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At least 469 records · Page 26Linked to original sources
PubMed1976

Skin reaction. A quantitative system for measurement of radiosensitisation in man.

Areas of skin have been irradiated using a radio-strontium plaque giving 800 to 1100 rad. Visual ranking of the reactions produced proved to be the best method of measuring the response. Erythema was poorly related to dose but in most cases the amount of pigmentation produced was directly related to it. This system, for use in the testing of radiosensitisers, allows a quantitative estimate of enhancement of response to be made.

Abdominal Neoplasms↗
PubMed1979

Effectiveness of topical steroids in the control of radiation dermatitis: a randomised trial using 1% hydrocortisone cream and 0.05% clobetasone butyrate (Eumovate).

Radiation dermatitis often presents as a problem for patients and radiotherapists during treatment. Topical corticosteroids have been shown to have an anti-inflammatory effect in the treatment of many skin diseases and are commonly prescribed during a course of radiation treatment. A comparison of two different steroid creams, 1% hydrocortisone cream and 0.05% clobetasone butyrate (Eumovate), in a double blind trial was carried out in 54 patients undergoing radiation therapy for breast cancer. 'The cream' was administered when patients reached a given dose of 2000 rad (or earlier if required) whether a skin reaction was present or not. The aim of the trial was to evaluate the general effectiveness of steroids in controlling radiation dermatitis and whether one type of cream was superior to the other. The majority of patients using either cream derived benefit in its soothing effect. There was, however, a significant difference in the intensity of reactions seen, patients using clobetasone butyrate developed more severe radiation reactions despite both groups having similar radiation doses. The possibility of two differing populations having different responses to radiation is discussed as is the 'breakthrough phenomenon' described in the literature. It is concluded that neither cream should be used as first choice in the control of radiation dermatitis.

Administration, Topical↗
PubMed2003

Gemcitabine-induced radiation recall dermatitis following whole pelvic radiation therapy.

OBJECTIVES: Radiation recall dermatitis secondary to gemcitabine use has been reported in isolated cases of patients treated for breast and lung cancers. There have been no reports of radiation recall dermatitis from gemcitabine after whole pelvic radiation therapy employed as a treatment of a gynecologic cancer. CASE: A 67-year-old woman was treated with whole pelvic radiation for palliation of lower extremity swelling and pain due to recurrent ovarian adenocarcinoma. Three months later, the patient was treated with gemcitabine for three courses. Therapy was discontinued secondary to severe cellulitis and edema of the skin of the anterior abdominal wall in the field of her prior radiation therapy. CONCLUSIONS: Radiation recall dermatitis secondary to gemcitabine should be considered in any patient with pelvic or lower abdominal skin abnormalities after pelvic radiation and subsequent gemcitabine therapy.

Adenocarcinoma↗
PubMed2000

Avoidance of radiation injuries from medical interventional procedures.

Interventional radiology (fluoroscopically-guided) techniques are being used by an increasing number of clinicians not adequately trained in radiation safety or radiobiology. Many of these interventionists are not aware of the potential for injury from these procedures or the simple methods for decreasing their incidence. Many patients are not being counselled on the radiation risks, nor followed up when radiation doses from difficult procedures may lead to injury. Some patients are suffering radiation-induced skin injuries and younger patients may face an increased risk of future cancer. Interventionists are having their practice limited or suffering injury, and are exposing their staff to high doses. In some interventional procedures, skin doses to patients approach those experienced in some cancer radiotherapy fractions. Radiation-induced skin injuries are occurring in patients due to the use of inappropriate equipment and, more often, poor operational technique. Injuries to physicians and staff performing interventional procedures have also been observed. Acute radiation doses (to patients) may cause erythema at 2 Gy, cataract at 2 Gy, permanent epilation at 7 Gy, and delayed skin necrosis at 12 Gy. Protracted (occupational) exposures to the eye may cause cataract at 4 Gy if the dose is received in less than 3 months, at 5.5 Gy if received over a period exceeding 3 months. Practical actions to control dose to the patient and to the staff are listed. The absorbed dose to the patient in the area of skin that receives the maximum dose is of priority concern. Each local clinical protocol should include, for each type of interventional procedure, a statement on the cumulative skin doses and skin sites associated with the various parts of the procedure. Interventionists should be trained to use information on skin dose and on practical techniques to control dose. Maximum cumulative absorbed doses that appear to approach or exceed 1 Gy (for procedures that may be repeated) or 3 Gy (for any procedure) should be recorded in the patient record, and there should be a patient follow-up procedure for such cases. Patients should be counselled if there is a significant risk of radiation-induced injury, and the patient's personal physician should be informed of the possibility of radiation effects. Training in radiological protection for patients and staff should be an integral part of the education for those using interventional techniques. All interventionists should audit and review the outcomes of their procedures for radiation injury. Risks and benefits, including radiation risks, should be taken into account when new interventional techniques are introduced.A concluding list of recommendations is given. Annexes list procedures, patient and staff doses, a sample local clinical protocol, dose quantities used, and a procurement checklist.

