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PubMed1996

Radiation-induced skin injuries from fluoroscopy.

Since 1992, the U.S. Food and Drug Administration (FDA) has received reports of radiation-induced injuries to the skin in patients who had undergone fluoroscopically guided interventional procedures. The reports were investigated to determine the procedure- or equipment-related factors that may have contributed to the injury. The injuries ranged in severity from erythema to moist desquamation to tissue necrosis that required skin grafting. They occurred after a variety of interventional procedures that required extended periods of fluoroscopy compared with those of typical diagnostic procedures. Medical facilities and physicians should be aware of the magnitude of radiation doses to the skin that can result from the long exposure times required by complex interventional procedures. The FDA recommends several steps for reducing these injuries, including establishing protocols for each procedure, determining radiation dose rates for specific fluoroscopy systems and operating modes, and monitoring cumulative absorbed doses to areas of the skin.

Adult↗
PubMed2002

Minimizing radiation-induced skin injury in interventional radiology procedures.

Skin injury is a deterministic effect of radiation. Once a threshold dose has been exceeded, the severity of the radiation effect at any point on the skin increases with increasing dose. Peak skin dose is defined as the highest dose delivered to any portion of the patient's skin. Reducing peak skin dose can reduce the likelihood and type of skin injury. Unfortunately, peak skin dose is difficult to measure in real time, and most currently available fluoroscopic systems do not provide the operator with sufficient information to minimize skin dose. Measures that reduce total radiation dose will reduce peak skin dose, as well as dose to the operator and assistants. These measures include minimizing fluoroscopy time, the number of images obtained, and dose by controlling technical factors. Specific techniques-dose spreading and collimation-reduce both peak skin dose and the size of skin area subjected to peak skin dose. For optimum effect, real-time knowledge of skin-dose distribution is invaluable. A trained operator using well-maintained state-of-the art equipment can minimize peak skin dose in all fluoroscopically guided procedures.

Dose-Response Relationship, Radiation↗
PubMed1982

Prophylaxis of radiation dermatitis with a topical cortisone cream.

Nineteen cancer patients receiving radiation therapy to the head, neck, chest wall, or abdomen were evaluated in a double-blind study to determine the effectiveness of 0.2% hydrocortisone valerate vs. placebo in reducing acute radiation dermatitis. Patients applied hydrocortisone valerate to one-half of the irradiate area and the placebo to the other half beginning two weeks after the initiation of radiotherapy and continuing until three weeks after completion. Left and right sides were scored each week with respect to erythema, dry desquamation, moist desquamation, ulceration, and the duration and intensity of symptoms such as soreness, burning, and itching. No statistically significant difference was found between the 0.2% hydrocortisone valerate and the placebo in the acute skin response or the symptoms of radiation dermatitis. The patients were evaluated three months following radiotherapy for evidence of skin atrophy. There were no differences found between hydrocortisone valerate and the placebo with respect to the late effects of radiation therapy.

Administration, Topical↗
PubMed1999

Severe skin reactions from interventional fluoroscopy: case report and review of the literature.

Some patients with certain preexisting health conditions may be at elevated risk for unusually intense radiation-induced skin reactions and late tissue damage from high-dose interventional procedures. The authors present a case report of a patient with mixed connective tissue disease and non-insulin-dependent diabetes mellitus who developed an unusual complication after placement of a transjugular intrahepatic portosystemic shunt. On the basis of a review of the literature, the following experiences may help identify patients at increased risk: previous high-dose procedures, connective tissue disease, diabetes mellitus, and homozygosity for ataxia telangiectasia.

Diabetes Mellitus, Type 2↗
PubMed2001

Improvement of skin care during radiotherapy.

BACKGROUND: State-of-the-art radiotherapy, new insights into pharmacology and novel operating techniques require patient-oriented adaptation of care. PATIENTS AND METHOD: At the Radio-oncology Department of the Kaiser Franz Josef Spital, Vienna, a new skin care concept for patients undergoing radiotherapy was introduced in March 1999. This concept has subsequently been applied in all cases regardless of the diagnosis prompting referral (79 ENT, 305 breast, 134 prostate, 89 colorectal cancer and 751 other patients). Radiotherapy consisted of photon and/or electron radiation on the linear accelerator. The energy ranges were between 6 and 15 MV for photon therapy and between 6 and 12 MeV for electron radiation. Patients received an average total radiation dose of 50-66 Gy at single fractional doses of 1.8-2 Gy 5 times a week. Powdering of the skin was replaced by a moist skin care program. Patients were allowed to take cool whole-body showers without soap, including the irradiated skin areas, 3 times a week. RESULTS: With the new skin care program dryness of the skin and resultant allergic skin reactions became less common. Broken skin an epitheliolysis were clearly reduced and superinfections were prevented. CONCLUSION: Moist care of irradiated skin areas during radiotherapy thus improved radiation tolerance and patient acceptance.

