Non-invasive quantitative measures of qualitative grading effectiveness as the indices of acute radiation dermatitis in breast cancer patients

Abstract

Background Recent improvement of machinery evaluation for the skin changes in various therapies enabled us to evaluate fine changes quantitatively. In this study, we performed evaluation of the changes in radiation dermatitis (RD) using quantitative and qualitative methods, and verified the validity of the conventional qualitative assessment for clinical use. Methods Forty-three breast cancer patients received conventional fractionated radiotherapy to whole breast after breastconserving surgery. Erythema, pigmentation and skin dryness were evaluated qualitatively, and biophysical parameters of RD were measured using a Multi-Display Device MDD4 with a Corneometer for capacitance, a Tewameter for transepidermal water loss (TEWL), a Mexameter for erythema index and melanin index. Measurements were performed periodically until 1 year. Results The quantitative manifestations developed serially from skin erythema followed by dryness and pigmentation. Quantitative measurements detected the effects of irradiation earlier than that of qualitative indices. However, the grades of the domains in RD by qualitative and quantitative assessment showed similar time courses and peak periods. However, no significant correlation was observed between the skin dryness grade and skin barrier function. In contrast to serial increase in pigmentation grades, melanin index showed initial decrease followed by marked increase with significant correlation with pigmentation grades. Conclusion Subjectively and objectively measured results of RD were almost similar course and peak points through the study. Therefore, validity of the conventional qualitative scoring for RD is confirmed by the present quantitative assessments. Instrumental evaluations revealed the presence of modest inflammatory changes before radiotherapy and long-lasting skin dryness, suggesting indication of intervention for RD.

Effect of standard skin care treatments on skin barrier function in X-irradiated hairless mice

“…A multi-center clinical study of RT patients with breast cancer has revealed that the TEWL ratio (irradiated side breast/non-irradiated side breast) decreased from the second week of RT ( P ​< ​0.01). 7 Given these facts, the association between changes in TEWL and the development of RD has not been fully elucidated experimentally and clinically.…”

“… 6 In addition to TEWL, other indices such as skin hydration, melanin index, erythema index, and skin temperature are also used to evaluate skin barrier function. 7 In fact, it has been reported that TEWL in the lesions of patients with psoriasis and atopic dermatitis is significantly higher than in healthy individuals, and that skin temperature in the lesions of patients with atopic dermatitis is significantly higher than in healthy individuals. 8 Furthermore, the patients treated with RT for breast cancer have decreased skin water content 9 , 10 and sebum content.…”

Quantitative assessments of late radiation-induced skin and soft tissue toxicity and correlation with RTOG scales and biological equivalent dose in breast cancer

“…Thus, several studies have attempted to measure RIT using quantitative methods (Table 2). Numerous techniques have been developed to objectively assess RIT via the measurement of associated skin characteristics, including ultrasound [11][12][13], spectrophotometry [14,20], thermal images [17], LDF [18], mexameter probes [19,21], viscoelasticity skin analyzers [23], corneometry [19][20][21] and multiprobe devices, etc. [19,21,[24][25][26].…”

“…Numerous techniques have been developed to objectively assess RIT via the measurement of associated skin characteristics, including ultrasound [11][12][13], spectrophotometry [14,20], thermal images [17], LDF [18], mexameter probes [19,21], viscoelasticity skin analyzers [23], corneometry [19][20][21] and multiprobe devices, etc. [19,21,[24][25][26]. Yoshida et al [11] tested the reliability of the ultrasonic assessment of radiation toxicity and found that the resulting ultrasound measurements of skin thickness changes were correlated with the RTOG scale score, suggesting that this technique can be used as a reliable method to assess RIT.…”

“…To avoid this bias, many objective assessment tools have been introduced for monitoring skin changes more accurately, including ultrasound [11][12][13], reflectance spectrophotometry [14][15][16], thermal images [17], laser Doppler flowmetry (LDF) [18] and other multiprobe devices which consists of various probes that can assess different skin parameters, including erythema, pigmentation, hydration; skin pH, skin temperature etc. [19][20][21]. Although these objective techniques demonstrate advantages in providing a more reliable quantification of RIT over subjective assessments, very rare tools have been routinely used in clinical practice or in comparison to RTOG or CTCAE scales successfully.…”