Adult↗
PubMed2004

[Analysis of variation in delivered dose in diagnostic and therapeutic cerebral angiography].

OBJECTIVES: Analysis of dose-area product (DAP) in cerebral angiography, according to the type of pathology and technique used. MATERIALS AND METHODS: Use of dosimetric and clinical data resulting from 84 diagnostic cerebral angiograms and 32 cerebral embolizations. RESULTS: The diagnostic angiography data were divided into three categories: A/ When a secondarily embolized aneurysm was diagnosed: n=17. B/ When the final diagnosis was an arteriovenous malformation (AVM): n=10. C/ In the case where the diagnosis was neither AVM, nor aneurysm to embolize: n=57. The cerebral embolizations were classified in two sub-groups: K/ When the embolization immediately followed the diagnostic angiogram: n=15. L/ When the embolization of the aneurysm took place 24 to 48H after the angiography: n=17. The mean DAP of group B containing the AVM is higher than mean DAP values in groups A and C, because of the increased cinegraphic time. There is a strong correlation between the duration of the fluoroscopy and the DAP (n=116; r=0.931; p<0.0001). Addition of runs in the group L contributes to the augmentation of the exposure time (significant difference in time: p=0.0054) and thus with the fact that DAP L>DAPK. CONCLUSION: Radiation dose during diagnostic cerebral angiography is increased in the presence of AVM. DAP of embolizations are higher when diagnostic and therapeutic phases are separated in time.

Adult↗
PubMed2000

Continuous hyperfractionated accelerated radiotherapy with/without mitomycin C in head and neck cancers.

BACKGROUND AND PURPOSE: Radiation therapy is often the primary treatment for advanced cases of head and neck cancers not considered suitable for radical surgery. In these cases locoregional tumour control rates are low and has warranted innovative treatment modifications, such as altered fractionation schedules and combination with chemotherapy. PATIENTS AND METHODS: From October 1990 to December 1997, 239 patients with squamous cell cancers originating in the head and neck region were randomized to one of three treatment options. Standard therapy consisting of conventional fractionation with 70 Gy in 7 weeks in 35 fractions (CF). The second treatment option consisted of a continuous hyperfractionated accelerated radiotherapy delivering a total dose of 55.3 Gy in 33 fractions over 17 consecutive days (V-CHART). The third study arm had identical fractionation and dose as the above accelerated treatment, with the additional administration of 20 mg/m(2) mitomycin C (MMC) on day 5 of treatment (V-CHART+MMC). RESULTS: Main toxicity resulted from accelerated fractionation in confluent mucositis (Grade 3-4 in 95%) requiring nasogastral tube feeding, analgetics and antiphlogistics in the majority of cases. Haematological toxicity Grade 3-4 was seen after MMC administration in 18%. MMC administration did not influence mucosal reaction. Overall duration of mucositis was not different in the three treatment groups. Loco-regional tumour control was 31% after CF, 32% after V-CHART and 48% after V-CHART+MMC, respectively (P<0.05). Overall crude survival was 24% after CF, 31% following V-CHART and 41% after V-CHART+MMC, respectively (P<0.05). Median follow up was 48 months (assessment performed in February 1999). CONCLUSION: Following shortening overall treatment time from 7 weeks to 17 consecutive days and dose of radiotherapy from 70 to 55.3 Gy the results in the radiotherapy only treated patients are identical. A significant improvement regarding local tumour control and survival was seen following administration of MMC to the accelerated fractionated treatment.

Adult↗
PubMed2001

Potent corticosteroid cream (mometasone furoate) significantly reduces acute radiation dermatitis: results from a double-blind, randomized study.

