Semi-permanent tattoos in breast radiotherapy (STaBRad) study: a randomised-controlled clinical trial comparing the ‘Precision Plus Micropigmentation System’ to permanent skin tattoos in radical breast radiotherapy patients

Abstract

Introduction and purposeAccurate and reproducible patient positioning is a critical step in radiotherapy for breast cancer. This has seen the use of permanent skin markings becoming standard practice in many centres. Permanent skin markings may have a negative impact on long-term cosmetic outcome, which may in turn, have psychological implications in terms of body image. The aim of this study was to investigate the feasibility of using a semi-permanent tattooing device for the administration of skin marks for breast radiotherapy set-up.Materials and methodsThis was designed as a phase II double-blinded randomised-controlled study comparing our standard permanent tattoos with the Precision Plus Micropigmentation (PPMS) device method. Patients referred for radical breast radiotherapy were eligible for the study. Each study participant had three marks applied using a randomised combination of the standard permanent and PPMS methods and was blinded to the type of each mark. Follow up was at routine appointments until 24 months post radiotherapy. Participants and a blind assessor were invited to score the visibility of each tattoo at each follow-up using a Visual Analogue Scale. Tattoo scores at each time point and change in tattoo scores at 24 months were analysed by a general linear model using the patient as a fixed effect and the type of tattoo (standard or research) as covariate. A simple questionnaire was used to assess radiographer feedback on using the PPMS.ResultsIn total, 60 patients were recruited to the study, of which 55 were available for follow-up at 24 months. Semi-permanent tattoos were more visible at 24 months than the permanent tattoos. Semi-permanent tattoos demonstrated a greater degree of fade than the permanent tattoos at 24 months (final time point) post completion of radiotherapy. This was not statistically significant, although it was more apparent for the patient scores (p=0·071) than the blind assessor scores (p=0·27). No semi-permanent tattoos required re-marking before the end of radiotherapy and no adverse skin reactions were observed.ConclusionThe PPMS presents a safe and feasible alternative to our permanent tattooing method. An extended period of follow-up is required to fully assess the extent of semi-permanent tattoo fade.

Adoption of multiple strategies to reduce the rate of marker detachment during radiotherapy in patients with cancer

“…This information is essential for accurate treatment delivery throughout the course of radiotherapy (2,3). However, permanent markings can have a negative psychological impact on patients, by reminding them of past treatments and affecting skin esthetics (4,5). These markings can also cause anxiety, as patients grapple with the extent of exposure and treatment accuracy.…”

Emotional Experiences of Skin Markings Among Patients Undergoing Radiotherapy and Related Factors: A Questionnaire-Based Cross-Sectional Study

“… 2 Since patients continue to work and lead their daily lives while undergoing treatment, 3 markings that are noticeable to others can be a source of concern. 4 Moreover, visible skin markings are a constant reminder that they are suffering from cancer. 5 Patient emotions in healthcare are influenced not only by what patients express, but also by their experience, stage of illness, and other conditions, as well as their relationship with their healthcare provider.…”