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Socioeconomic barriers are associated with delayed diagnoses, adherence to treatment, and survival for patients with head and neck cancer. Few studies have investigated how these barriers affect clinical support requirements during and post-radiation therapy (RT). This study analyzed 24 patients diagnosed with head and neck cancer and enrolled in an open-label randomized trial assessing a keratin-based topical cream for radiation dermatitis. All patients were treated to a minimum dose of 60 Gy. At baseline, participants completed a questionnaire with questions regarding demographics, socioeconomic barriers to care, and baseline level of physical activity. Nutritional and oncologic outcomes were abstracted from the medical record including: on-treatment weight loss, gastrostomy tube (G-tube) placement, completion of RT, locoregional failure, distant failure, and death. We performed descriptive analyses of questionnaire responses, radiation treatment, and clinical outcomes. Median study follow-up was 2.3 years. The median age of participants was 64 and most patients (n = 14, 71%) had Stage III or Stage IV disease. All patients reported either they were extremely or quite a bit confident with filling out forms. Most patients (n = 19, 88%) had at least some college or post-graduate education. Some patients (n = 2, 8%) reported they did not have adequate money to support their family needs within the past 4 weeks or some (n = 4, 16%) required occasional assistance for self-care or were unable to carry on normal activity or do normal work. Nearly half of patients (n = 10, 42%) either have rare or light to moderate activity intermittently. Some patients (n = 3, 15%) reported 1 or more falls within the past 6 months. Seven (30%) patients required G-tube placement, 4 (17%) were prophylactic (placed prior to RT treatment). The median change in BMI was a 4.8% decrease from baseline. Among all patients, 6 (25%) had an emergency department visit or hospital admission within 30 days post-RT treatment. Three patients (12%) had locoregional progression, 3 (12%) had distant progression, and 20 (83%) patients were alive at the end of study follow-up. No associations between baseline factors and weight loss, G-tube use, or oncologic outcomes were identified. A substantial proportion of patients with head and neck cancer report indicators of socioeconomic stress, financial toxicity, and reduced performance status at baseline. In this exploratory analysis, these factors were not associated with nutritional or oncologic outcomes. Further research is needed to assess how socioeconomic barriers and ability for self-care affect treatment-related outcomes. Earlier identification and support for patients at risk can improve patient quality-of-life and reduce healthcare resource utilization. [ABSTRACT FROM AUTHOR]

Both capecitabine and radiotherapy have been widely used for patients with breast cancer. Although concurrent capecitabine and radiotherapy showed favorable efficacy and tolerable toxicities in patients with gastrointestinal carcinoma, there is still a paucity of real-world evidence on the safety of the concurrent treatment in breast cancer. The aim of this study is to investigate the toxicity of concurrent radiotherapy with capecitabine in breast cancer patients. Patients pathologically diagnosed as breast cancer, aged 18-70 years old, received concurrent radiotherapy and capecitabine between January 2017 and December 2020, radiation target volume involved chest wall or whole breast with and without lymph node regions, with complete medical record were selected and analyzed. Patients' characteristics, tumor information, treatment details including irradiation dosimetric index, systemic regimens doses were assembled. Both acute and chronic adverse events (AEs) were evaluated by a senior radiation oncologist, a senior medical oncologist and a radiologist, according to National Cancer Institute common terminology criteria for adverse events, version 5.0. Totally, fifty-three patients were analyzed. Baseline characteristics are shown in Table I. Four of them received concurrent chemoradiotherapy after local recurrence. Hypofractionation radiation, with total dose of 43.5Gy-49.5Gy, 2.9Gy per fraction, were delivered to 36 patients and the remaining patients received conventional fractionation radiotherapy, with dose of 50-62.5 Gy, 1.8-2Gy per fraction. Thirty-nine patients (73.6%) were treated with concurrent capecitabine at a dose of 1000mg/m2 bid d1-14/q3w, and the remaining 14 patients (26.4%) were treated with a low-dose maintenance therapy at 500mg tid. The median follow-up time was 26.5 months. The most common side effects were dermatitis (N = 45) and leukopenia (N = 33) at any grade. Followed by radiation esophagitis (N = 17), fatigue (N = 16) and hand-foot syndrome (N = 15). The most common G3 side effects were radiation induced dermatitis (N = 11) and hand-foot syndrome (N = 4). All of them were cured after intervention. All of the patients finished the whole course of radiotherapy. None but 1 patient discontinued concurrent medication because of gastrointestinal reaction. No grade 4-5 AE was observed. In general, concurrent radiotherapy and capecitabine in breast cancer were safe with acceptable and controllable toxicities. Dermatitis should be paid more attention in clinical works. [ABSTRACT FROM AUTHOR]

The Partner and localizer of BRCA2 (PALB2) gene has crucial role in DNA double-strand break repair, upkeep of genome integrity, and suppression of cancer development. PALB2-deficient cells are known to be hypersensitive to ionizing radiation. Multigene panel testing has increasingly identified patients with PALB2 variants raising the question if those patients with heterozygous PALB2 variants have compromised outcomes or are at increased risk of radiation toxicity. We hypothesize that outcomes with radiation are acceptable with moderately hypofractionated (Hypo-RT) or conventionally fractionated (CRT) radiation after breast conserving surgery (BCS) or mastectomy in patients with heterozygous germline PALB2 pathogenic variants or variants of uncertain significance (VUS). Between 2005 and 2023, breast cancer patients treated with radiation were consented for peripheral blood sequencing (PBS) on an institutionally approved IRB protocol. PALB2 variants detected by high-throughput PBS were designated benign, pathogenic, VUS, or with conflicting interpretations of pathogenicity using the ClinVar database. Variants designated benign or likely benign were excluded and those with conflicting interpretations of pathogenicity or variants of uncertain significance were classified as VUS. Toxicities were abstracted from medical records and were graded per Common Terminology Criteria for Adverse Events v5. Additional clinicopathologic information was abstracted from the medical records. A total of 583 patients were sequenced. After excluding benign PALB2 variants, 14 were included in this analysis: 5(36%) were pathogenic and 9(64%) were VUS. Median tumor size was 2 cm and median age at diagnosis was 51.5 years (range = 42–69). Among these patients 12(86%) had invasive disease, 10(71%) were ER+, and 9(64%) received chemotherapy; 11(79%) had BCS with 7(50%) undergoing sentinel lymph node dissection. All patients received photon based external beam radiation, 3 (21%) were treated with Hypo-RT, 11 (79%) with CRT, and 7(50%) received nodal irradiation. Median follow up was 69 months. Grade 2 acute radiation dermatitis (ARD) was noted in 8(57%) patients, and grade 3 in 2(14%) patients. For patients with grade 3 ARD, one had a pathogenic variant of PALB2, the other had a VUS. Late grade 2 fibrosis was recorded in 1(7%) patient. There were no grade 4 or 5 toxicities. Contralateral breast cancer did not occur in any patients. One patient (7%) had chest wall recurrence 4 months after finishing radiation. This represents the first report on clinical outcomes in breast cancer patients with PALB2 undergoing radiation. We concluded that radiation therapy in individuals with heterozygous PALB2 germline pathogenic variants or variants of uncertain significance (VUS) appears to be well-tolerated with acceptable clinical outcomes. [ABSTRACT FROM AUTHOR]

