A long-term follow-up of early breast cancer patients treated with photobiomodulation during conventional fractionation radiotherapy in the prevention of acute radiation dermatitis.

OBJECTIVES: The evidence demonstrating the efficacy of photobiomodulation (PBM) therapy for preventing and managing acute radiation dermatitis (ARD) is growing steadily. The question that arises from many clinicians is, if PBM is safe for oncologic patients. This study aimed to evaluate the disease-free survival (DFS), cancer-free survival (CFS), and overall survival (OS) of breast cancer patients treated with PBM for ARD. METHODS: Clinical data of 120 breast cancer patients treated with prophylactic PBM (n = 60, 2x/week, 808-905 nm, 4 J/cm2 ) or placebo (n = 60) during conventional fractionation (CF) radiotherapy (RT) between April 2015 and June 2017 were retrospectively analyzed (TRANSDERMIS trial). During follow-up (April 2015 to May 2022), patients underwent a complete clinical evaluation every 6 months and blood analysis and mammography yearly in the first 5 years after the end of RT. The DFS, CFS, and OS were estimated. RESULTS: At a median follow-up time of 66 months (range 4-81), there was no significant difference in DFS (73.7% vs. 98.3%, resp., p = 0.54), CFS (68.4% vs. 77.8%, resp., p = 0.79), and OS (87.9% vs. 98.3%, resp., p = 0.30) between the placebo and PBM group. CONCLUSIONS: This paper is the first to describe the results of a long-term follow-up in early-stage breast cancer patients who underwent PBM for ARD. Results suggest that using PBM in breast cancer patients undergoing CF RT does not influence the locoregional recurrence, the development of new primary tumors, or OS.

Photobiomodulation therapy for the prevention of acute radiation dermatitis in breast cancer patients undergoing hypofractioned whole-breast irradiation (LABRA trial).

OBJECTIVES: To evaluate the efficacy of photobiomodulation therapy in breast cancer patients post-lumpectomy undergoing hypofractionated whole-breast irradiation (HF-WBI) for the prevention and management of acute radiodermatitis (ARD). MATERIALS AND METHODS: A randomized, multicentric clinical trial (LABRA trial, NCT03924011) was set up at the Limburg Oncology Center, including the Jessa Hospital (Hasselt, BE) and Ziekenhuis Oost-Limburg (Genk, BE). A total of 71 breast cancer patients planned to undergo HF-WBI were randomized to one of the two study arms: the control group (n = 32) or the PBM group (n = 39). The PBM group received the standard institutional skincare combined with PBM (2×/week) during the complete radiotherapy (RT) course. Patients in the control group received the standard skincare combined with placebo treatment (2x/week). Patients' skin reactions were evaluated weekly during the RT treatment by using the modified version of the Radiation Therapy Oncology Group (RTOG) criteria. RESULTS: At week 3 of RT, one patient presented a grade 2 and one patient a grade 3 skin reaction in the control group, while in the PBM group, all patients still presented grade 1 ARD. At the final RT session 28% of the patients presenting grade 2-3 ARD, while in the PBM group 10% presented grade 2 and no grade 3 ARD. PBM reduced the incidence of severe ARD by 18%. However, the difference was not significant (p = 0.053). CONCLUSION: Based on the LABRA trial results, PBM seems not able to reduce the incidence of severe ARD in breast cancer patients undergoing HF-WBI. Research in a larger patient population is recommended.

[State of art of photobiomodulation in the management of radiotherapy adverse events: Indications and level of evidence]. / État de l'art de la photobiomodulation dans la prise en charge des effets secondaires de la radiothérapie : indications et niveaux de preuve.

