eficaz de la radiodermitis, especialmente de sus formas más graves. Cabe destacar que el aloe vera puede prevenir la radiodermatitis al aumentar la oxigenación de la lesión y reducir la cantidad local de tejido muerto. El estudio también permite comprender mejor el papel del personal de enfermería en la radioterapia y la rehabilitación cutánea. Conclusión: El aloe vera desempeña un papel decisivo en la prevención de la radiodermatitis y es un agente terapéutico innovador en el campo de la enfermería dermatológica y oncológica.(AU)

Erythema multiforme provoked by radiotherapy.

Radiation dermatitis is one of the most common adverse effects that occur in patients treated with radiation therapy. It is usually limited to the irradiated area. However, cases of generalized lesions have also been described in the literature. A rare but highly important cutaneous manifestation can be erythema multiforme-like lesions localized all over the patient's skin. A 63-year-old patient was admitted to the Department of Dermatology for disseminated erythematous lesions localized on the trunk and extremities. The patient denied taking any new medications or dietary supplements. However, he was undergoing radiotherapy treatment. On admission, the patient was in good general condition. During the stay in the department, the patient was treated orally as well as intravenously with corticosteroids, acyclovir, and a topical ointment consisting of gentamicin and betamethasone, as well as hydrocortisone and cooling ointment. After 1 month, a significant improvement in the patient's skin condition was noted. When skin lesions resembling erythema multiforme occur in patients undergoing oncological treatment, radiation therapy should be considered as a potential trigger.

A novel, multi-active emollient for the prevention of acute radiation dermatitis in breast cancer patients: a randomized clinical trial.

PURPOSE: To investigate the efficacy of a novel, multi-active emollient in preventing and managing acute radiation dermatitis (ARD) in breast cancer patients undergoing moderate hypofractionated (HF) radiotherapy (RT) compared to standard of care. METHODSA: A monocentric, open-label, randomized clinical trial (RCT) with breast cancer patients receiving moderate HF (dose: 40.05-55.86 Gy, fractions: 15-21) was conducted between January 2022 and May 2023. The experimental group received the novel emollient, while the control group received the standard skin care. Patients applied the skin care products twice daily during the complete RT course. The primary outcome was the severity of ARD at the final RT session measured by the modified Radiation Therapy Oncology Group (RTOG) criteria. Secondary outcomes included patient symptoms, quality of life (QoL), and treatment satisfaction. RESULTS: A total of 100 patients with 50 patients per group were enrolled. In the control group, 50% of the patients developed RTOG grade 1 ARD and 48% grade 2 or higher, while in the experimental group, the severity of ARD was significantly lower with 82% grade 1 and 16% grade 2 ARD (P = .013, χ2-test). The frequency and severity of xerosis were significantly lower in the experimental compared to the control group (Ps ≤ .036, Mann Whiney U test). The impact of ARD on the QoL was low, and treatment satisfaction was high in both groups, with no significant difference. CONCLUSION: This RCT shows that the novel, multi-active emollient significantly reduced the ARD RTOG grade. Research in a more diverse patient population is warranted. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04929808 (11/06/2021).

Autophagy gene Atg7 regulates the development of radiation-induced skin injury and fibrosis of skin.

BACKGROUND: Radiation-induced skin injury, which may progress to fibrosis, is a severe side effect of radiotherapy in patients with cancer. However, currently, there is a lack of preventive or curative treatments for this injury. Meanwhile, the mechanisms underlying this injury remain poorly understood. Here, we elucidated whether autophagy is essential for the development of radiation-induced skin injury and the potential molecular pathways and mechanisms involved. METHODS AND RESULTS: We used the myofibroblast-specific Atg7 knockout (namely, conditional Atg7 knockout) mice irradiated with a single electron beam irradiation dose of 30 Gy. Vaseline-based 0.2% rapamycin ointment was topically applied once daily from the day of irradiation for 30 days. On day 30 post irradiation, skin tissues were harvested for further analysis. In vitro, human foreskin fibroblast cells were treated with rapamycin (100 nM) for 24 h and pretreated with 3-MA (5 mM) for 12 h. Macroscopic skin manifestations, histological changes, and fibrosis markers at the mRNA and protein expression levels were measured. Post irradiation, the myofibroblast-specific autophagy-deficient (Atg7Flox/Flox Cre+ ) mice had increased fibrosis marker (COL1A1, CTGF, TGF-ß1, and α-SMA) levels in the irradiated area and had more severe macroscopic skin manifestations than the control group (Atg7Flox/Flox Cre- ) mice. Treatment with an autophagy agonist rapamycin attenuated macroscopic skin injury scores and skin fibrosis marker levels with decreased epidermal thickness and dermal collagen deposition in Atg7Flox/Flox Cre+ mice compared with the vehicle control. Moreover, in vitro experiment results were consistent with the in vivo results. Together with studies at the molecular level, we found that these changes involved the Akt/mTOR pathway. In addition, this phenomenon might also relate to Nrf2-autophagy signaling pathway under oxidative stress conditions. CONCLUSION: In conclusion, Atg7 and autophagy-related mechanisms confer radioprotection, and reactivation of the autophagy process can be a novel therapeutic strategy to reduce and prevent the occurrence of radiodermatitis, particularly skin fibrosis, in patients with cancer.