We report on our early experience of a multi-institutional phase II study of dose escalated five fraction stereotactic partial breast irradiation (S-PBI) for early-stage breast cancer after partial mastectomy using a cobalt stereotactic radiation system. Patient eligibility included DCIS or invasive epithelial histologies, AJCC clinical stage 0, I, or II with tumor size < 3 cm, and negative margins. Prior safety of Phase I dose escalation has been reported. Dose was 40 Gy delivered in 5 fractions to the CTV, and minimum dose 30 Gy in 5 fractions to the PTV. CTV margin was 1 cm and PTV margin 3 mm. For PTV cavities larger than 100cc, dose was reduced to 35Gy in 5 fractions to the CTV and 30 Gy in 5 fractions to the PTV. Primary endpoint of the study is to determine the 3-year patient global cosmesis score (4-point scale excellent, good, fair, or poor) and adverse cosmesis using a dose escalated approach with smaller PTV margins than conventional methods. Both patients and physicians completed baseline and subsequent cosmesis outcome questionnaires. Treatment related toxicity graded (using the NCI version 5.0 and RTOG/EORTC late radiation scale). From March 2019 to October /2021, 74 patients were treated respectively. Of these, 38 were treated to 40 Gy and 36 were treated to 35 Gy. Median follow up (f/u) was 36 months (mo), range (r) 3-58 mo. Median age was 63 years (r = 43-77). Histology included 28 DCIS, and 46 invasive carcinomas. Fort-five of 46 invasive tumors were ER+. Sixty of 74 (81%) patients received endocrine therapy, and 7/74 patient received chemotherapy. There were 225 acute grade 1 toxicities, and 30 Grade 2 toxicities. No grade 3 or higher acute toxicities were reported (< 90 days). The most common Grade 2 toxicities were radiation dermatitis (12), breast pain (8), blister (4), skin infection (2), nipple discharge (2), and fatigue (2). In the late period, there were 103 Grade 1 late toxicities, 3 Grade 2 late toxicities, and no Grade 3 or higher late toxicities. Grade 2 toxicities included fibrosis 1, and pain (2). Three patients developed grade 1 asymptomatic nonpalpable fat necrosis. The most common grade 1 late toxicities were breast pain (25), hyperpigmentation (11), fibrosis (11), and fatigue (5). Physicians scored cosmesis excellent or good 71/74 (95.9%), 59/61 (96.7%), 61/62 (98.3%), 33/33(100%) respectively at baseline, 12 months, 24 months, and 36months post SBRT, while patients scored the same periods 63/72 (87.5%), 54/60 (90.0%), 57/64 (89.0%), 35/37 (94.6%). There have been no local regional or distant disease recurrences. Results at 36-month median follow-up, of our dose escalated stereotactic partial breast 5 fraction regimen, has low acute and late toxicity, while maintaining high proportion of excellent/good cosmetic outcomes. Clinical trials.gov identifier is NCT03581136. [ABSTRACT FROM AUTHOR]

We aimed to compare radiation toxicities and reconstructive complications after photon and proton post-mastectomy radiotherapy (PMRT) among patients who received pre-pectoral implant-based breast reconstruction (PP-IBBR). The hypothesis is that proton PMRT will yield fewer radiation toxicities and reconstructive complications. A single-institution retrospective cohort study included breast cancer patients undergoing mastectomy and PP-IBBR followed by PMRT (Jan 2020-Oct 2022) with one-year follow-up. Acute radiation toxicities of interest were dermatitis, esophagitis, and fatigue. Reconstructive complications included minor infection (requiring oral antibiotics), major infection (intravenous antibiotics with hospital admission), wound, implant exposure, flap necrosis, seromas, re-operations, capsular contracture, and implant failures. The rates of toxicities and complications between proton and photon PMRT were compared using Chi-square test or Fisher's exact test. Group comparison of continuous variables was assessed using Wilcoxon rank-sum test. Logistic regression analyses identified clinical factors associated with ≥2 surgical complications. 114 patients met inclusion criteria. Two patients had bilateral implants/radiation, therefore 116 PP-IBBR receiving PMRT (75 photon and 41 proton). There was a significant difference between photon (n = 66) and proton (n = 40) groups regarding prescription mean PMRT dose (median 42.56 Gy vs 50 Gy, P < 0.0001), and fractionation was conventional (45-50.4 Gy/25-28 Fractions) in 17 photon patients (25.8%) vs 40 (100%) photon vs proton groups, respectively. There was no significant differences between the two groups with respect to radiation toxicities: dermatitis grade 1 (78.7% in photon vs 78% in proton), grade 2 (14.7% vs 19.5%), and grade 3 (1.3% vs 0%); esophagitis grade 1 (32% vs 24.4%), grade 2 (10.7% vs. 4.9%); and fatigue (26.7% vs 29.3%). For surgical complications, 7.8% (n = 9) implants had major infections (Photon 9.3% vs Proton 4.9%) and 0.9% (n = 1) had minor infections (Photon 1.3% only). 7.8% (n = 9) had wound complications (Photon 10.7% vs Proton 2.4%); 0.9% (n = 1) had partial flap necrosis (Photon 1.3% only); 2.6% (n = 3) had seromas (Photon 4% only); 15.5% (n = 18) had re-operations for any surgical complications (Photon 20% vs Proton 7.3%); 14.7% (n = 17) had implant failure (Photon 18.7% vs Proton 7.3%); 18.1% (n = 21) had grade 3 or 4 capsular contracture (Photon 18.7% vs Proton 17.1%). Photon was significantly associated with a higher risk of ≥2 surgical complications in univariable analysis (OR = 3.71, 95% CI: 1.02-13.53, P = 0.047) and in the multivariable model adjusting for stage (OR = 4.84, 95% CI: 1.27-18.46, P = 0.021). Compared to traditional photon PMRT, proton PMRT had fewer surgical complications but no difference regarding radiation toxicities in patients with PP-IBBR. [ABSTRACT FROM AUTHOR]