PURPOSE: To evaluate the current and potential indications of photobiomodulation (PBM) and their level of evidence in the prevention or management of radiation therapy-related side effects. MATERIALS AND METHODS: The Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, and LILACS databases were systematically reviewed to include and analyze publications of clinical studies that have assessed PBM in the prevention or management of radiotherapy-related side effects. The keywords used were "photobiomodulation"; "low level laser therapy"; "acute oral mucositis"; "acute dysphagia"; "acute radiation dermatitis"; "lymphedema"; "xerostomia"; "hyposalivation"; "trismus"; "bone necrosis"; "osteoradionecrosis"; and "radiation induced fibrosis". Prospective studies were included, whereas retrospective cohorts and non-original articles were excluded from the analysis. RESULTS: PBM in the red or infrared spectrum has demonstrated efficacy in randomized controlled trials in the prevention and management of radiotherapy-related side effects, especially acute oral mucositis, acute radiation dermatitis, and upper extremity lymphedema. The level of evidence associated with PBM was heterogeneous, but overall was still moderate. The main shortcomings were the diversity and lack of detail in treatment protocols, which could have compromised efficiency and reproducibility of PBM results. CONCLUSION: The published data suggest that PBM may be considered as a full-fledged supportive care for patients treated with radiotherapy, or at least in the setting of a therapeutic clinical trial. However, until strong evidence has been published on its long-term safety, the use of PBM should be considered with caution, specifically when applied near areas with proven or potential tumors. The patient should be informed of the theoretical benefits and risks of PBM in order to obtain his informed consent before treatment.

Effect of photobiomodulation therapy on radiodermatitis in a mouse model: an experimental animal study.

This study aimed to evaluate the effect of photobiomodulation (PBM) for prevention of radiodermatitis in an irradiated mouse model and compare the efficacy of PBM using 633- or 830-nm wavelengths. Irradiated mice were randomly distributed into three groups: A (633 nm), B (830 nm), and C (without PBM). On post-irradiation days 7 and 21, we compared acute damage and recovery in treated skin samples to non-irradiated skin using H&E, Masson's trichrome, anti-CD45 and PCNA immunohistochemistry, and a TUNEL assay. Grade 3 radiodermatitis was evident only in group C. Compared with that in group C, the skin in groups A and B had significantly less epidermal hyperplasia, inflammatory cell infiltration, and thinner dermis on day 7 and less inflammatory cell infiltration, fewer apoptotic cells, and thinner dermis on day 21. However, there was no significant difference between groups A and B. This study indicates PBM could prevent severe radiodermatitis by reducing epidermal and dermal damage, inflammation, and apoptosis. There was no difference in PBM efficacy between the 633- and 830-nm wavelengths.

Preditores e qualidade de vida em pacientes com radiodermatite: estudo longitudinal / Predictores y calidad de vida en pacientes con radiodermatitis: estudio longitudinal / Predictors and quality of life in patients with radiodermatitis: a longitudinal study

Resumo Objetivo: Analisar os preditores sociodemográficos, clínicos e terapêuticos e a qualidade de vida em pacientes com radiodermatite. Métodos: Trata-se de um estudo longitudinal, realizado com 196 pessoas que desenvolveram reações cutâneas como evento adverso ao tratamento radioterápico. Foi utilizado um formulário para caracterização e avaliação clínica e o instrumento European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 para mensuração da qualidade de vida em duas etapas. A análise dos dados foi constituída pelos testes Wilcoxon, Mann-Whitney e Kruskal-Wallis , considerando diferença estatisticamente significativa para p < 0,05. Resultados: A comparação entre os escores de qualidade de vida mostrou que a radiodermatite contribuiu para piora do estado global de saúde e da qualidade de vida, deterioração da capacidade funcional, dificuldade financeira e intensificação de reações emocionais e de sintomas físicos como ansiedade, depressão, dor, fadiga, insônia e falta de apetite. Fatores como sexo, renda, escolaridade, quimioterapia concomitante, localização anatômica da lesão e grau de destruição tecidual foram determinantes para o maior comprometimento dos escores globais. Diante disso, surge a necessidade de intervenções de enfermagem que favoreçam a identificação de preditores e que otimizem o cuidado a partir de diretrizes e recomendações clínicas. Conclusão: A radiodermatite influenciou negativamente a qualidade de vida dos pacientes, tendo alto impacto associado ao maior grau de destruição tecidual e como principais preditores destacaram-se os aspectos clínicos e terapêuticos. Estudos dessa natureza são imprescindíveis para formulação de políticas públicas efetivas, integradas, sustentáveis e baseadas em evidências voltadas para prevenção, controle e tratamento da lesão.