Adult↗
PubMed2002

Radiation recall dermatitis from docetaxel.

BACKGROUND: Experiences with inflammatory skin reactions after treatment with docetaxel and prior exposure to radiotherapy like a recall phenomenon are very rare. We present the case of an uncommon and severe skin reaction after docetaxel application and prior radiotherapy. PATIENT AND METHODS: A 40-year-old female was treated with an upper body irradiation with electrons because of relapsed breast cancer. In addition, because of metastases of brain and bone she received radiotherapy on the whole brain and the left pelvis. One week after radiotherapy weekly chemotherapy with docetaxel was started. RESULTS: Radiotherapy was well tolerated. There was a cutaneous erythema RTOG grade 1. After second application of docetaxel the patient developed a severe skin erythema, after fourth application confluent desquamations exactly demarcated the previously irradiated skin area. After discontinuation of docetaxel and after antiinflammatory treatment the skin reactions improved rapidly. CONCLUSION: In our opinion the severe skin reaction was clearly associated with the application of docetaxel like a recall phenomenon after previous radiotherapy. In case of severe skin reaction after this therapy it is important to know the possibility of recall phenomenon.

Adult↗
PubMedDate not supplied

Platelet-activating factor antagonist WEB 2086 inhibits ultraviolet-B radiation-induced dermatitis in the human skin.

It has been suggested that platelet-activating factor (PAF) plays a role in the pathomechanisms of various inflammatory diseases. In an experimental animal model we demonstrated earlier that a selective PAF receptor antagonist gel inhibits ultraviolet-B (UVB) light-induced edema in mouse ears. The goal of our present investigation was to determine whether locally applied WEB 2086, a selective PAF receptor antagonist, alters the dermatitis-causing effect of UVB light on human skin. We induced dermatitis in healthy volunteers by irradiating their skin with UVB light in increasing doses. The irradiated area was treated with WEB 2086 gel (3%) or with a placebo. Erythema was measured spectrophotometrically after 24 and 48 h. After both 24 and 48 h, the WEB 2086 gel significantly inhibited the UVB light-induced erythema at each radiation dose in comparison with the placebo. The PAF antagonist gel therefore proved to be effective against UVB-induced dermatitis. Our results may help to understand the relative importance of mediators in UVB-induced dermatitis and might perhaps pave the way to better therapeutic modalities in this condition.

Adult↗
PubMed2004

Cytogenetic damage in lymphocytes for the purpose of dose reconstruction: a review of three recent radiation accidents.

The analysis of chromosomal aberrations in peripheral blood of radiation accident victims is an established method of biological dosimetry. The dose estimate on the basis of an in vitro calibration curve is straightforward when the radiation exposure is homogeneous and the analysis not delayed. In recent years three radiation accidents occurred, where the irradiation or sampling conditions precluded a simple estimation of the dose. During the Georgian accident soldiers carried in their pockets small sources of 137Cs leading to partial and protracted body exposures. During the Tokai-mura accident, three employees involved in the process of 235U enrichment were exposed to very high doses of gamma rays and neutrons. During the Bialystok accident, five patients with breast cancer undergoing radiotherapy were exposed to a single dose of electrons which reached about 100 Gy. In the present paper the approaches chosen to estimate, by cytogenetic methods, the doses absorbed by the people involved in the accidents are described.

Breast Neoplasms↗
PubMed2005

Frequency of radiation recall dermatitis in adult cancer patients.

BACKGROUND: The re-occurrence of an inflammatory skin reaction which is limited to previously irradiated areas after the administration of a promoting agent is called radiation recall dermatitis. Despite a number of case reports no systematic analysis about the frequency of the phenomenon exists. Therefore we performed an observation study in order to obtain information about this phenomenon in clinical practice. PATIENTS AND METHODS: 142 patients who underwent palliative radiotherapy were included in the study. The skin reaction at the day of completion of radiotherapy was documented and the patients were followed until cytotoxic chemotherapy was administered or at least 6 months. RESULTS: 91 patients received different types of chemotherapy. In 8 patients a radiation recall dermatitis was observed, corresponding to a frequency of 8.8%. The radiation skin reactions occurred within 6 weeks after the completion of radiotherapy which corresponded to the time-period most of the chemotherapies were applied in. The grade of observed radiation recall dermatitis ranged from a mild erythema to a severe exfoliative dermatitis. CONCLUSION: The radiation recall dermatitis is a reaction of moderate frequency among adult cancer patients. Its possible severity as well as consecutive therapeutic consequences argue for its consideration in clinical settings.

Adult↗