Acute radiodermatitis in cancer patients: incidence and severity estimates

To estimate the incidence and distribution of the degree of radiodermatitis in cancer patients submitted to radiotherapy in the regions of head and neck, breast, and pelvis.

Method:

Prospective, longitudinal, quantitative study conducted from March 15, 2016 to May 4, 2017 with patients observed for five weeks of treatment. The primary outcome was the proportion of grade 1 or higher radiodermatitis each week. The degree of radiodermatitis and mean time of occurrence for each patient were secondary outcomes.

Results:

This study included 112 patients. The incidence of radiodermatitis was 100% among those whose head and neck region was irradiated, followed by 98% for breast and 48% for the pelvic region. The degree of radiodermatitis varied with the irradiated site; the worst degrees were found in the head and neck region, followed by the breast. In the three groups, the mean time of the first occurrence of radiodermatitis was approximately eleven days.

Conclusion:

The incidence of radiodermatitis in the studied groups was high, which reinforces the need to perform the same evaluation nationwide. This would support creating and standardizing protocols and recommendations for a proper management of radiodermatitis, specially concerning its prevention.

Radiodermatitis; Head and Neck Neoplasms; Breast Neoplasms; Pelvic Neoplasms; Oncology Nursing

Sociodemographic and Clinical Characteristics	HN	Breast	Pelvis
Sociodemographic and Clinical Characteristics	(n = 31)	(n = 50)	(n=31)
Age (years), mean (standard deviation)	58.8 (14.5)	53.0 (13.4)	62.4 (11.0)
Median (min, max)	59 (22.83)	52 (26.84)	65 (39.79)
Gender, n (%)
Male	21 (68)	1 (2)	23 (74)
Female	10 (32)	49 (98)	8 (26)
BMI categories, n (%)
Obese (BMI ≥ 30 kg/m²)	-	20 (40)	-
Overweight (BMI > 25 and < 29.9 Kg/m²)	-	18 (36)	-
Normal Weight (BMI >18.5 and < 24.9 Kg/m²)	-	11 (22)	-
Underweight (BMI < 18.5 Kg/m²)	-	1 (2)	-
Color
White	21 (68)	21 (42)	10 (32)
Brown	9 (29)	24 (48)	5 (16)
Black	1 (3)	5 (10)	16 (52)
Educational level
Illiterate	2 (6)	4 (8)	2 (7)
Primary	19 (62)	14 (28)	16 (52)
Secondary	9 (27)	27 (54)	9 (29)
Superior	1 (3)	5 (10)	4 (13)
Smoking status
Smoker	2 (6)	4 (8)	5 (16)
Former smoker	25 (81)	16 (32)	14 (45)
Never smoked	4 (13)	30 (60)	12 (39)
Drinking status
Drinker	3 (10)	17 (34)	12 (39)
Former drinker	23 (74)	2 (4)	10 (32)
Never drank	5 (16)	31 (62)	9 (29)
Presence of diabetes, n (%)	5 (16)	10 (20)	6 (19)
Daily sun exposure, yes, n (%)	24 (77)	0 (0)	4 (13)
Performance Status (PS)
Normal activity (PS 0)	29 (94)	43 (86)	28 (90)
Presence of disease symptoms, but able to ambulate and lead a normal routine (PS 1)	2 (6)	7 (14)	3 (10)

Degree of Radiodermatitis		Number of patients with radiodermatitis
Degree of Radiodermatitis		W1	W2	W3	W4	W5
n		31	31	31	31	31
0	No change	20	10	2	1	2
1	Faint or dull erythema	10	19	13	4	0
1.5	Bright erythema	1	2	14	15	8
2	Dry desquamation with or without erythema	0	0	2	10	19
2.5	Small to moderate amount of moist desquamation	0	0	0	1	1
3	Confluent moist desquamation	0	0	0	0	1
Proportion of patients with grade 1 or higher (95% Confidence Interval)		0.36 (0.20; 0.52)	0.67 (0.51; 0.83)	0.92 (0.83; 0.99)	0.95 (0.88; 1)	0.92 (0.83; 0.99)

Degree of Radiodermatitis		Week (%)
Degree of Radiodermatitis		W1	W2	W3	W4	W5
n		50	50	48	43	32
0	No change	42	17	5	1	1
1	Faint or dull erythema	8	30	29	14	4
1.5	Bright erythema	0	3	12	18	11
2	Dry desquamation with or without erythema	0	0	0	6	10
2.5	Small to moderate amount of moist desquamation	0	0	1	4	6
3	Confluent moist desquamation	0	0	1	0	0
Proportion of patients with grade 1 or higher (95% Confidence Interval)		0.17 (0.07; 0.27)	0.66 (0.53; 0.78)	0.89 (0.80; 0.97)	0.97 (0.91; 1)	0.95 (0.88; 1)

Degree of Radiodermatitis		Week (%)
Degree of Radiodermatitis		W1	W2	W3	W4	W5
n		31	31	31	28	26
0	No change	29	28	27	21	20
1	Faint or dull erythema	1	1	2	4	5
1.5	Bright erythema	0	0	1	2	0
2	Dry desquamation with or without erythema	0	0	0	0	0
2.5	Small to moderate amount of moist desquamation	1	2	1	1	1
Proportion of patients with grade 1 or higher (95% Confidence Interval)		0.08 (0.01; 0.17)	0.11 (0.02; 0.22)	0.14 (0.03; 0.26)	0.26 (0.11; 0.42)	0.24 (0.09; 0.40)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Paula Elaine Diniz dos Reis Laboratório Interdisciplinar de Oncologia, Faculdade de Ciências da Saúde, Universidade de Brasília Campus Darcy Ribeiro, Asa Norte CEP 70910-900 - Brasília, DF, Brazil pauladiniz@unb.br

Brasil

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Acute radiodermatitis in cancer patients: incidence and severity estimates* * Extracted from the dissertation: “Ocorrência de radiodermatite em pacientes com câncer em um hospital de ensino de Brasília”, Programa de Pós-Graduação em Enfermagem, Universidade de Brasília, 2017.

Radiodermatitis aguda en pacientes con cáncer: estimación de la incidencia y la severidad

ABSTRACT

Objective:

Method:

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Conclusion:

Acute radiodermatitis in cancer patients: incidence and severity estimates^* * Extracted from the dissertation: “Ocorrência de radiodermatite em pacientes com câncer em um hospital de ensino de Brasília”, Programa de Pós-Graduação em Enfermagem, Universidade de Brasília, 2017.