Resumen Objetivo: Analizar los predictores sociodemográficos, clínicos y terapéuticos y la calidad de vida en pacientes con radiodermatitis. Métodos: Se trata de un estudio longitudinal, realizado con 196 personas que presentaron reacciones cutáneas como evento adverso al tratamiento radioterápico. Se utilizó un formulario para la caracterización y evaluación clínica y el instrumento European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 para la medición de calidad de vida en dos etapas. El análisis de los datos se realizó a través de las pruebas Wilcoxon, Mann-Whitney y Kruskal-Wallis , considerando una diferencia estadísticamente significativa de p < 0,05. Resultados: La comparación entre las puntuaciones de calidad de vida demostró que la radiodermatitis contribuyó con el empeoramiento del estado global de salud y de la calidad de vida, el deterioro de la capacidad funcional, la dificultad financiera y la intensificación de reacciones emocionales y de síntomas físicos como ansiedad, depresión, dolor, fatiga, insomnio y falta de apetito. Factores como sexo, ingresos, escolaridad, quimioterapia simultánea, ubicación anatómica de la lesión y nivel de destrucción tisular fueron determinantes para un mayor comprometimiento de la puntuación global. Ante esto, surge la necesidad de intervenciones de enfermería que favorezcan la identificación de predictores y que optimicen el cuidado a partir de directrices y recomendaciones clínicas. Conclusión: La radiodermatitis influyó negativamente en la calidad de vida de los pacientes, con un alto impacto relacionado con un mayor nivel de destrucción tisular, y como principales predictores se destacaron los aspectos clínicos y terapéuticos. Estudios de esta naturaleza son imprescindibles para la formulación de políticas públicas efectivas, integradas, sustentables y basadas en evidencias orientadas hacia la prevención, control y tratamiento de la lesión.

Abstract Objective: To analyze sociodemographic, clinical and therapeutic predictors and quality of life in patients with radiodermatitis. Methods: This longitudinal study was conducted with 196 participants who developed skin reactions as an adverse event to radiotherapy treatment. A form was used for clinical characterization and evaluation, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 instrument was used for measuring the quality of life in two stages. Data analysis consisted of the Wilcoxon, Mann-Whitney and Kruskal-Wallis tests, considering a statistically significant difference for p<0.05. Results: The comparison between scores of the quality of life showed that radiodermatitis contributed to the worsening of overall health status and quality of life, deterioration of functional capacity, financial difficulty and intensification of emotional reactions and physical symptoms such as anxiety, depression, pain, fatigue, insomnia and appetite loss. Factors such as sex, income, educational level, concomitant chemotherapy, anatomical location of the injury and degre of tissue destruction were determinant for the greater impairment of global scores. Thus, the need for nursing interventions that favor the identification of predictors and care optimization based on clinical guidelines and recommendations. Conclusion: Radiodermatitis negatively influenced the quality of life of patients, had a high impact associated with a greater degree of tissue destruction and the main predictors were clinical and therapeutic aspects. Studies of this nature are essential for the formulation of effective, integrated, sustainable and evidence-based public policies aimed at preventing, controlling and treating the injury.

A Narrative Review on the Use of Photobiomodulation Therapy for the Prevention and Management of Acute Radiodermatitis: Proposed Mechanisms, Current Clinical Outcomes, and Preliminary Guidance for Clinical Studies.

Objective: A narrative review of the available scientific evidence to identify the current proposals relating the use of photobiomodulation (PBM) to treat acute radiodermatitis (ARD), to guide future research. Background data: A devastating side effect of radiotherapy (RT) is ARD, defined as an inflammatory skin reaction induced by RT. Currently, there is still no standard of care for ARD. PBM is a non-invasive light therapy that is a growing modality in the field of supportive cancer care. There is a need for identifying the therapeutic irradiation windows in this field, based on the available literature. Methods: An electronic search of original articles in the PubMed database was performed with the following keywords: "photobiomodulation therapy," "low-level light therapy," "low-level laser therapy," "acute radiodermatitis," and "radiotherapy" until December 2019. Randomized controlled trials, prospective non-randomized, case report, cohort, cross-over, and retrospective studies were selected for this review. Results: Nine clinical trials that investigated the use of photobiomodulation therapy (PBMT) in ARD were available for evaluation. Results demonstrate that PBMT could significantly reduce the severity of ARD and the accompanying discomfort and pain in patients with cancer. Conclusions: Based on the available evidence of the narrative review, PBM might be an effective therapy for the prevention and management of ARD in patients with cancer. More research is needed to confirm this finding.

