According to the guidelines on cancer treatment up to 52% of newly diagnosed cancer patients should be treated with external beam radiotherapy. Ionizing radiation (IR)-induced skin injury (radiation dermatitis) occurs in up to 95% of radiotherapy patients and can manifest from mild erythema till necrosis and ulceration. Individual radiosensitivity was proposed to be an important factor for the development of adverse reactions to IR. Therefore, assessment of radiosensitivity could be useful in predicting and dealing with radiation injuries caused by both radiotherapy and accidental overexposure. Here, we present a case of early diagnosis of IR-induced skin lesions performed by reflectance confocal microscopy in comparison to clinical evaluation in a highly radiosensitive patient.

Background: During radiotherapy (RT), most breast cancer patients experience ionizing radiation (IR)-induced skin injury—acute radiation dermatitis (ARD). The severity of ARD is determined by a physician according to CTCAE or RTOG scales, which are subjective. Reflectance confocal microscopy (RCM) is a noninvasive skin imaging technique offering cellular resolution. Digital dermoscopy (DD) performed in conjugation with RCM can provide more information regarding skin toxicity. The purpose of this study is to create an RCM and DD features-based ARD assessment scale, to assess the association with CTCAE scale and possible predictive value. Methods: One hundred and three breast cancer patients during RT were recruited; every week, clinical symptoms of ARD (CTCAE scale) were evaluated and RCM, together with digital dermoscopy (DD), was performed. Results: According to RCM; after 2 RT weeks, exocytosis and/or spongiosis were present in 94% of patients; after 3 weeks, mild contrast cells (MMCs) were detected in 45%; disarrayed epidermis (DE) was present in 66% of patients after 4 weeks and in 93% after 5 weeks; abnormal dermal papillae (ADP) were present in 68% of patients after 5 weeks. The coefficients of RCM features (RCMcoef) alone and together with dermoscopically determined erythema (RCM-ERYcoef) were significantly associated with ARD severity grade. RCMcoef is a significant predictive factor for the clinical manifestation of ARD. Conclusions: RCM features of irradiated skin appear earlier than clinical symptoms, have a characteristic course, and allow the severity of ARD to be predicted.

Introduction. Prostate cancer (PC) is the most common oncologic disease among men. The number of patients with recurrent PC after primary radiotherapy is increasing, unfortunately, criteria for the choice among different treatment methods for these patients have not been defined yet. Salvage treatment options include prostatectomy, brachytherapy (BT), cryotherapy, thermoablation, and high frequency ultrasound. The lack of long-term evaluation of the toxicity and influence on the survival of patients after salvage high-dose-rate (HDR) BT is an important problem when considering this treatment option. In this study we have analyzed the treatment results of twelve patients who were diagnosed with local recurrent prostate cancer after primary radiotherapy and then treated with HDR BT. Materials and methods. Patients were treated with salvage HDR BT between January 2013 and February 2014 at the Institute of Oncology, Vilnius University Results. Average age of the patients at the time of salvage treatment was 67.5 years (min 54 years, max 76 years). The PSA value at the salvage treatment was from 2.06 ng/ml to 9.20 ng/ml. The time from the initial diagnosis till the salvage treatment was from 33 months to 134 months. All 24 procedures were successful and without any early complications. Conclusions. HDR BT is a presumable and safe treatment option for local prostate cancer recurrence after primary radiotherapy. Prospective clinical trial is initiated to evaluate survival, long-term toxicity and predictive value of different biomarkers.

Background: Up to 95% of irradiated patients suffer from ionizing radiation (IR) induced early skin reaction, acute radiation dermatitis (ARD). Some experts think that additional skin hydration can reduce acute skin reactions. Individual radiosensitivity (IRS) determined from lymphocytes may help to predict acute radiation toxicity. The purpose of this study is to evaluate the clinical manifestation of ARD in different skincare groups during whole breast radiotherapy depending on IRS and other risk factors. Methods: A total of 108 early-stage breast cancer patients were randomized into best supportive care (BSC) and additional skincare (ASC) groups. IRS was evaluated using a G2 assay modified with caffeine-induced G2 checkpoint arrest. All patients received a 50 Gy dose to the breast planning target volume (PTV). Clinical assessment of ARD symptoms according to the CTCAE grading scale was performed once a week. Results: IRS was successfully determined for 91 out of 108 patients. A total of 10 patients (11%) had normal IRS, 47 patients (52%) were categorized as radiosensitive, and 34 (37%) as highly radiosensitive. There was no significant difference in the manifestation of ARD between patient groups by skincare or IRS. According to logistic regression, patients with bigger breasts were prone to more severe ARD (p = 0.002). Conclusions: The additional skincare did not improve skin condition during RT. A total of 89% of patients had increased radiosensitivity. IRS determined before RT did not show the predictive value for the manifestation of ARD. Logistic regression revealed that breast volume was the most significant risk factor for the manifestation of ARD.