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Predictors of radiation-induced skin toxicity in nasopharyngeal cancer patients treated by intensity-modulated radiation therapy: a prospective study

Published online by Cambridge University Press:  24 March 2016

Khaldoon M. Radaideh  and
Laila M. Matalqah
Khaldoon M. Radaideh*
Affiliation:
Radiologic Technology Department, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
Laila M. Matalqah
Affiliation:
Faculty of Medicine, Yarmouk University, Irbid, Jordan
*
†Correspondence to: Khaldoon Mahmoud Radaideh, Radiologic Technology Department, College of Applied Medical Sciences, Qassim University, Buraida 51477, Saudi Arabia. Tel: +00966 54 733 2755. Fax: 009 66 380 0882. E-mail: khaldoonmah1@yahoo.com
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Abstract

Purposes

Exposure of skin to high doses of radiation may lead to the development of erythematous skin changes. The aims of this study were to measure skin doses and to identify potential factors that may contribute to skin reactions in nasopharyngeal cancer patients undergoing intensity-modulated radiation therapy (IMRT).

Material and methods

This study was a prospective study with 21 nasopharyngeal cancer patients treated by IMRT. Personal data were collected and in vivo skin dose measurements were performed using Thermoluminescent dosimeters. All patients were monitored clinically and skin reactions were classified according to the Radiation Therapy Oncology Group criteria. Univariate and multivariate logistic regression was conducted using Statistical Package for Social Sciences Software to identify skin toxicity risk factors.

Results

Grade 1 toxicity was observed in eight patients, Grade 2 in 11 patients and Grade 3 in two patients towards the end of treatment. It was found that accumulative skin doses >7 Gy (p<0·05) was a risk factor for skin toxicity. However, previous or concomitant chemotherapy with radiotherapy and stage of cancer were not significant factors for the severity of skin reactions.

Conclusion

The neck skin should be identified as a sensitive structure for dose optimisation. Skin dose measurement and skin-sparing techniques are highly recommended for head and neck patients treated with IMRT.

Keywords

head and neck cancerIMRTrisk factorsskin toxicity
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 3 , September 2016 , pp. 276 - 282
Copyright
© Cambridge University Press 2016 

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References

1. Xia, P, Fu, K K, Wong, G W et al. Comparison of treatment plans involving intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2000; 48: 329–337.Google Scholar
2. Lee, N, Le, Q-T. New developments in radiation therapy for head and neck cancer: intensity modulated radiation therapy and hypoxia targeting. Semin Oncol 2008; 35 (3): 236–250.Google Scholar
3. Lee, N, Chuang, C, Quivey, J M et al. Skin toxicity due to intensity-modulated radiotherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys 2002; 53: 630–637.Google Scholar
4. Wagner, L K, McNeese, M D, Marx, M V, Siegel, E L. Severe skin reactions from interventional fluoroscopy: case report and review of the literature. Radiology 1999; 213: 773–776.Google Scholar
5. Balter, S, Hopewell, J W, Miller, D L, Wagner, L K, Zelefsky, M J. Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair. Radiology 2010; 254: 326–341.Google Scholar
6. Hoppe, B S, Laser, B, Kowalski, A V et al. Acute skin toxicity following stereotactic body radiation therapy for stage 1 non-small-cell lung cancer: who’s at risk? Int J Radiat Oncol Biol Phys 2008; 72 (5): 1283–1286.Google Scholar
7. Mettler, F A, Koenig, T R, Wagner, L K, Kelsey, C A. Radiation injuries after fluoroscopic procedures. Semin Ultrasound CT MR 2002; 23: 428–442.Google Scholar
8. Chung, H, Jin, H, Dempsey, J F et al. Evaluation of surface and build-up region dose for intensity-modulated radiation therapy in head and neck cancer. Med Phys 2005; 32: 2682–2690.Google Scholar
9. Cherpak, A, Studinski, R C, Cygler, J E. MOSFET detectors in quality assurance of tomotherapy treatments. Radiother Oncol 2008; 86: 242–250.Google Scholar
10. Cox, J D, Stetz, J, Pajak, T F. 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: 1341–1346.Google Scholar
11. Radaideh, K M, Matalqah, L M, Lee Luen, F W, Tajuddin, A A., Abdel Munem, E M E, Bauk, S. Development and evaluation of a Perspex anthropomorphic head and neck phantom for three dimensional conformal radiation therapy (3D-CRT). J Radiother Pract 2013; 12 (3): 1–9. doi:10.1017/S1460396912000453.Google Scholar
12. Rankin, G, Stokes, M. Statistical analysis of reliability studies. Clin Rehabil 1998; 12: 187–199.Google Scholar
13. Evans, C A. Cross practitioner inter-rater variability: grading of adverse skin reactions after radiation therapy. Education Doctoral Paper No. 143, st. John Fisher College, Southeast of Rochester, Nt, in the Suburb of Pittsford. 2012.Google Scholar
14. Rosewall, T, Yan, J, Bayley, A J et al. Inter-professional variability in the assignment and recording of acute toxicity grade using the RTOG system during radiotherapy. Radiother Oncol 2009; 90: 395–399.Google Scholar
15. Greenland, S. Invited commentary: variable selection versus shrinkage in the control of multiple confounders. Am J Epidemiol 2008; 167: 523–529.Google Scholar
16. VanDam, J, Marinello, G. Methods for in Vivo Dosimetry in External Radiotherapy, 2nd edition. Mounierlaan 83/12- 1200 Brussels (Belgium), ESTRO: Garant, 2006; 51–53.Google Scholar
17. Kron, T. Applications of thermoluminescence dosimetry in medicine. Radiat Prot Dosimetry 1999; 85: 1–4.Google Scholar
18. Mayles, W, Heisig, S, Mayles, H. Treatment verification and in vivo dosimetry. Radiother Phys 2000; 2: 227–251.Google Scholar
19. Huyskens, D, Bogaerts, R, Verstraete, J et al. Practical guidelines for the implementation of in vivo dosimetry with diodes in external radiotherapy with photon beams (entrance dose). ESTRO Physics Booklets. 2001.Google Scholar
20. Koenig, T R, Wolff, D, Mettler, F A, Wagner, L K. Skin injuries from fluroroscopically guided procedures. I. Characteristics of radiation injury. Am J Roentgenol 2001; 177: 3–11.Google Scholar
21. Porock, D. Factors influencing the severity of radiation skin and oral mucosal reactions: development of a conceptual framework. Eur J Cancer Care 2002; 11: 33–43.Google Scholar
22. Shih, A, Miaskowski, C, Dodd, M J, Stotts, N A., MacPhail, L. Mechanisms for radiation-induced oral mucositis and the consequences. Cancer Nurs 2003; 26: 222–229.Google Scholar
23. Fiets, W, Van Helvoirt, R, Nortier, J, Van der Tweel, I, Struikmans, H. Acute toxicity of concurrent adjuvant radiotherapy and chemotherapy (CMF or AC) in breast cancer patients: a prospective, comparative, non-randomised study. Eur J Cancer 2003; 39: 1081–1088.Google Scholar
24. See, A, Wright, S, Denham, . A pilot study of dermofilm in acute radiation-induced desquamative skin reactions. Clinic Oncol (R Coll Radiol) 1998; 10: 182–185.Google Scholar
25. Noble-Adams, R. Radiation-induced reactions: development of a measurement tool. Br J Nurs 1999; 8 (18): 1208–1211.Google Scholar