The role of ultrasound quantitative parameters in the assessment of acute radiodermatitis after breast-conserving surgery.

This study aimed to assess the severity of acute radiodermatitis (ARD) by ultrasound quantitative parameters and to try to identify the influencing factors of skin toxicity. A total of 55 patients who underwent radiotherapy after unilateral breast-conserving surgery (BCS) were included in the study. The irradiated side of the breast was used as the research object and the quantitative ultrasound parameters (skin thickness, shear wave elasticity) were evaluated before radiotherapy, every week during radiotherapy. Two weeks after radiotherapy, the patients were divided into two groups, according to the World Health Organization scoring standard: mild (0-2 grade) and severe (3-4 grade). The differences in the parameters between the groups and the changes during radiotherapy were compared, and the relationship between these parameters and the severity of ARD was analyzed. In addition, some clinical factors that may affect ARD were also included in our study. Ninety-eight percent of patients developed different degrees of ARD, and Group 2 accounted for ~31%. At the end of 5 weeks of radiotherapy, the difference in thickness between the two groups was statistically significant (P < 0.05). There was no significant change in the elastic modulus of breast skin between the two groups (P > 0.05). Body mass index >25 kg/m2, breast thickness ≥18 mm, skin basic elastic modulus <23 kPa and skin thickness increment >0.3 mm were considered to be associated with severe skin reactions (P < 0.05). Ultrasound can be a useful tool for the non-invasive and objective assessment of skin changes during radiotherapy, documenting quantitative changes in the skin of breast cancer patients following BCS undergoing radiotherapy.

The efficacy of medicinal plant preparations in the alleviation of radiodermatitis in patients with breast cancer: A systematic review of clinical trials.

Radiodermatitis in breast cancer patients varies from mild irritation to life-threatening lesions. Several studies suggest a role for topical corticosteroid ointments in the treatment of radiodermatitis. Yet, to avoid the adverse effects of corticosteroids, many authors recommend the use of topical herbal products instead. The therapeutic role of herbal treatments has yet to be fully understood. This systematic review evaluates the role of topical or oral herbal medicines in radiodermatitis prevention and treatment. A systematic search of four databases (Embase, PubMed, Web of Science, and Scopus) was performed without language and time restrictions from their inception until April 2023. The bibliographies of potential articles were also searched manually. Studies evaluated and compared the effects of herbal preparations with the control group, on dermatitis induced by radiotherapy for breast cancer. The Cochrane risk of bias tool was used to assess the included studies. Thirty-five studies were included in the systematic review. Studies which used herbal drugs including topical and oral formulations were evaluated. Herbal monotherapy and combination therapy were reported, and their effects on radiodermatitis were explained in the systematic review. In conclusion, henna ointments, silymarin gel, and Juango cream were reported to reduce the severity of radiodermatitis. These agents should be considered for radiodermatitis prophylaxis and treatment. The data on aloe gel and calendula ointment were conflicting. Further randomized controlled trials of herbal medications and new herbal formulations are required to determine their effects on breast cancer radiodermatitis.

Therapeutic effect of turmeric on radiodermatitis: A systematic review.

Radiodermatitis (RD) occurs in 95% of cancer patients undergoing radiation therapy. At present, there is no effective treatment for the management of this complication of radiotherapy. Turmeric (Curcuma longa) is a polyphenolic and biologically active natural compound with various pharmacological functions. The aim of this systematic review was to determine the efficacy of curcumin supplementation for reducing RD severity. This review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive literature search was conducted in Cochrane library, PubMed, Scopus, Web of Science, and MEDLINE databases. A total of seven studies comprising 473 cases and 552 controls were included in this review. Four studies demonstrated that curcumin supplementation had a beneficial effect on RD intensity. These data provide evidence for the potential clinical use of curcumin in supportive cancer care. Further large prospective and well-designed trials are warranted to exactly determine the "real effective extract, supplemental form and dose of curcumin" for RD prevention and treatment of patients receiving radiotherapy.

Effects of oral supplementation to manage radiation dermatitis in cancer patients: a systematic review.