Treating Acute Cervical Radiodermatitis with Photobiomodulation Therapy: A Report of Two Cases.

Objective: The objective of this study was to report the application of photobiomodulation therapy (PBMT) in the treatment of two patients diagnosed with acute cervical radiodermatitis (RD) induced by radiotherapy. Background data: An undesirable effect of radiotherapy, RD often poses a limitation to the continuity of treatment that can negatively affect the control and prognosis of the disease. RD is frequently associated with pain and aesthetic impairment and can significantly influence quality of life. Many agents used to prevent and treat RD do not have sufficient scientific evidence to support its use. Materials and methods: In both clinical cases, the patients presented RD degree 3 and were in drug treatment, with no satisfactory response, and PBMT was started. Two diode lasers were used, with a dose of 35.71 J/cm2, 10 sec/point, 100 mW of power, and a beam area of 0.028 cm2 and dose of 27.77 J/cm2, 25 sec/point, 40 mW, and 0.036 cm2 beam area. Both lasers were applied at the wavelength of red, daily, in contact and perpendicular to the skin, to deliver 1 J/point/1.5 cm, which covered the entire area affected with RD. Results: The PBMT made possible an expressive improvement in the healing process and reduction of painful symptoms associated with RD. Conclusions: Although PBMT facilitated healing and reduced pain experienced with RD, randomized controlled trials are needed to evaluate all of its possible benefits.

Feasibility of photobiomodulation therapy for the prevention of radiodermatitis: a single-institution pilot study.

Acute radiodermatitis is one of the major complications when radiation therapy (RT) is delivered to the head and neck region in cases of head and neck cancers or lung cancers with supraclavicular lymph node metastasis. In these cases, high dose of RT is generally used so that acute radiodermatitis is observed in more than 90% of patients, and it negatively affects patients' quality of life. In this pilot study, we evaluated the clinical feasibility of photobiomodulation (PBM) therapy before conducting a randomized trial based on the hypothesis that PBM therapy may reduce the severity of radiodermatitis in participants receiving 60 Gy or higher dose. Patients who were to receive 60 Gy or higher dose in the neck were included in the study. Thirty-three patients received PBM therapy three times a week during RT. The severity of radiodermatitis was evaluated by two dermatologists and a radiation oncologist using the modified Common Terminology Criteria for Adverse Events (CTCAE). Patients were followed up until a week after RT. In all patients, 90.6% of planned PBM schedule was completed. There was no significant side effect of PBM therapy. Thirteen (39%) patients showed wet desquamation (CTCAE grade 2b or higher). Only three (9%) of them showed grade 3 toxicity, which is a favorable result compared with previous studies. This pilot study showed that PBM therapy is safe and feasible in the clinic, and it might reduce the severity of radiodermatitis. A randomized trial should be warranted to prove the efficacy of PBM therapy.

Fatores Preditores de Complicações após Radioterapia Conformacional 3D em Pacientes com Adenocarcinoma de Próstata / Predictors of Complications following 3D Conformational Radiotherapy in Patients with Prostate Adenocarcinoma / Factores Predictores de Complicaciones después de la Radioterapia Conformacional 3D en Pacientes con Adenocarcinoma de Próstata

Introdução: O câncer de próstata é considerado a neoplasia maligna mais comum que acomete homens em todas as Regiões do país, à exceção do câncer de pele não melanoma. Se diagnosticado e tratado precocemente, o câncer de próstata tem alta taxa de cura; contudo, terapêuticas como a radioterapia podem gerar complicações agudas que podem impactar as atividades cotidianas. Apesar das complicações no pós-tratamento, a radioterapia tem sido um método bastante praticado e que apresenta resultados positivos, ocasionando melhoria da sobrevida livre de doença. Objetivo: Avaliar os principais fatores preditores de complicações agudas que acometem pacientes em tratamento radioterápico para câncer de próstata. Método: Para identificação de fatores preditores de complicações agudas pós-radioterapia, avaliaram-se, consecutiva e prospectivamente, 208 pacientes diagnosticados com adenocarcinoma de próstata tratados com radioterapia conformacional 3D em um centro referência vinculado ao SUS entre os anos 2016 e 2017. Realizou-se ainda avaliação retrospectiva de prontuários para coleta de dados adicionais. A análise estatística foi realizada por meio dos testes qui-quadrado, exato de Fisher, Anova e regressão logística ordinal. Resultados: Após análise da amostra, evidenciou-se que, entre as complicações agudas, as de maior incidência foram radiodermite, cistite e enterite/retite, de forma que tais complicações tiveram como fatores associados volume irradiado, tratamento prévio e sintomas prévios ao tratamento. Conclusão: O estudo sugere que, apesar da existência de complicações ao final do tratamento, a grande maioria é de baixa complexidade e que pacientes submetidos a procedimentos cirúrgicos prévios podem evoluir com presença de complicações mais graves.