Spatially fractionated radiotherapy (i.e. GRID radiotherapy) is utilized to treat bulky (> = 6cm) tumors. Reports on the modern use of GRID radiotherapy for the treatment of locally advanced or metastatic bulky tumors are limited. In this study we analyzed clinical and treatment outcomes in patients treated with GRID at our institution. Patients with locally advanced or metastatic bulky tumors treated with GRID radiotherapy from December 2013 to June 2022 were retrospectively reviewed. Consolidative external beam radiation therapy (EBRT) was delivered at physicians' discretion. Patient and treatment characteristics, treatment response (symptom/imaging improvement, locoregional control) and toxicity data were collected. The study cohort consisted of 80 patients treated with 82 GRID treatments. Median age at treatment was 58.5 years. Head and neck was the most frequently treated site (n = 40, 49%), followed by thorax (n = 17, 21%), pelvis (n = 16, 19.5%), extremities (n = 7, 8.5%), and abdomen (n = 2, 2.4%). Treatment intent was 50% definitive and 50% palliative. The most prescribed GRID dose was a single fraction of 20 Gy (n = 78, 95%, range = 15-20 Gy). The majority of patients (n = 62, 76.5%) were treated with a GRID block and 19 patients (23.5%) were treated with GRID IMRT using the IMRT system. EBRT was delivered post-GRID in 62 (75.6%) courses with a median time interval from GRID to EBRT of 1 day (range = 1-47 days), and EBRT was delivered pre-GRID in 6 (7.3%) courses, and the remaining 14 (17.1%) courses were delivered with GRID alone. Median EBRT dose and fractionation was 46.3 Gy (range = 8-70 Gy) and 25 fractions (range = 1-35 fractions), respectively. Concurrent systemic therapy was administered in 36 treatment courses (43.9%), including 26 (31.7%) concurrent chemotherapy and 10 concurrent immunotherapy (12.2%). Median follow-up was 8 months (range = 1-100 months). 54 patients (87%) had disease response (either symptomatic response, imaging response, or both), 8 (13%) patients had either no improvement or disease progression after treatment. Median progression free survival was 3 months (95% confidence interval: 1.8-4.1), and median overall survival was 4.7 months (95% confidence interval: 0.8-8.6). There are a total of 101 acute toxicities recorded, including 32 (31.7%) grade 1, 51 (50.5%) grade 2, 18 (17.8%) grade 3 and 0 grade 4. The most common acute toxicities were radiation dermatitis (13.86%, grade 2) and oral mucositis (12.87%, grade 2). There are a total of 41 late toxicities recorded, including 16 (39%) grade 1, 21 (51.2%) grade 2, 4 (9.8%) grade 3 and 0 grade 4. The most common late toxicities are fatigue (9.76%, grade 1), pain (12.2%, grade 2) and dry mouth (9.76%, grade 2). Our study is among the largest single-institution study to date on GRID radiotherapy outcomes and toxicities. Our results suggest GRID combined with EBRT provides a high response rate and tolerable toxicity profile for bulky locally advanced or metastatic tumors. [ABSTRACT FROM AUTHOR]

Betel nut chewing is an established cause of oral cancer. We hypothesized that patients with nonoperative betel nut-related locally advanced oral squamous cell carcinoma (LAOSCC) can benefit from the addition of concurrent and adjuvant camrelizumab to cisplatin-based concurrent chemoradiotherapy (CCRT) as first-line treatment. The purpose of this single arm, phase 2 trial was to evaluate the efficacy and safety of CCRT plus concurrent and adjuvant camrelizumab as first-line treatment for patients with nonoperative betel nut-related LAOSCC. This study was an open-label, single-arm phase 2 trial. A total of 60 patients with betel nut-related (consumption of at least 10 betel nuts per day for more than 5 years), nonoperative, stage III to IVB oral squamous cell carcinoma (OSCC) were enrolled. All patient were treated with CCRT plus concurrent and adjuvant camrelizumab as first-line treatment. The concurrent head and neck irradiation using intensity-modulated radiation therapy (IMRT) was administered at a dose of 70 Gy in 35 fractions. Cisplatin was administered at a dosage of 100mg /m2 Q3W, concurrently with radiotherapy. Camrelizumab (200 mg on days 1, 22, and 43) was given concurrently to CCRT, and this was followed by adjuvant doses of 200 mg every 3-weeks for 1 year or until disease progression, the occurrence of unacceptable adverse events (AEs), withdrawal of consent or investigator's decision. The primary endpoint was disease-free survival (DFS). Secondary outcomes were treatment response, overall survival (OS), local recurrence-free survival (LRFS), local regional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and treatment-related toxicity. This trial is registered with chictr.org.cn (ChiCTR2200056298). Median follow-up duration was 12 months. The objective response rate (ORR), complete response (CR) rate and partial response (PR) rate were 100%, 88.3%, and 11.7%, respectively. The 1-year DFS, OS, LRFS, LRRFS, and DMFS were 86.7%, 95.0%, 91.7%, 88.3%, and 86.7%, respectively. Compared to patients with a PD-L1 combined positive score (CPS) of < 1, those with a CPS ≥1 have significant higher CR rate (94.1% vs 55.5%, P = 0.001), DFS (92.2% vs 55.5%, P = 0.003), and OS (98.0% vs 77.8%, P = 0.011). The common (incidence ≥ 10%) severe (≥ grade 3) toxic effects included oral mucositis (65.0%), decreased lymphocyte count (36.6%), dysphagia (23.3%), nausea (16.6%), hyponatremia (13.3%), weight loss (11.6%), vomiting (11.6%), and radiation dermatitis (10.0%). The incidence of reactive capillary endothelial proliferation (RCEP) was 6.7%, all of which are grades 1-2. No grade 5 toxicities were observed. Cisplatin-based concurrent chemoradiotherapy plus concurrent and adjuvant camrelizumab as first-line treatment has demonstrated significant efficacy in patients with nonoperative betel nut-related locally advanced oral squamous cell carcinoma, with tolerable toxicity profiles. [ABSTRACT FROM AUTHOR]

