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Early and late radiation-induced skin alterations. Part II: Nursing care of irradiated skin.

Teaching patients how to care for irradiated skin during and after a course of radiation therapy is a major concern of oncology nurses. Part I of this two-part article (ONF 19(5):801-807) focused on the mechanisms of skin injury. Many topical preparations are available for skin care. When these substances are applied, both the active ingredient and the vehicle must be appropriate for the condition being treated. Preparations may be applied to the skin as liquids (e.g., lotions, solutions, tinctures used in wet dressings, soaks, baths) or solids (e.g., powders, creams, ointments). As skin reaction progresses during a course of radiation therapy, recommendations for skin care will change. Healing of injury occurs in three stages: inflammation, proliferation, and maturation. Wound healing proceeds more rapidly in a moist environment, and a variety of occlusive dressings can be used with moist desquamation.

Dermatologic Agents↗

Efficiency of topical imiquimod 5% cream in the management of chronic radiation dermatitis with multiple neoplasias.

The immune response modifier imiquimod 5% cream (Aldara) was locally applied to an extensive thoracic chronic radiation dermatitis for 2 weeks on a once daily basis. After moderate to severe irritative reactions with erythema and crusted erosions, areas cleared up within 4 weeks. The patient has now been in complete remission for 2 years.

Administration, Topical↗

Skin eruptions following treatment with Iodine-131 for hyperthyroidism: a rare and un-reported early/intermediate side effect.

BACKGROUND: Iodine-131 ((131)I) is a well-established method for the treatment of hyperthyroidism. Following such therapy, patients may experience symptoms relating to early or delayed side effects that can be prevented or minimized if necessary measures are taken. We have noticed an unusual side effect of (131)I therapy in the form of a skin eruption (iododerma) and aimed at assessing the frequency and severity of this side effect. MATERIAL AND METHODS: Retrospective review of 141 patients treated with (131)I between January 1994 to December 2000 (86 F, 55 M; mean age 41.35 +/- 11.02 years) was performed. The dose of (131)I ranged from 250-500 MBq. Post therapy clinical and biochemical evaluation of thyroid function was done at 6 weeks, 3, 6, and 9 months then annually. RESULTS: Of the 141 treated patients, 3 patients (2.1%) presented with iododerma 4-6 weeks after (131)I therapy administration. Lesions were observed at both ankles & lower legs in all 3 cases. All lesions disappeared within 6 months with no residual effect. No other skin lesions were seen thereafter during the follow-up period. CONCLUSION: Iododerma is a rare complication of (131)I therapy that has not been reported before. It appears within 4-6 weeks after therapy and is a self-limiting condition.

Adult↗

Histological examination in assessment of ultraviolet-induced suppression of contact hypersensitivity response.

The evaluation of contact hypersensitivity (CHS) reaction is one of the methods used in the assessment of the immune status of an organism after UV radiation. The aim of the study was to compare usefulness of visual scoring system and histological morphometry in the assessment of CHS response after exposure of humans to solar simulated radiation (SSR). The study included 140 healthy volunteers, 33 people were irradiated for 2 days, 34 - for 10 days and 33 - for 30 days with SSR. Forty non-irradiated individuals served as controls. All the volunteers were sensitized with diphenylocyclopropenone (DPCP) 24 h after final exposure. Statistical analysis comparing intensity of CHS reaction based on visual score between irradiated groups and non-irradiated group revealed no differences (p>0.05). We found a significant difference in epidermal thickness between healthy skin and irradiated groups (p<0.05) and a positive correlation between intensity of spongiosis and clinical score for CHS response at 3.2 DPCP site (p<0.000001). A negative correlation between time of irradiation and spongiosis score was revealed (R=-0.28; p<0.001). We conclude that histological examination of biopsies taken from one of the series of elicitation sites is a reliable and sensitive method in the evaluation of CHS response after UVR.

Adult↗

Acute effects of postmastectomy radiotherapy after immediate TRAM flap reconstruction in breast cancer patients.