Introduction: Prostate cancer is considered the most common malignancy that affects men in all regions of the country, except for non-melanoma skin cancer. If diagnosed and treated early, prostate cancer has a high cure rate; however, therapies such as radiotherapy can generate acute complications that can impact daily activities. Despite post-treatment complications, radiotherapy has been a widely practiced method and has shown positive results, leading to improved disease-free survival. Objective: To evaluate the main predictive factors for acute complications that affect patients undergoing radiotherapy for prostate cancer. Method: To identify predictive factors for acute post-radiotherapy complications, 208 patients diagnosed with prostate adenocarcinoma treated with 3D conformational radiotherapy were consecutively and prospectively evaluated at a referral center linked to SUS between the years 2016 and 2017. It was carried out retrospective evaluation of medical records to collect additional data. Statistical analysis was performed using the chi-square test, Fisher's exact, Anova and ordinal logistic regression. Results: After analyzing the sample, it was evidenced that among the acute complications, those with the highest incidence were radiodermatitis, cystitis, enteritis/rectitis, so that these complications had associated predictive factors as irradiated volume, previous treatment and symptoms. Conclusion: The study suggests that despite the existence of complications at the end of the treatment, the vast majority are of low complexity and that the patients submitted to previous surgical procedures can evolve with the presence of more severe complications.

Introducción: El cáncer de próstata se considera la neoplasia maligna más común que afecta a los hombres en todas las regiones del país, con la excepción del cáncer de piel no melanoma. Si se diagnostica y trata temprano, el cáncer de próstata tiene una alta tasa de curación; sin embargo, las terapias como la radioterapia pueden generar complicaciones agudas que pueden afectar las actividades diarias. A pesar de las complicaciones posteriores al tratamiento, la radioterapia ha sido un método ampliamente practicado y ha mostrado resultados positivos, lo que lleva a una mejor supervivencia libre de enfermedad. Objetivo: Evaluar los principales predictores de complicaciones agudas que afectan a los pacientes sometidos a radioterapia para el cáncer de próstata. Método: Para identificar los factores predictivos de complicaciones agudas posteriores a la radioterapia, 208 pacientes diagnosticados con adenocarcinoma de próstata tratados con radioterapia conformacional 3D fueron evaluados consecutiva y prospectivamente en un centro de referencia vinculado al SUS entre los años 2016 y 2017. Se realizó evaluación retrospectiva de registros médicos para recopilar datos adicionales. El análisis estadístico se realizó utilizando la prueba de chi-cuadrado, exacta de Fisher, de Anova y la regresión logística ordinal. Resultados: Después de analizar la muestra, se evidenció que, entre las complicaciones agudas, las de mayor incidencia fueron radiodermatitis, cistitis, enteritis/retitis y síntomas obstructivos, por lo que estas complicaciones tenían factores predictivos asociados, como el volumen irradiado, el tratamiento previo y los síntomas. Conclusión: El estudio sugiere que a pesar de la existencia de complicaciones al final del tratamiento, la gran mayoría son de baja complejidad. Como factores predictivos encontrados, se puede mencionar el volumen irradiado, la existencia de tratamiento previo y los síntomas en la consulta inicial.

Photobiomodulation therapy for acute radiodermatitis.