Background and Objectives: Chronic radiotherapy-induced skin injury (cRISI) is an irreversible and progressive condition that can significantly impact a patient’s quality of life. Despite the limited literature available on the assessment of the epidermal barrier in cRISI, there is a consensus that appropriate skincare, including the use of emollients, is the primary therapeutic approach for this group of patients. The aim of this study was to evaluate the biophysical properties of the skin during the late period (at least 90 days) following radiation therapy (RT) for head and neck cancer. Materials and Methods: This was a single-center prospective non-randomized study. It involved the analysis of 16 adult patients with head and neck cancer who underwent RT at the Greater Poland Cancer Center, along with 15 healthy volunteers. The study and control groups were matched for gender and age (p = 0.51). Clinical assessment, based on the LENT-SOMA scale, was conducted for all patients. Evaluation of the skin’s biophysical properties included: an analysis of transepidermal water loss (TEWL), stratum corneum hydration (SCH), and skin visualization using high-frequency ultrasonography (HF-USG). Results: A significantly higher TEWL was observed in the irradiated area compared to the control area in the study group (p = 0.004). However, there was no statistically significant difference in SCH (p = 0.073). Additionally, no significant difference was observed in the values of TEWL and SCH in the irradiated area between the group of patients with and without clinically obvious RISI (p = 0.192 and p = 0.415, respectively). The skin thickness of the irradiated area, assessed by HF-USG, did not differ significantly from the skin thickness of the control area (p = 0.638). Furthermore, no difference in skin thickness was observed in patients with clinical features of cRISI in the irradiated and control areas (p = 0.345). The mean time after RT was 6.1 years. Conclusions: This study marks the first demonstration of epidermal barrier damage in patients in the long term following RT for head and neck cancer. The impairment of the epidermal barrier was observed independently of evident cRISI features. This observation underscores the necessity to recommend appropriate skin care, including the use of emollients, for all patients following RT. We also suggest that HF-USG examination is generally inconclusive in determining the degree of skin damage in the late period after RT.

Abnormal crosstalk between endothelial cells and podocytes mediates TKI-induced proteinuria and kidney injury I via i blockage of VEGF receptors and their signaling. The patient presented with sunitinib-induced AEs, and his serum creatinine level gradually increased from 123 mol/L (initiation of sunitinib) to 203 mol/L, along with hypertension, 2+ proteinuria, and trace glycosuria. Dear Editor, Pazopanib is a multitargeted tyrosine kinase inhibitor (TKI) that acts against vascular endothelial growth factor (VEGF), platelet-derived growth factor, fibroblast growth receptor, and c-Kit [[1]]. [Extracted from the article]

Key Clinical Message 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.

Adverse skin reactions caused by ionizing radiation are collectively called radiation dermatitis (RD), and the use of nanomedicine is an attractive approach to this condition. Therefore, we designed and large-scale synthesized fullerenols that showed free radical scavenging ability in vitro. Next, we pretreated X-ray-exposed cells with fullerenols. The results showed that pretreatment with fullerenols significantly scavenged intracellular reactive oxygen species (ROS) produced and enhanced the antioxidant capacity, protecting skin cells from X-ray-induced DNA damage and apoptosis. Moreover, we induced RD in mice by applying 30 Gy of X-ray irradiation, followed by treatment with fullerenols. We found that after treatment, the RD scores dropped, and the histological results systematically demonstrated that topically applied fullerenols could reduce radiation-induced skin epidermal thickening, collagen deposition and skin appendage damage and promote hair regeneration after 35 days. Compared with Trolamine cream, a typical RD drug, fullerenols showed superior radiation protection. Overall, the in vitro and in vivo experiments proved that fullerenols agents against RD. [ABSTRACT FROM AUTHOR]

Skin rejuvenation procedures have increasingly flooded the aesthetic market, one of which includes microneedling. In microneedling, multiple fine punctures of the skin are performed with a needle to induce neocollagenesis. Microneedling has increasingly been used to treat inflammatory acne, acne scarring, photodamaged skin, and even radiation dermatitis. We present a patient with a stable history of liquid injectable silicone (LIS) given 20 years prior who developed chronic periocular and facial hypersensitivity after undergoing microneedling at a medi-spa. Long-term steroids and immunosuppressants were needed for control. The patient's severe reaction and resistance to treatment highlights the potential complications of microneedling administered by a non-medical professional in the setting of prior injectable silicone. [ABSTRACT FROM AUTHOR]

Background: Definitive chemoradiotherapy (CRT) with 5-fluorouracil plus mitomycin-C is a standard treatment for stage II/III squamous cell carcinoma of the anal canal (SCCA). We performed this dose-finding and single-arm confirmatory trial of CRT with S-1 plus mitomycin-C to determine the recommended dose (RD) of S-1 and evaluate its efficacy and safety for locally advanced SCCA. Methods: Patients with clinical stage II/III SCCA (UICC 6th) received CRT comprising mitomycin-C (10 mg/m2 on days 1 and 29) and S-1 (60 mg/m2/day at level 0 and 80 mg/m2/day at level 1 on days 1–14 and 29–42) with concurrent radiotherapy (59.4 Gy). Dose-finding used a 3 + 3 cohort design. The primary endpoint of the confirmatory trial was 3-year event-free survival. The sample size was 65, with one-sided alpha of 5%, power of 80%, and expected and threshold values of 75% and 60%, respectively. Results: Sixty-nine patients (dose-finding, n = 10; confirmatory, n = 59) were enrolled. The RD of S-1 was determined as 80 mg/m2/day. Three-year event-free survival in 63 eligible patients who received the RD was 65.0% (90% confidence interval 54.1–73.9). Three-year overall, progression-free, and colostomy-free survival rates were 87.3%, 85.7%, and 76.2%, respectively; the complete response rate was 81% on central review. Common grade 3/4 acute toxicities were leukopenia (63.1%), neutropenia (40.0%), diarrhea (20.0%), radiation dermatitis (15.4%), and febrile neutropenia (3.1%). No treatment-related deaths occurred. Conclusions: Although the primary endpoint was not met, S-1/mitomycin-C chemoradiotherapy had an acceptable toxicity profile and favorable 3-year survival and could be a treatment option for locally advanced SCCA. Clinical trial information: jRCTs031180002. [ABSTRACT FROM AUTHOR]

