Abstract
Background
Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT.
Patients and methods
Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a “matched” group (n = 25) was generated from the control group based on propensity for potentially confounding variables.
Results
In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5.
Conclusion
PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery.
Zusammenfassung
Hintergrund
Radiotherapie (RT) ist integrativer Bestandteil der multimodalen Therapie beim Mammakarzinom. Strahlentherapieinduzierte Hauttoxizität ist dabei das häufigste unerwünschte Ereignis; dennoch sind Prävention und Management der Radiodermatitis (RD) weiterhin trivial. Klinische Studien ergaben, dass die Photobiomodulation (PBM) mit Leuchtdioden (LED) die Wundheilung fördern und entzündungshemmend wirken kann. Diese Single-Institut-Studie untersucht die Wertigkeit der PBM-LED zur Prävention und Linderung der RD während der adjuvanten Brustkrebs-RT.
Patienten und Methoden
Von insgesamt 70 konsekutiv behandelten Patienten wurden 25 Patienten nach brusterhaltender Operation 2‑mal wöchentlich mit PBM-LED vor adjuvanter 3D-RT behandelt. RD wurde nach den Common Toxicity Criteria Version 4.0 dokumentiert und RD-assoziierte Schmerzen mit der visuellen Analogskala (VAS) erfasst. Die Kontrollgruppe (n = 45) erhielt keine PBM-LED vor RT. Zusätzlich wurde eine „gematchte“ Gruppe (n = 25) aus der Kontrollgruppe basierend auf der Neigung für potenzielle Störvariablen gebildet.
Ergebnisse
In der PBM-Gruppe präsentierten 22 Patienten (88 %) eine Grad-1-RD und 3 (12 %) eine Grad-2-RD. In der Kontrollgruppe zeigten 25 Patienten (55,6 %) eine Hauttoxizität vom Grad 1, 18 (40 %) vom Grad 2 und 2 (4,4 %) eine Grad-3-RD. Hinsichtlich der Schmerzintensität hatten 15 Patienten (60 %) der PBM-Gruppe keine Schmerzen, 5 (20 %) VAS 2 und 5 (20 %) VAS 3. In der Kontrollgruppe hatten 13 Patienten (28,9 %) keine Schmerzen, 2 (4,4 %) VAS 1, 7 (15,6 %) VAS 2, 9 (20 %) VAS 3, 12 (26,7 %) VAS 4 und 2 (4,4 %) Patienten VAS 5.
Schlussfolgerung
PBM-LED-Therapie vor adjuvanter RT könnte die Inzidenz und Ausprägung von RD bei Brustkrebspatientinnen nach brusterhaltender Operation verringern.
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Acknowledgements
We thank THOR Photomedicine Ltd who kindly provided the light-emitting diode photobiomodulation device. This study has no funding.
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I. Strouthos, G. Chatzikonstantinou, N. Tselis, D Bon, E. Karagiannis, E. Zoga, K. Ferentinos, J. Maximenko, V. Nikolettou-Fischer, and Nikolaos Zamboglou declare that they have no competing interests.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Strouthos, I., Chatzikonstantinou, G., Tselis, N. et al. Photobiomodulation therapy for the management of radiation-induced dermatitis. Strahlenther Onkol 193, 491–498 (2017). https://doi.org/10.1007/s00066-017-1117-x
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DOI: https://doi.org/10.1007/s00066-017-1117-x