Acute Radiation Dermatitis Evaluation with Reflectance Confocal Microscopy: A Prospective Study

Abstract

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.

Understanding the Importance of Daily Imaging in the Treatment of Non-Melanoma Skin Cancer with Image Guided Superficial Radiation Therapy

“…A meta-analysis compared the cure rates of radiotherapy modalities with (IGSRT) and without (XRT and SRT) image guidance. IGSRT's real-time adaptive use imaging prior to every dose led to superior cure rates (local control) when compared to XRT and SRT without imaging [20]. This study demonstrates, the connection between image guidance and high rates of efficacy.…”

“…More studies are necessary to better understand ARD, as well as the precise mechanisms of NMSC tumor depth fluctuations and repopulation. This is challenging because ARD is rarely biopsied, mostly due to concerns about wound healing during RT (radiation therapy) [20].…”