The present study attempts to evaluate the acute and subacute toxicities of hypofractionated volumetric modulated arc therapy (HFX-VMAT) in patients with early breast cancer (EBC). It is a retrospective analysis of 23 patients treated with HFX-VMAT after breast-conserving surgery between September 2021 and February 2022. A total dose of 50.05 to 52.55 Gy was delivered, consisting of 40.05 Gy to the ipsilateral whole breast in 15 fractions of 2.67 Gy and a tumor bed boost dose of 10-12.5 Gy in 4-5 fractions. The primary endpoint was acute/subacute radiation pneumonitis (RP). The secondary endpoint was poor cosmesis, indicating acute/subacute radiation dermatitis. Chest computed tomography (CT) and the Common Terminology Criteria for Adverse Events v.5.0 were used to assess acute and subacute RP and dermatitis, respectively, during radiotherapy (RT) and at 3- and 6-months post-RT. The median follow-up duration was 3.8 months (range, 2.3-4.2). A total of seven patients developed RP. None of these patients presented RP-related symptoms; the diagnosis was based on radiologic findings observed on follow-up chest CT. Among the seven patients with RP, five had right-sided, and two had left-sided breast tumors (71.4 vs. 28.6%; P=0.026). Grade 1 erythema was observed in 19 patients (82.6%) and grade 2 erythema in four (17.4%). The mean target dose, D105% (the dose received by 105% of the target volume), homogeneity index, mean lung dose, ipsilateral lung V20 (the percentage volume receiving 20 Gy), and V30 (the percentage volume receiving 30 Gy) for ipsilateral whole breast RT were significantly associated with RP (P=0.039, 0.047, 0.018, 0.015, 0.018 and 0.003, respectively.). HFX-VMAT showed tolerable acute/subacute toxicities. Therefore, HFX-VMAT is an effective and safe treatment option for EBC. [ABSTRACT FROM AUTHOR]

Aim: This was a double‐blind, placebo‐controlled randomized study investigating whether melatonin can protect against radiation dermatitis in women receiving radiation therapy for primary breast cancer. Methods: Patients were included before radiation therapy and followed once weekly throughout treatment with a 3‐week follow‐up. Patients applied 1 g of cream to the irradiated skin twice daily, consisting of either 25 mg/g melatonin and 150 mg/g dimethyl sulfoxide, or placebo. Our outcomes were the Radiation Therapy Oncology Group's (RTOG) acute radiation morbidity scoring criteria for skin, a pixel analysis of erythema in clinical photographs, and patients' use of corticosteroid cream. Outcomes were evaluated once weekly throughout the trial. The primary outcomes were RTOG‐score and pixel analysis at 2 weeks follow‐up. Secondary outcomes were the use of corticosteroid cream and analyses of RTOG‐scores and pixel analyses throughout the trial. Results: Sixty‐five patients were included, 17 dropped out, totaling 26 and 22 patients randomized to melatonin and placebo, respectively. RTOG‐scores and pixel analyses at 2 weeks follow‐up showed no difference p =.441 and p =.890, respectively). There was no difference in the use of corticosteroid cream (p =.055). Using logistic regression, the melatonin group had a higher likelihood of having a low RTOG‐score (p =.0016). The logistic regression showed no difference between the groups for the pixel analyses. Conclusion: Our primary outcome showed no difference in RTOG‐scores at 2 weeks follow‐up, however, the RTOG‐score over the entire duration of the study demonstrated a protective effect of melatonin. Further studies are warranted investigating higher doses of melatonin, and whether corticosteroids may influence the effect of melatonin cream against radiation dermatitis. [ABSTRACT FROM AUTHOR]

Background: As part of a breast-conservation strategy for breast cancer, there are presently no data from randomized controlled studies on the use of intraoperative radiation (IORT) as a tumor bed boost. The effectiveness and safety of IORT as a boost therapy at a tertiary cancer center were retrospectively reviewed in this study. Methods: Patients had breast-conserving surgery from 2012 to 2016 that included staging of the axillary lymph nodes, a single dose of 20 Gy IORT with 50-kV photons, whole-breast irradiation (WBI), and (neo-)adjuvant systemic treatment (if applicable). During the follow-up patients were monitored for the assessment of acute and late toxicities (using the Common Terminology Criteria for Adverse Events version 4.03). Results included ipsilateral (IBTR), contralateral (CBE), and distant metastasis-free (DMFS) breast progression-free survival, as well as overall survival (OS). Results: The 68 patients had a median follow-up of 91.5 months (with a range of 9–125). Most patients (n = 51) had T1 disease and were clinically node negative. Only a small number of individuals had triple negative or high-grade illness. The majority of patients had sentinel node biopsy, and three (4.4%) had to have their tumors removed again since their original margins were positive. Finally, there were no distinct tumor bed margins. Neoadjuvant chemotherapy was administered to ten (14.7%). The median duration from BCS to WBI was 54.5 days, and conventionally fractionated WBI was used to accomplish WBI most frequently (n = 57, 96.6%). IORT was administered in a single 20 Gy dosage. 50 Gy was the median WBI dosage (range 40.05–50.4 Gy). There were no grade 4 adverse events for any patients in. Toxicities following surgery were minimal. There were only one patient with grade 3 toxicity (radiation dermatitis) to observe. Five tumor bed recurrences and two contralateral breast incident each occurred. Conclusion: This work adds to the preliminary evidence already in the literature and supports the use of IORT in boost settings. When randomized trials like TARGIT-B are eventually published, these hopeful findings should be prospectively evaluated. [ABSTRACT FROM AUTHOR]

Background: Oral and/or oropharyngeal cancers account for approximately 2% of all malignancies, with variation across age groups, genders, and geographic locations. Treatments for oral and/or oropharyngeal cancers usually consist of a combination of surgical excision most commonly followed by radiotherapy ± chemotherapy and/or immunotherapy/biotherapy depending on the nature of the malignancy. The significant morbidity caused by high‐dose radiotherapy to the head and neck region is widely observed. Proton therapy is a promising treatment option that localises a proton beam to direct radiation at a specific target, with reduced irradiation to adjacent structures. Method: The objective was to explore the toxicity associated with proton therapy for adults with oral and/or oropharyngeal cancer. Eligibility criteria included full‐text articles, English articles, published between up till 7 January 2023. Databases included PubMed, Scopus, Web of Science, Embase, and Scopus. Results: The systematic search identified 345 studies and a total of 18 studies were included after two independent reviewers completed title, abstract, and full‐text screening. Included studies were from four countries, and median participant age range was 53.3 to 66 years. The most commonly reported acute toxic effects included dysphagia, radiation dermatitis, oral mucositis, dysgeusia, and alopecia. Conclusion: Proton therapy is an evolving cancer treatment technique that has diverse advantages over conventional radiotherapy and chemotherapy. This review provides evidence that supports that proton therapy has an improved acute toxicity profile compared to radiotherapy to treat oral and/or oropharyngeal cancer individuals. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Ferroptosis is a newly discovered cell death type which is different from apoptosis, autophagy, pyroptosis as well as necrosis in the following aspects: morphology, biochemistry, gene and regulatory mechanisms. Ferroptosis is regulated by multiples of mechanisms such as system Xc− mechanism, glutathione peroxidase 4 (GPX4) mechanism, iron metabolism and lipid metabolism. Currently, ferroptosis has been revealed to be significant in wound healing such as diabetic wound, irradiated wound and ultraviolet (UV)‐driven wound. Hence, how to intervene in the pathogenesis as well as the development of wounds and promote the wound healing by the regulation of ferroptosis have become a research hotspot. This review systematically summarises the latest scientific advances of ferroptosis and wound healing fields, with hoping to propose a new insight and advance in the wound treatment. [ABSTRACT FROM AUTHOR]