OBJECTIVES: To study the acute effects of radiotherapy after mastectomy and immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction in breast cancer patients treated at Ramathibodi Hospital. MATERIAL AND METHOD: Between January 2004 and March 2005, ten breast cancer patients (age 32-51 years) were treated with postoperative radiotherapy after mastectomy and immediate TRAM flap reconstruction. Medical records of these patients were retrospectively reviewed. Radiotherapy was delivered to the chest wall and reconstructed TRAM flap using 6-MV x-ray or Cobalt-60. The total dose was 45 to 50.4 Gy delivered in 25 to 28 fractions. Patients were evaluated weekly during the course of radiation and then at 1 and 2 months after treatment completion to determine acute effects or toxicities of radiation. RESULTS: During radiation, 3 patients developed erythema or mild hyperpigmentation of the skin, and 4 developed moderate hyperpigmentation. Three patients who were treated with Cobalt-60 and/or bolus to the chest wall developed skin desquamation (1 dry desquamation, 2 moist desquamation). No patient required a treatment break because of acute side effects. One patient who received chemotherapy after radiation developed recalled moist desquamation. CONCLUSION: Radiotherapy after mastectomy and immediate TRAM flap reconstruction is well tolerated and is not associated with increased acute complication or radiation interruption. The authors have noticed that chemotherapy given after radiation was related to severe skin reaction, so it should be used with caution.

Acute Disease↗

Gemcitabine-induced rectus abdominus radiation recall.

CONTEXT: Radiation recall has been described in the context of gemcitabine chemotherapy. However, this phenomenon has been largely limited to skin. CASE REPORT: We hereby report a case of radiation recall dermatitis and myositis occurring on gemcitabine monotherapy, five months after completing chemoradiation for locally advanced pancreatic cancer. Radiation recall resolved spontaneously with withdrawal of gemcitabine. CONCLUSIONS: This is the second case report that describes gemcitabine-induced radiation recall in rectus abdominus muscles after gemcitabine-based radiation therapy. Given the wide use of gemcitabine following chemoradiation for pancreatic cancer, providers should be aware of this potential complication.

Abdominal Muscles↗

[Concurrent chemoradiotherapy (CRT) with S-1 and cisplatin (CDDP) in patients (pts) with locally advanced head and neck cancer (HNC)].

The standard care for unresectable locally advanced head and neck cancer (HNC) is concurrent chemoradiotherapy (CRT). Although there is no standard regimen of CRT, a platinum-based regimen has shown a better survival benefit than other regimens. The control arm in a randomized trial for unresectable locally advanced HNC is radiotherapy concurrent with CDDP (100 mg/m2, every 3 weeks), which has been considered to be too toxic for clinical practice in Western countries and has required frequent dose modifications. Because the Japanese also have been considered unable to tolerate this regimen, no prospective study of it has been conducted in Japan. Most Japanese patients with locally advanced head and neck cancer have received concurrent chemoradiotherapy with 5-FU and CDDP (70-80 mg/m2). S-1 has shown high activity in HNC with a response rate of 34%. Furthermore, a combination of cisplatin and S-1 therapy for HNC has been reported to have good efficacy. With this rationale in mind, we conducted a phase I study of CRT with S-1 and CDDP for unresectable locally advanced squamous cell carcinoma of the head and neck. The CR rate was very promising, though preliminary, and warrants further investigation. The Japan Clinical Oncology Group (JCOG) is planning a multicenter phase II study of concurrent chemoradiotherapy with S-1 and CDDP for locally advanced unresectable HNC.

Adult↗

[Ultrastructure of human normal and pathological reassembled collagen fibers].

It is possible, in vitro, to break down human skin then reassemble the collagen fibres of the dermis, essentially type I collagen. The authors have developed a biophysical process for the manufacture of type I autocollagen. They present the electron microscopic study of this collagen. These healthy collagen fibres are compared with the fibres obtained from radiation dermatitis skin and keloid scars. Major ultrastructural differences are demonstrated.

Cicatrix↗

[Anastomosis of free flaps to the inferior epigastric artery].

The inferior epigastric vessels are a reliable and easily accessible vascular pedicle for free tissue transplantation to the perineum, genital area, and the abdominal wall. Two cases serve to illustrate the procedure: the first involves a post-radiation ulcer following recurring carcinoma of the vulva with loss of the symphysis; the second involves a reconstruction of the abdominal wall employing a two-fold latissimus dorsi flap in a patient with malignant fibrous histiocytoma.

Abdominal Muscles↗

Clinical features and comprehensive treatment of late stage radiation skin injuries.

105 patients with late stage radiation skin injury were treated from 1970 to 1986, using drugs combined with surgical intervention according to the clinical features of the injury. Drug therapy consisted of topical application of urea, antibiotics, trypsin and elastase, and systematic use of alpha 2-Macroglobulin. Of 62 patients receiving medication, 55 (88.7%) were completely or basically treated and 7 failed. Of 51 lesions of 43 patients receiving surgical treatment, 47 healed by first intention. In 4 patients, necrosis of partial and/or peripheral skin flaps healed after renewed repair.

Adolescent↗