PURPOSE: To evaluate the effectiveness and safety of oral supplementation as a radioprotective intervention in the management of radiation dermatitis (RD). METHODS: Systematic review and meta-analysis. Six databases and the gray literature were searched for randomized controlled clinical trials (RCTs). Meta-analysis was performed only with studies that evaluated the same intervention. Methodology of included studies was evaluated by the Cochrane risk-of-bias tool for randomized trials (RoB 2.0), and the certainty of evidence was assessed by the GRADE instrument. RESULTS: Seventeen RCTs were included in this review. These evaluated different types of oral supplementations. Findings from three meta-analyses demonstrated no significant benefits to the more severe grades of RD, as oral curcuminoids (RR, 0.59; 95% CI, 0.27 to 1.29; P = 0.19; I2 = 88%), glutamine (RR, 0.40; 95% CI, 0.15 to 1.03; P = 0.06; I2 = 78%) or Wobe-Mugos (RR, 0.57; 95% CI, 0.29 to 1.14; P = 0.11; I2 = 72%). Also, the certainty of the evidence of outcomes evaluated was moderate or low. Except for a few gastrointestinal adverse events, oral supplementation was well tolerated. CONCLUSION: Most oral supplements cannot yet be recommended to manage RD due to insufficient or conflicting evidence. However, despite no significant results, glutamine was shown to be a promising substance in terms of the potential radioprotective effect and may be well tolerated. These results suggest that more RCTs with larger samples are needed to evaluate the efficacy, safety, and tolerance of glutamine in the management of RD.

Tratamentos tópicos para prevenção da radiodermatite em pacientes oncológicos: um protocolo de revisão de escopo / Topical treatments for the prevention of radiodermatitis in cancer patients: a scoping review protocol

OBJETIVO: Mapear as evidências disponíveis sobre os tratamentos tópicos utilizados na prevenção da radiodermatite no paciente oncológico. MÉTODO: Protocolo de revisão de escopo seguindo a metodologia do Joanna Briggs Institute (JBI). A estratégia de busca subdivide-se em três etapas utilizando os bancos de dados MEDLINE, CINAHL, LILACS, Web of Science (WoS) e literatura cinzenta (teses, dissertações, guidelines, opiniões de especialistas e material de divulgação de empresas detentoras de produtos), sem restrição de idioma ou temporal. A seleção dos artigos será realizada por dois revisores independentes e a extração de dados se dará através de um formulário construído para esse propósito. Os dados extraídos serão apresentados em diagramas ou tabelas, alinhados com o objetivo dessa revisão de escopo, concluindo com um resumo narrativo.

OBJECTIVE: To map the available evidence on topical treatments used to prevent radiodermatitis in cancer patients. METHOD: Scoping review protocol developed following the Joanna Briggs Institute (JBI) methodology. The search strategy is subdivided into three steps using the MEDLINE, CINAHL, LILACS, Web of Science (WoS), and grey literature databases (theses, dissertations, guidelines, expert opinions, and promotional material from companies that own specific products), with no language or time restriction. Two independent reviewers will select articles, and data extraction will take place through a form built for this purpose. The extracted data will be presented in diagrams or tables, aligned with the objective of this scoping review, closing with a narrative synthesis.

Randomized clinical trial of tissue equivalent bolus prescription in postmastectomy radiotherapy stratified by skin involvement status.

Purpose: To assess the impact and optimize the prescription of tissue-equivalent bolus in postmastectomy radiotherapy (PMRT), we compared the use of different bolus regimens tailored by skin involvement status. Methods: Patients with breast cancer who required PMRT were recruited (NCT01925651) and classified into two groups: standard-risk (SR, without skin involvement) and high-risk (HR, with skin involvement). SR was randomized between no bolus or 5 mm-bolus on alternate days and HR between 5 mm-bolus on alternate days or daily. Conventional fractionation (50.4 Gy; 1.8 Gy/daily) was used. Acute skin toxicity was evaluated blindly and the radiodermatitis-specific toxicity index [rads-TI] calculated. Subsequently, patients were followed up to assess oncologic outcomes, focusing on chest wall (CW) local control. Results: Fifty-eight patients were enrolled (34 SR and 24 HR). Baseline characteristics were similar between arms within the same risk group. Overall, maximal radiodermatitis rates were 29.4 % (G2) and 15.7 % (G3). In the SR group, no difference existed in G2 radiodermatitis incidence between the subgroups (p = 0.70) and no G3 events occurred. In the HR group, incidences of G2 (100 % vs 44.5 %, p = 0.01) and G3 radiodermatitis (70 % vs 11.1 %, p = 0.02) were higher with daily bolus. After adjusting for confounders, the daily bolus had a higher incidence of G2 (p = 0.03), G3 radiodermatitis (p = 0.04), and worse rads-TI (p < 0.01). After a median follow-up of 6.2 years, the 5-year local control was 95.8 % (95 %CI: 88.2 %-100 %) in the SR and 91.7 % (95 %CI: 77.3 %-100 %) in the HR groups. Per risk group, there was no difference in local control between the SR (p = 0.90) or the HR bolus regimens (p = 0.70). Conclusion: Daily 5 mm bolus prescription significantly increased the overall toxicity burden. In this preliminary study, within the same risk group, no detriment in CW local control was detected with less intense bolus regimens (SR: no bolus; HR: alternate-days bolus). Additionally, the rads-TI was able to distinguish overall radiodermatitis burden.