Background: Over the years, radiotherapy has been established as a tool to improve local control for high-grade sarcomas. Although the European Society for Medical Oncology guidelines has taken notice of a shift toward a neoadjuvant radiotherapy approach, the American Society for Radiation Oncology guidelines clearly favor a neoadjuvant approach, citing debilitating long-term adverse effects when radiotherapy is applied postoperatively. In this study, we examined these irradiation-associated adverse events for adjuvant radiotherapy and focused on the prognostic factors for disease outcome, including local control. Methods: In this retrospective study, data for 106 patients with extremity soft-tissue sarcomas diagnosed between 1997 and 2021, of which 40 received adjuvant radiotherapy, were collected from the clinical and radiological information systems of a high-volume sarcoma treatment center. These data were then analyzed for radiation-associated side effects as well as predictive factors for overall survival, disease-free survival, local control, and surgical complications. Results: Radiotherapy was beneficial to patients improving local control, especially for high-grade sarcomas, even when those were resected with negative margins. Side effects due to radiotherapy occurred in 87.5% of the patients, and these effects primarily included radiation dermatitis in 67.5%; however, only 40.0% had any adverse event of ≥ grade 2 according to Common Terminology Criteria for Adverse Events. Long-term function-limiting side effects occurred in 45.0% of the patients; 10% exhibited ≥ grade 2 function-limiting adverse events. Greater time between surgery and adjuvant radiotherapy was beneficial for the patients, whereas joint infiltrating sarcomas were associated with more severe long term, function-limiting adverse events. 28.3% of the patients experienced a recurrence at any location (median time 18.35 months) and in 16% the recurrence was local (median time 16.11 months), resulting in 1, 3, and 5 year disease-free survival rates of 74.1, 58.9, and 38.5% and local control rates of 78.7, 61.6, and 42.8% were observed, respectively. Conclusion: Recurrences may be avoided with high-dose radiation, especially for high-grade G2 and G3 sarcomas, even after complete R0 resection. This resulted in a low rate of severe long-term function-limiting adverse events. Thus, adjuvant radiotherapy should be seriously considered when planning patient treatment, especially when treating patients that present with high-grade sarcomas. [ABSTRACT FROM AUTHOR]

Keratinocyte carcinomas are amenable to many treatments, including radiation therapy (RT). Electronic skin surface brachytherapy (ESSB) enables the precise delivery of radiation without radioisotopes. In this prospective multicenter clinical trial, we characterized early outcomes of ESSB prospectively through both patient- and clinician-reported measures. To corroborate the cosmesis observations, we also assessed patient-reported quality of life (QoL) and adverse events. Patients ≥60 years old with stage T 1 N 0 M 0 keratinocyte carcinoma were treated with ESSB. At 2-, 6-, and 12-weeks post-treatment, cosmesis from ESSB was assessed by both the patient and a clinician study investigator as either "good," "fair," or "bad." The Skindex-16 and the Skin Cancer Index (SCI) were used to assess patient QoL before and after treatment. Adverse events were assessed using the Common Toxicity Criteria for Adverse Events, version 4.0. Cosmesis and QoL were collected at 97% (99/102) of possible patient follow-up times. By 12 weeks post-treatment, 93.9% (31/33) of patient-reported and 96.9% (31/32) of clinician-reported cosmesis outcomes were "good." Compared with baseline, total Skindex-16 score significantly deteriorated at 2 weeks post-treatment (10.5 vs 24.5, P <.001), but significantly improved at 6 weeks (10.5 vs 4.7, P =.014) and 12 weeks (10.5 vs 2.1, P =.001) post-treatment. The total SCI score significantly improved from baseline to 6 weeks (78.4 vs 89.0, P =.001) post-treatment. The most frequent adverse events were radiation dermatitis, skin pain, and pruritus. All adverse events resolved to Grade ≤1 by 12 weeks post-treatment. This prospective, multicenter study demonstrated that ESSB is associated with a high rate of "good" early patient-reported cosmesis and increasing QoL and satisfaction with time. Validated assessments demonstrated a significant improvement in quality of life and resolution of moderate early adverse events by 6 to 12 weeks after treatment and corroborate the observation of favorable cosmesis. [ABSTRACT FROM AUTHOR]