PURPOSE: Radiation-induced dermatitis is a very common side effect of radiation therapy, and may necessitate interruption of the therapy. There is a substantial lack of evidence-based treatments for this condition. The aim of this study was to investigate the effect of mometasone furoate cream (MMF) on radiation dermatitis in a prospective, double-blind, randomized study. MATERIAL AND METHODS: The study comprised 49 patients with node-negative breast cancer. They were operated on with sector resection and scheduled for postoperative radiotherapy using photons with identical radiation qualities and dosage to the breast parenchyma. The patients were randomized to receive either MMF or emollient cream. The cream was applied on the irradiated skin twice a week from the start of radiotherapy until the 12th fraction (24 Gy) and thereafter once daily until 3 weeks after completion of radiation. Both groups additionally received non-blinded emollient cream daily. The intensity of the acute radiation dermatitis was evaluated on a weekly basis regarding erythema and pigmentation, using a reflectance spectrophotometer together with visual scoring of the skin reactions. RESULTS: MMF in combination with emollient cream treatment significantly decreased acute radiation dermatitis (P=0.0033) compared with emollient cream alone. There was no significant difference in pigmentation between the two groups. CONCLUSIONS: Adding MMF, a potent topical corticosteroid, to an emollient cream is statistically significantly more effective than emollient cream alone in reducing acute radiation dermatitis.

Acute Disease↗
PubMed2001

Characterizing the phenomenon of radiation recall dermatitis.

Radiation recall represents the 'recalling' of an effect similar in appearance to that of an acute radiation reaction in a previously irradiated field. The recall is triggered by the administration of certain drugs days to years after the exposure to ionizing radiation. This review focuses almost exclusively on the skin manifestations of radiation recall to assemble the largest data base upon which to discuss this rare phenomenon. No absolute radiation dose threshold is apparent, but rather an interplay between dose and time before drug exposure seems to affect both the risk and speed of onset of recall. Recall usually occurs on first exposure to a particular recall-triggering drug. The skin reaction develops within minutes to days. The time to develop the reaction may be slightly longer for oral than intravenously administered drugs reflecting their bioavailability. Most drugs associated with recall are cytotoxics, but several other drugs may elicit the phenomenon. Individuals exposed to a number of potentially recall-triggering drugs reveal the marked drug specificity characteristic of the phenomenon. Skin reactions usually settle within a few days of stopping the triggering drug. The role of steroids or anti-histamines in affecting resolution is unclear. Drug rechallenge tends to produce either only a mild recurrence or no recurrence of recall. Steroids or dose reduction may favour uneventful rechallenge. A number of aetiological hypotheses on radiation recall exist. Using the available evidence these hypotheses are critically reviewed and a novel hypothesis based on radiation affecting local cutaneous immunological responses proposed.

Humans↗
PubMed1998

Do inflammatory processes contribute to radiation induced erythema observed in the skin of humans?

BACKGROUND: Two prospective trials were designed to determine whether there may be a role for inflammatory mediators in human skin erythema at both high and low doses per fraction and for 'out of field' effects. METHODS: Trial 1. Effects of topical indomethacin (1%) and hydrocortisone (1%) applied before and during radiotherapy were compared for erythema induced by 20 Gy in four fractions (n = 26, 6 MV). Trial 2. Effects of topical hydrocortisone (1 %) applied before and during radiotherapy and no medication were compared for erythema induced by 1, 3, 5 and 7 Gy in five fractions (n = 21, 120 kV). Erythema was measured using reflectance spectrophotometry (RFS) and laser Doppler (LD) on a weekly basis. RESULTS: Trial 1. A bi-phasic reaction time course was suggested in two-thirds of the cases. The first phase did not appear to be influenced by hydrocortisone cream but the second was significantly attenuated. Indomethacin had no effect on either reaction phase. Erythema measured several centimetres outside of the field was reduced by hydrocortisone but not by indomethacin. Trial 2. Trial 2 confirmed the presence of measurable erythema, invisible to the eye, that coincided in its time course to the first phase of erythema noted in trial 1. This reaction was more intense than predicted by the LQ formula and was non-significantly attenuated by topical hydrocortisone. RFS readings proved to be less subject to inter- and intra-patient variations than the LD unit used. CONCLUSION: Inflammatory responses may play a role in the mediation of the erythematous response to radiation in human skin. Further studies are warranted.

Aged↗