PURPOSE OF REVIEW: The number of clinical trials on the use of photobiomodulation therapy (PBMT) for the management of cancer therapy-related complications is growing steadily. One of the side-effects that is under investigation is acute radiodermatitis (ARD), an inflammatory skin reaction caused by radiotherapy. In this review, an overview is given on the state of art of the application of PBMT for the prevention and management of ARD. RECENT FINDINGS: Up to now about seven clinical trials have been performed, investigating the use of PBMT in the prevention and/or management of ARD. Results demonstrate that PBMT can effectively reduce the incidence of severe ARD, decrease the accompanying pain, and improve the patients' quality of life. Moreover, the technique seems to be well tolerated in oncologic patients. SUMMARY: On the basis of the available evidence, there could be a strong recommendation to use PBMT in the prevention and management of ARD in cancer patients.

Effect of laser therapy on quality of life in patients with radiation-induced breast telangiectasias.

OBJECTIVE: To evaluate the effects of laser monotherapy on quality of life in breast cancer patients with chronic radiation dermatitis. STUDY DESIGN: A prospective, IRB-approved study was conducted at Memorial Sloan Kettering Cancer Center. Breast cancer patients with chronic radiation dermatitis completed health-related quality of life (HR-QOL) questionnaires before and after laser monotherapy for radiation-induced breast telangiectasias (RIBT). METHODS: After informed consent, all patients were issued the Skindex-16 and Breast-Q Adverse Effects of Radiation HR-QOL questionnaires prior to receiving laser treatment. Patients were treated with a 595 nm pulsed dye laser at 4- to 6-week intervals, with percent telangiectasia clearance and adverse events recorded at each visit. Post-treatment HR-QOL questionnaires were collected after clinician-assessed telangiectasia clearance of >50%. Median HR-QOL scores before and after therapy were reported for individual HR-QOL domains (Skindex-16) and HR-QOL totals (Skindex-16 and Breast-Q Adverse Effects of Radiation). Before- and after-differences were calculated using the Wilcoxon Signed-Rank Test. RESULTS: Twenty-two female patients (average age 56 years) enrolled in this study. A majority (13/22, 59%) exhibited telangiectasias across the décolletage and axilla in addition to the breast. Sixteen patients reached the 50% RIBT clearance threshold during the study period, and 11 of these patients (69%) completed follow-up HR-QOL questionnaires. Patients showed statistically significant improvements in emotional and functional Skindex-16 HR-QOL domains and in overall Skindex-16 HR-QOL score. Breast-Q scores also improved significantly, illustrating a decrease in specific physical and cosmetic concerns common to radiated breast skin. Common adverse events were transient post-treatment pain and redness. CONCLUSION: Breast cancer patients with RIBT presented with substantial deficits in several HR-QOL arenas. Laser monotherapy effectively treated the appearance of radiation dermatitis in these patients and also significantly improved HR-QOL. Lasers Surg. Med. 50:284-290, 2018. © 2017 Wiley Periodicals, Inc.

Photobiomodulation therapy for the management of radiation-induced dermatitis : A single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery.

BACKGROUND: Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT. PATIENTS AND METHODS: Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a "matched" group (n = 25) was generated from the control group based on propensity for potentially confounding variables. RESULTS: In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5. CONCLUSION: PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery.

Same strategy for pitfalls of radiotherapy in different anatomical districts.

Oral mucositis (OM) and radiodermatitis (RD) are serious side effects of radiotherapy (RT), often leading to its suspension, need for analgesics, and enteral/parenteral nutrition. Laser therapy is becoming a recommended treatment option. This prospective study aimed at demonstrating the beneficial effect of class IV laser therapy (HPLT) on RT-induced OM, an off-label use of HPLT to treat RD in breast cancer patients. Fifty-three cancer patients, during/after RT and/or chemotherapy (CT), affected by OM, were treated with HPLT during four consecutive days (970 ± 15 nm, 5 W (50 %), 35-6000 Hz, 240 s). Assessment of OM (Grading Objective Scale, WHO-SCALE), pain (visual analogue scale, VAS), functional ability, subjective parameters, and site/severity of OM were recorded over time. Similarly, 27 breast cancer patients affected by RD were treated by HPLT and monitored over time for grade, discomfort, itching, and bleeding. Progressive improvement of WHO-SCALE from day 7 on, and of VAS from day 2 on (p < 0.000) was registered. All patients' functional capacity improved on day 4 (p < 0.05). All subjective parameters improved on day 14 (p < 0.001) except for voice, which improved on day 21 (p < 0.000). Ulcerations' dimension and erythema's severity significantly decreased in all sites examined (p < 0.05). Similarly, HPLT proved to be beneficial in managing RD for all the parameters considered (p < 0.002). Regardless of OM grade/site and of kind/site of tumor, HPLT proved to be effective in healing OM as well as RD. In both cases, effective treatment can improve life quality through a safe, easy, innovative approach. Therefore, HPLT may become an integral part of everyday practice in the management of RT adverse effects.