Background Implant-based breast reconstruction (IBBR) is the most common method of reconstruction after mastectomy.(1) Postoperative radiotherapy is associated with a significant increase in complications. We report our experience with the use of autologous fat transfer (AFT) to reduce radiation complications in (IBBR) and assess survival of the transferred fat after breast radiation. Patient and methods This study was a prospective comparative study of 20 patients who were divided into two groups using the closed envelope technique: group (A) consisted of 10 patients treated with (AFT) during the first phase of (IBBR), group (B) consisted of 10 patients not treated with (AFT) during the first phase of (IBBR), both groups underwent postmastectomy radiotherapy (PMRT). A survey was done to analyze radiation complications and assessment of fat survival using computed tomography. Results Both groups (A) and (b) consist of 10 patients (9 unilateral and one bilateral) with 11 treated breasts in both groups Mean follow-up was 6 months. Complication rates in group (A) versus group (B) were as follows: surgical-site infection, 0% versus 9.1%; Superficial mastectomy flap necrosis, 9.1% versus 18.2%; wound dehiscence, 0% versus 9.1%; minor capsular contracture grade 1 2, 36.4% versus 54.5%; major capsular contracture grade 3,4 0 percent versus 18.2%; Radiation dermatitis 9.1% versus 27.3%; no hematoma, Seroma, Full-thickness mastectomy flap necrosis nor extrusion in both groups The average fat retention percentage after radiation was 74.82±4.21%. Conclusions Early data of the use of AFT as a protective measure in prepectoral IBBR in Patients with postmastectomy radiation therapy show promising results. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we aimed to develop a novel Bayesian optimization based multi-stacking deep learning platform for the prediction of radiation-induced dermatitis (grade = two) (RD 2+) before radiotherapy, by using multi-region dose-gradient-related radiomics features extracted from pre-treatment planning four-dimensional computed tomography (4D-CT) images, as well as clinical and dosimetric characteristics of breast cancer patients who underwent radiotherapy. Materials and methods: The study retrospectively included 214 patients with breast cancer who received radiotherapy after breast surgeries. Six regions of interest (ROIs) were delineated based on three PTV dose -gradient-related and three skin dose-gradient-related parameters (i.e., isodose). A total of 4309 radiomics features extracted from these six ROIs, as well as clinical and dosimetric characteristics, were used to train and validate the prediction model using nine mainstream deep machine learning algorithms and three stacking classifiers (i.e., meta-learners). To achieve the best prediction performance, a Bayesian optimization based multi-parameter tuning technology was adopted for the AdaBoost, random forest (RF), decision tree (DT), gradient boosting (GB) and extra tree (XTree) five machine learning models. The five parameter -tuned learners and the other four learners (i.e., logistic regression (LR), K-nearest neighbors (KNN), linear discriminant analysis (LDA), Bagging) whose parameters cannot be tuned, all as the primary week learners, were fed into the subsequent meta-learners for training and learning the final prediction model. Results: The final prediction model included 20 radiomics features and eight clinical and dosimetric characteristics. At the primary learner level, on base of Bayesian parameter tuning optimization, the RF, XGBoost, AdaBoost, GBDT, and LGBM models with the best parameter combinations achieved AUC of 0.82, 0.82, 0.77, 0.80, and 0.80 prediction performance in the verification data set, respectively. In the secondary meta-learner lever, compared with LR and MLP meta-learner, the best predictor of symptomatic RD 2+ for stacked classifiers was the GB meta-learner with an area under the curve (AUC) of 0.97 [95% CI: 0.91-1.0] and an AUC of 0.93 [95% CI: 0.87-0.97] in the training and validation datasets, respectively and the 10 top predictive characteristics were identified. Conclusion: A novel multi-region dose-gradient-based Bayesian optimization tunning integrated multi-stacking classifier framework can achieve a highaccuracy prediction of symptomatic RD 2+ in breast cancer patients than any other single deep machine learning algorithm. [ABSTRACT FROM AUTHOR]

Background: Acute radiation dermatitis (ARD) is one of the most common acute adverse reactions in breast cancer patients during and immediately after radiotherapy. As ARD affects patient quality of life, it is important to conduct individualized risk assessments of patients in order to identify those patients most at risk of developing severe ARD. Methods: The data of breast cancer patients who received radiotherapy were prospectively collected and analyzed. Serum ferritin, high-sensitivity C-reactive protein (hs-CRP) levels, and percentages of lymphocyte subsets were measured before radiotherapy. ARD was graded (0–6 grade), according to the Oncology Nursing Society Skin Toxicity Scale. Univariate and multivariate logistic regression analyses were used and the odds ratio (OR) and 95% confidence interval (CI) of each factor were calculated. Results: This study included 455 breast cancer patients. After radiotherapy, 59.6% and 17.8% of patients developed at least 3 (3+) grade and at least 4 (4+) grade ARD, respectively. Multivariate logistic regression analysis found that body mass index (OR: 1.11, 95% CI: 1.01–1.22), diabetes (OR: 2.70, 95% CI: 1.11–6.60), smoking (OR: 3.04, 95% CI: 1.15–8.02), higher ferritin (OR: 3.31, 95% CI: 1.78–6.17), higher hs-CRP (OR: 1.96, 95% CI: 1.02–3.77), and higher CD3 + T cells (OR: 2.99, 95% CI: 1.10–3.58) were independent risk factors for 4 + grade ARD. Based on these findings, a nomogram model of 4 + grade ARD was further established. The nomogram AUC was 0.80 (95% CI: 0.75–0.86), making it more discriminative than any single factor. Conclusion: BMI, diabetes, smoking history, higher ferritin, higher hs-CRP, and higher CD3 + T cells prior to radiotherapy for breast cancer are all independent risk factors for 4 + grade ARD. The results can provide evidence for clinicians to screen out high-risk patients, take precautions and carefully follow up on these patients before and during radiotherapy. [ABSTRACT FROM AUTHOR]

Radiation recall dermatitis (RRD) is an extremely rare phenomenon. A variety of factors such as antineoplastic agents, pharmaceutical agents, physical and environmental factors have been proposed to be the underlying cause of RRD. Only a handful cases have been reported till date, where trastuzumab is sought to be the triggering agent. The presentation of RRD varies from mild erythematous to extensive confluent dermatitis, resolving over a period of 1 to 2 weeks with conservative management. Most of the patients tend to tolerate rechallenge well without showing reappearance. We hereby describe a lady with breast cancer having RRD following administration of trastuzumab. She developed reaction 28 days post-radiotherapy and managed conservatively. Furthermore, she was rechallenged with the same dose, that she tolerated very well, without any reappearance. Hence, an acquaintance of the clinicians to this rare entity is essential for timely diagnosis and appropriate management. [ABSTRACT FROM AUTHOR]

Introduction: Radiation recall reaction is an acute inflammatory reaction confined to previously irradiated areas that are most commonly triggered by the administration of anti-cancer agents after radiotherapy. Radiation recall myositis is a relatively rare form of radiation recall reaction. Case report: Here we report a 29-year-old female patient who suffered from metastatic monophasic synovial sarcoma. 8.5 months after post-operative radiotherapy of the right thigh region, the patient suffered pain, edema, redness, and increased temperature locally on the right thigh. Physical exam showed red fixed skin, rigidity and severe tenderness of region, and thigh magnetic resonance imaging revealed dense edema areas at the addiction, semimembranous-semitendinous muscle, and superior part of the biceps femoris and vastus lateralis isointense on T1AG, hyperintense T2AG images. Based on these findings, the patient was diagnosed with pazopanib-induced radiation recall myositis. Management & outcome: Pazopanib was stopped and pentoxifylline (2 × 400 mg), Vitamin E (3 × 400 mg), and methylprednisolone (2 × 8 mg) were prescribed. After 1 month, complete relief of thigh pain and marked recovery of rigidity, as well as erythema, were achieved and no recurrence of radiation recall reaction-related symptoms was observed after the pazopanib rechallenge. Discussion: Myositis is a relatively rare presentation of radiation recall reaction and physicians must be aware of the symptoms of the patients who are treated by radiotherapy and pazopanib. [ABSTRACT FROM AUTHOR]

