|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 4 | Page : 882-883
Beauty of radiotherapy is not just skin deep!
Ram Charith Alva, Janaki Gururajachar Manur, Kirthi Koushik Agrahara Srinivas
Department of Radiation Oncology, Ramaiah Medical College, Bengaluru, Karnataka, India
|Date of Submission||01-Oct-2020|
|Date of Decision||08-Dec-2020|
|Date of Acceptance||08-Dec-2020|
|Date of Web Publication||25-Dec-2020|
Janaki Gururajachar Manur
Department of Radiation Oncology, Ramaiah Medical College, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Alva RC, Manur JG, Agrahara Srinivas KK. Beauty of radiotherapy is not just skin deep!. Cancer Res Stat Treat 2020;3:882-3
Talapatra et al. in their review article have comprehensively discussed all the aspects of radiation dermatitis. Radiotherapy was very simple with the conventional opposing beams, especially on telecobalt, as the dermatitis was confined to the field of radiation. In the case of intensity modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT), and stereotactic body radiation therapy, the beams enter from various different angles, as a result of which the skin changes are seen over a wider area, especially over regions such as the nape of the neck and collar area. One must be extremely careful when planning radiotherapy and the skin should be considered an organ at risk. However, not much work has been done in this area, despite there being a broad scope to study many new aspects, as dermatitis is one of the most common sequelae of radiation. Recently, there has been rising interest in the skin as an organ at risk during IMRT that needs to be studied further.
We tried moist skin care in the form of a mild (3%) urea lotion and found that it not only delayed but also prevented the occurrence of higher grades of radiation dermatitis. Urea lotion maintained skin texture and helped in the faster regression of reactions complemented with subjective improvements that differed from patient to patient. It is an affordable, effective, and well-tolerated regimen, but needs to be prepared as it is not commercially available.
We also tried concurrent chemoradiation for a small number of selected patients with a high risk of locoregional recurrence before hypofractionation, and radiation after adjuvant chemotherapy became the standard treatment for patients with breast cancer. However, we observed more Grade III toxicities (28% vs. 3%) and concluded that it was not well tolerated in these patients.
Another area where we studied radiation dermatitis was with accelerated radiation with a weekend boost, in which the gross disease received an additional fraction on Saturday, thereby reducing the overall treatment time marginally. We observed Grade II/III radiation dermatitis in 18.6 and 4.6% of the patients, respectively, but the reactions settled by 4 weeks.
Even though a considerable amount of work has been done in the area of radiation dermatitis, a lot more can be done for providing greater comfort to the patients, especially those with head-and-neck cancers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Talapatra K, Singh P, Jaiswal I, Rais S, Pandey S. Radiation dermatitis: A narrative review of the Indian perspective. Cancer Res Stat Treat 2020;3:526-36. [Full text]
Lee N, Chuang C, Quivey JM, Phillips TL, Akazawa P, Verhey LJ, et al
. Skin toxicity due to intensity-modulated radiotherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys 2002;53:630-7.
Alva RC, Janaki MG. 'Effectiveness of 3% Urea Lotion in Prevention of Radiation Dermatitis in Head and Neck Cancer Patients.' Completed. Bengaluru: Rajiv Gandhi University of Health Sciences; 2009.
Kumar M, Subramanian M, Rajeev AG, Ponni A, Nirmala S, Kilara N, et al
. Feasibility of concurrent weekly paclitaxel and radiotherapy in node positive breast cancer: An experience from India. J Clinl Oncol 2012;30:27:201.
Pushpa Naga CH, Janaki MG, Arul Ponni TR, Rajeev AG, Kirthi Koushik AS, Mohan Kumar S. Accelerated radiation therapy using weekend boost with concurrent cisplatin in head and neck squamous cell cancers: An Indian institutional experience. J Med Imaging Radiat Sci 2017;48:307-15.