IL12RB2 and ABCA1 genes are associated with susceptibility to radiation dermatitis.

PURPOSE: Severe acute radiation dermatitis is observed in approximately 5% to 10% of patients who receive whole-breast radiotherapy. Several factors, including treatment-related and patient-oriented factors, are involved in susceptibility to severe dermatitis. Genetic factors are also thought to be related to a patient's susceptibility to severe dermatitis. To elucidate genetic polymorphisms associated with a susceptibility to radiation-induced dermatitis, a large-scale single-nucleotide polymorphism (SNP) analysis using DNA samples from 156 patients with breast cancer was conducted. EXPERIMENTAL DESIGN: Patients were selected from more than 3,000 female patients with early breast cancer who received radiotherapy after undergoing breast-conserving surgery. The dermatitis group was defined as patients who developed dermatitis at a National Cancer Institute Common Toxicity Criteria grade of > or =2. For the SNP analysis, DNA samples from each patient were subjected to the genotyping of 3,144 SNPs covering 494 genes. RESULTS: SNPs that mapped to two genes, ABCA1 and IL12RB2, were associated with radiation-induced dermatitis. In the ABCA1 gene, one of these SNPs was a nonsynonymous coding SNP causing R219K (P = 0.0065). As for the IL12RB2 gene, the strongest association was observed at SNP-K (rs3790568; P = 0.0013). Using polymorphisms of both genes, the probability of severe dermatitis was estimated for each combination of genotypes. These analyses showed that individuals carrying a combination of genotypes accounting for 14.7% of the Japanese population have the highest probability of developing radiation-induced dermatitis. CONCLUSION: Our results shed light on the mechanisms responsible for radiation-induced dermatitis. These results may also contribute to the individualization of radiotherapy.

[Post-radiotherapy telangiectasias. Treatment with pulsed-dye laser. Sequential histological studies]. / Telangiectasias posradioterapia. Tratamiento con láser de colorante pulsado. Estudios histológicos secuenciales.

Chronic radiodermatitis after radiotherapy is a frequent sequela that may be worrying for the patient. Few cases have been published in the literature in which pulsed-dye laser has been used in the treatment of telangiectasias that appeared after radiotherapy for breast cancer. We present a female patient with radiodermatitis on the neck after radiotherapy for nasopharyngeal carcinoma. The patient received five sessions of pulsed-dye laser treatment (3 ms pulse duration, 7 mm spot size, fluence between 7 and 12 J/cm 2). Sequential histological studies were performed. The response to treatment was very good, with the lesions almost completely disappearing. The patient was very satisfied with the result. Pulsed-dye laser is a safe and effective treatment for chronic radiodermatitis of the neck after radiotherapy.

Pulsed dye laser treatment of telangiectasia after radiotherapy for carcinoma of the breast.

BACKGROUND: Chronic radiodermatitis after radiotherapy for carcinoma of the breast is a common sequela of treatment and can be distressing for the patient. The skin is atrophic and shows prominent telangiectasia due to dilatation of a reduced or poorly supported skin vasculature. The pulsed dye laser (PDL) is an established treatment of cutaneous telangiectatic disorders including facial telangiectasia and spider naevi, and is safe and efficacious. OBJECTIVES: To study the efficacy of the PDL in the treatment of postradiation telangiectasia of the breast or chest wall. METHODS: Prospective open study of the treatment of eight females with the Candela SPTL1B PDL. Subjective assessments of vessel clearance, adverse effects and patient questionnaires. RESULTS: All treated patients showed complete clearance of vessels. Two patients developed hypopigmentation. All patients reported a high degree of satisfaction with the treatment. CONCLUSIONS: PDL therapy clears postirradiation telangiectasia of the breast and chest wall successfully with minimal adverse reactions, and can be recommended for patients distressed by this disorder.