Is there agreement between evaluators that used two scoring systems to measure acute radiation dermatitis?

Abstract

To analyze the agreement between the nurses evaluating radiodermatitis that used the Radiation Therapy Oncology Group (RTOG) and the World Health Organization (WHO) scales. A prospective and longitudinal study conducted in 2016 to 2017, in a university hospital. We analyzed 855 images of irradiated sites of 100 breast cancer women during radiotherapy. In order to evaluate the agreement between 3 observers that evaluated theses irradiated sites Krippendorff's alpha and weighted kappa were obtained and analyzed. The pairwise agreement among the evaluators was fair and moderate (RTOG scale: 0.408, 95% confidence interval, CI 0.370–0.431; WHO scale: 0.559, 95% CI 0.529–0.590). In addition, the general agreement rates were 10.2% and 29.2%, respectively. When assessing the overall absolute agreement between the evaluators according with different phototypes and types of surgery, there was a fair agreement according to the RTOG scale when evaluating patients with phototype V or VI and mastectomy (3.7% and 8.8%, respectively). The RTOG and WHO scales should be used with caution in clinical practice to identify the prevalence of radiodermatitis and the severity. Another point of caution is that skin phototype and the type of surgery may influence the analysis outcome. An illustrative scale was designed and proposed, by our group, aiming to improve accuracy and agreement between evaluators that will be tested in subsequent clinical studies.

Objective Evaluation of Risk Factors for Radiation Dermatitis in Whole-Breast Irradiation Using the Spectrophotometric L*a*b Color-Space

“…Owing to the simple and quick application, these subjective gradings are widely accepted. However, such visual assessments were shown to be prone to considerable biases due to substantial intra- and inter-evaluator differences [ 6 , 9 , 11 , 16 , 17 ]. Especially when it comes to evaluating new therapeutic strategies for RID or the combination of radiotherapy with novel immunomodulatory agents, even minimal dermatitis differences are of interest, which in turn renders objective and precise assessments indispensable [ 11 ].…”

“…Despite the frequency of radiation dermatitis in WBI patients, there is still no comprehensive and, importantly, objective severity classification. Two of the most widely used severity gradings are the Common Terminology Criteria of Adverse Events (CTCAE) and RTOG/EORTC systems which are based on the visible skin color and integrity defined by erythema and desquamation [ 9 ]. These gradings are both easy to use and mostly sufficient for daily clinical routines.…”

“…These gradings are both easy to use and mostly sufficient for daily clinical routines. However, considerable and significant intra- and inter-observer variabilities of such subjective RID gradings have been reported and it is therefore quite challenging to compare or rather interpret data obtained throughout different studies [ 9 , 10 ]. Consequently, objective and semiquantitative measurements are needed, particularly in the context of clinical RID research, in which even minimal differences are critical [ 9 , 11 ].…”

A protective effect of morning radiotherapy on acute skin toxicity in patients with breast cancer

“…The photos that could not be agreed upon by the 3 expert professionals were reviewed and a final consensus was reached. [ 16 ]…”

Quantitative assessment of radiodermatitis through a non‑invasive objective procedure in patients with breast cancer

“…In this study, we used noninvasive instruments to objectively assess the patients' skin condition objectively. Conversely, Fuzissaki et al used the Radiation Therapy Oncology Group and the World Health Organization scale together, whereas Partl et al employed the application of a new image-analysis tool (20,21). These methods can help to assess a patient's skin without inter-observer variability.…”