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‐β1, 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. [ABSTRACT FROM AUTHOR]

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Background: Radiation dermatitis is known to be a major side-effect occurring following cancer treatment. We conducted the present study to understand whether salivary lactate dehydrogenase (LDH) could be conducive to predict the development of radiation-dermatitis in the head and neck cancer (HNC) patients undergoing curative radiotherapy (60-70 Gy).Method: This was a prospective study performed on HNC patients requiring curative radiotherapy. Saliva was collected at two points from the willing volunteers. The first time point was prior to the first fraction of 2 Gy radiation and the second one was 24 hours after the first fraction and before exposure to the second fraction. The saliva collected at the both time points were analyzed for the levels of salivary LDH using standard procedure. The patients were provided with the standard care throughout the treatment period and the incidence and severity of radiation dermatitis was noted down using a proforma sheet throughout the 7-week treatment period.Results: The results suggested that with exposure to 2 Gy fraction, there was an increase in the level of salivary LDH (387.11 ± 18.98 IU/L vs. 368. 13 ± 19.56IU/L); this increase was significant (t = 20.06 and P < 0.001). The LDH data was stratified based on the severity of dermatitis [mild (grades 1 and 2) vs. severe (grades 3 and 4)] in accordance to the Radiation Therapy Oncology Group/European Organization for Research and Treatment Cancer (RTOG) grading. The LDH values were subjected to Karl Pearson’s correlation analysis with the grade of dermatitis and the results indicated a P value of 0.019 and R value of 0.24.Conclusion: For the first time, our study revealed that salivary LDH could be a useful marker to understand the development of radiation-induced dermatitis in HNC patients undergoing curative radiotherapy. The most advantageous aspect herewith is that the collection of saliva does not require skilled people or special equipment; it cou ld be done at repeated intervals and without causing any invasive process.

Abstract Introduction Radiation therapy is one of the standard methods in the treatment of breast cancer. Radiotherapy-induced dermatitis (RID) is a common complication of radiotherapy (RT) resulting in less tolerance in RT and even discontinuation of treatment. Timolol is a β-adrenergic receptor antagonist that presents the best wound healing effects on both chronic and incurable wound healing. Topical forms of timolol could be effective in the prevention of RID due to the role of β-adrenergic receptors in skin cells and keratinocyte migration, as well as the anti-inflammatory effect of timolol. However, no placebo-controlled randomized trial is available to confirm its role. The current trial aimed to evaluate the efficacy of topical timolol 0.5% (w/w) on the RID severity and patients' quality of life (QOL). Method Patients aged older than 18 years with positive histology confirmed the diagnosis of invasive and localized breast cancer were included. Patients were randomized based on the random number table to receive each of the interventions of timolol 0.5% (w/w) or placebo topical gels from the first day of initiation of RT and for 6 weeks, a thin layer of gel twice daily. Patients were asked to use a thin layer of gel for at least two hours before and after radiation therapy. Primary outcomes were acute radiation dermatitis (ARD) grade using Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) scale and severity of desquamation based on Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Secondary outcomes were QOL based on Skindex16 (SD-16), maximum grade of ARD, and time of initial RD occurrence. Results A total of 64 female patients with an age range of 33 to 79 years were included. The means (SD) of age were 53.88 (11.02) and 54.88 (12.48) in the control and timolol groups, respectively. Considering the RTOG/EORTC and CTCAE scores the difference between groups was insignificant (P-Value = 0.182 and P-Value = 0.182, respectively). In addition, the mean (SD) of time of initial RID occurrence in placebo and timolol groups were 4.09 (0.588) and 4.53 (0.983) weeks, respectively (P-Value = 0.035). The maximum grade of RID over time was significantly lower in the timolol group. During the study period, 75.0% of patients in placebo groups had grade 2 of ARD while in the timolol group it was 31.3% (P-Value = 0.002). QoL was not significantly different between groups (P-Value = 0.148). Conclusion Although the topical formulation of timolol, 0.5% (w/w), was found to reduce the average maximum grade of ARD and increase the mean (SD) time of initial RID occurrence, it showed no effect on ARD, severity, and QOL. However, future clinical trials should be performed to assess timolol gel formulation in larger study populations. Trial registration https://irct.ir/ IRCT20190810044500N11 (17/03/2021).

Introduction: Radiotherapy plays an important adjuvant role in the surgical treatment of breast cancer by reducing locoregional recurrence and improving overall survival. However, up to 95% of patients experience some degree of radiodermatitis. This study aims to review the literature regarding topical agent therapies in preventing and treating acute radiation dermatitis in breast cancer patients. Methods: Integrative review of LILACS, Medline and Cochrane Library databases. We searched for original articles published between 2010 and 2020, including the descriptors breast neoplasms, radiodermatitis, skincare, and skin cream. Results: The initial search returned 158 articles. After screening for eligibility, 48 articles were included. Forty different topical agent therapies were identified and grouped into seven categories to facilitate data analysis: herbal medicines, hormones/vitamins/growth factors, topical corticosteroids, barrier products (film or cream), hyaluronic acid, silver-based dressings and others. Conclusions: This review identifies that topical corticosteroids of high (betamethasone-17-valerate) and medium potency (mometasone furoate 0.1%), as well as barrier films such as Mepitel®, Mepilex Lite®, and Hydrofilm®, are effective in managing acute breast radiodermatitis. The other topical agent therapies did not show benefits in preventing and/or treating acute radiodermatitis or have limited evidence.

Abstract Radiodermatitis, inflammatory lesions of skin and mucosa caused by radiation, is a common adverse effect during the radiation therapy of vulvar carcinoma. The incidence of radiodermatitis is affected by various factors, and the purpose of this study was to investigate the risk factors of radiodermatitis in patients with vulvar carcinoma. Patients with vulvar tumors who received radiotherapy from January 2015 to December 2020 were included in this retrospective study. Radiodermatitis was graded according to the grading criteria of the American Center for Radiological Oncology, and then univariate analysis and logistic multivariate regression analysis were used to determine the risk factors of radiodermatitis. A total of 60 eligible patients were enrolled, including 3 (5%), 25 (41.7%), 28 (46.7%), and 4 (6.6%) patients with grade 0, 1, 2, and 3 radiodermatitis, respectively. Univariate analysis showed that the incidence of radiodermatitis was significantly correlated with age, therapeutic strategy, pathological stage and radiotherapy dose (p

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/ m 2, 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. [ABSTRACT FROM AUTHOR]