Management of ‘In-Field' Skin Toxicity in Head and Neck Cancer Patients Treated with Combined Cetuximab and Radiotherapy

Cante, Domenico; Porta, Maria Rosa La; Franco, Pierfrancesco; Sciacero, Piera; Girelli, G.; Marra, Annamaria; Numico, Gianmauro; Denaro, Nerina; Russi, Elvio; Ricardi, Umberto

doi:10.1159/000355579

Cited by 11 publications

(8 citation statements)

References 33 publications

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“…Patients affected with HNC are frequently treated with multimodality treatment and thus can develop a wide range of acute and late side effects and long-term sequelae [3,[15][16][17][18]. The occurrence of OM in HNC patients treated with RT and/or CT is an extremely frequent finding with consistent clinical meaningfulness [7].…”

Section: Discussionmentioning

confidence: 99%

Prospective assessment of oral mucositis and its impact on quality of life and patient-reported outcomes during radiotherapy for head and neck cancer

et al. 2017

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Oral mucositis (OM) is a common acute side effect during radiotherapy treatments for head and neck cancer (HNC), with a potential impact on patient's compliance to therapy, quality of life (QoL) and clinical outcomes. Its timely and appropriate management is of paramount importance. Several quantitative scoring scales are available to properly assess OM and its influence on patient-reported outcomes (PROs) and QoL. We prospectively assessed OM in a cohort of HNC patients submitted to radiation using the Oral Mucositis Assessment Scale (OMAS), while its impact on PROs and QoL was evaluated employing the Oral Mucositis Weekly Questionnaire-Head and Neck Cancer (OMWQ-HN) and the Functional Assessment of Cancer Therapy-Head and Neck Cancer (FACT-HN). Evaluation of OMAS scores highlighted a progressive increase in OM during treatment and a partial recovery after the end of radiation. These trends were correlated to PROs and QoL as evaluated with OMWQ-HN and FACT-HN questionnaires. In the present study, we provided a quantitative assessment of OM, PROs and QoL in HNC patient undergoing radiotherapy, potentially useful for future comparison.

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Section: Discussionmentioning

confidence: 99%

Prospective assessment of oral mucositis and its impact on quality of life and patient-reported outcomes during radiotherapy for head and neck cancer

et al. 2017

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“…It was suggested that existing grading tools need a strong revision and a new grading system was proposed 49,50. Currently, an international group of experts proposed a new classification that considers the CTCAE recommendations regarding the activities of daily living to assess acute bioradiation dermatitis 51.…”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

Chronic radiation-induced dermatitis: challenges and solutions

Spałek

2016

CCID

117

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Chronic radiation dermatitis is a late side effect of skin irradiation, which may deteriorate patients’ quality of life. There is a lack of precise data about its incidence; however, several risk factors may predispose to the development of this condition. It includes radiotherapy dose, fractionation, technique, concurrent systemic therapy, comorbidities, and personal and genetic factors. Chronic radiation dermatitis is mostly caused by the imbalance of proinflammatory and profibrotic cytokines. Clinical manifestation includes changes in skin appearance, wounds, ulcerations, necrosis, fibrosis, and secondary cancers. The most severe complication of irradiation is extensive radiation-induced fibrosis (RIF). RIF can manifest in many ways, such as skin induration and retraction, lymphedema or restriction of joint motion. Diagnosis of chronic radiation dermatitis is usually made by clinical examination. In case of unclear clinical manifestation, a biopsy and histopathological examination are recommended to exclude secondary malignancy. The most effective prophylaxis of chronic radiation dermatitis is the use of proper radiation therapy techniques to avoid unnecessary irradiation of healthy skin. Treatment of chronic radiation dermatitis is demanding. The majority of the interventions are based only on clinical practice. Telangiectasia may be treated with pulse dye laser therapy. Chronic postirradiation wounds need special dressings. In case of necrosis or severe ulceration, surgical intervention may be considered. Management of RIF should be complex. Available methods are rehabilitative care, pharmacotherapy, hyperbaric oxygen therapy, and laser therapy. Future challenges include the assessment of late skin toxicity in modern irradiation techniques. Special attention should be paid on genomics and radiomics that allow scientists and clinicians to select patients who are at risk of the development of chronic radiation dermatitis. Novel treatment methods and clinical trials are strongly needed to provide more efficacious therapies.

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“…42,43 The CTCAEv4.0 classification published in May 2009 did not include a term specifically referring to the "in-field toxicity" induced by concomitant cetuximab treatment and radiotherapy among 3057 adverse effect terms drawn from the 67,159 MedDRAv.12 lowest level terms. [44][45][46] Indeed, CTCAEv4.0 considered only the lowest level terms "radiation dermatitis," which is categorized in the SOC "Injury, poisoning and procedural complications. "…”

Section: Management Of Skin Reactionsmentioning

confidence: 99%

“…When systemic impairment is suspected, evaluate the patient for the presence of systemic inflammatory response syndrome. 45,51 If systemic inflammatory response syndrome is present and infection is suspected, a culture should always be obtained before starting antibiotic therapy.…”

Section: Management Of Skin Reactionsmentioning

confidence: 99%

Management of Skin Reactions During Cetuximab Treatment in Association With Chemotherapy or Radiotherapy

Pinto¹,

Barone

Girolomoni

et al. 2016

American Journal of Clinical Oncology

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Management of ‘In-Field' Skin Toxicity in Head and Neck Cancer Patients Treated with Combined Cetuximab and Radiotherapy

Cited by 11 publications

References 33 publications

Prospective assessment of oral mucositis and its impact on quality of life and patient-reported outcomes during radiotherapy for head and neck cancer

Prospective assessment of oral mucositis and its impact on quality of life and patient-reported outcomes during radiotherapy for head and neck cancer

Chronic radiation-induced dermatitis: challenges and solutions

Management of Skin Reactions During Cetuximab Treatment in Association With Chemotherapy or Radiotherapy

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