Maillot O, Leduc N, Atallah V, Escarmant P, Petit A, Belhomme S, Sargos P, Vinh-Hung V
Department of radiation oncology, hôpital Clarac, CHU de Martinique, avenue Pasteur, 97200 Fort-de-France, France.
Department of radiation oncology, institut Bergonié, 229, cours de L'Argonne, 33800 Bordeaux, France.
Cancer Radiother. 2018 May;22(3):205-210. doi: 10.1016/j.canrad.2017.10.007. Epub 2018 Apr 17.
Radiotherapy is a common adjuvant treatment of breast cancer. Acute radiation-induced dermatitis is a frequent side effect. We hypothesized whether it is possible to capture the increase of local temperature as a surrogate of the inflammatory state induced by radiotherapy. We designed a prospective, observational, single-centre study to acquire data on temperature rise in the treated breast during the course of radiotherapy, establish a possible association with the occurrence of dermatitis and investigate the predictive value of temperature increase in future occurrences of radiation-induced dermatitis.
All patients presenting for neoadjuvant or adjuvant radiotherapy during the course of breast cancer treatment at the university hospital of Martinique were considered for inclusion. Every week, patients were examined by two trained investigators for the occurrence of radiation-induced dermatitis, graded based on Radiotherapy Oncology Group, Common Terminology Criteria for Adverse Events v.4.0 and Wright scales. A frontal thermal image of torso was taken in strictly controlled conditions, with a calibrated TE-Q1 camera (Thermal Expert, i3systems, Daejeon, Korea). We studied temperature differences between the irradiated breast or thoracic wall and the contralateral area. For each thermal picture, we measured the difference in maximum temperature as well as the difference in minimum temperature and the difference in the average temperature in the considered area. We studied the evolution of these parameters over time week after week, measuring the maximum recorded difference and its correlation to acute radiation dermatitis intensity.
Sixty-four consecutive patients were included. For all patients, we noticed an increase of temperature during the course of radiotherapy. Difference in maximum, minimum and average temperature was higher between the two breasts of patients with a radiation-induced dermatitis grade 2 or above compared to patients with no or mild dermatitis. Higher temperatures were also significantly associated with an increased sensation of discomfort, as recorded by questionnaire (P<0.05).
As expected from the inflammatory phenomena involved in radiation-induced dermatitis, a noticeable increase in temperature during the course of radiotherapy was seen in all patients. Furthermore, high-grade radiation-induced dermatitis was strongly associated with an additional increase in local temperature, which is probably linked to the intense inflammatory reaction. Lastly, with a 1.4°C threshold set beforehand, it is possible to anticipate the occurrence of radiation-induced dermatitis, with interesting positive and negative predictive values of 70% and 77%, respectively in our population. We note that these results need to be confirmed in a dedicated study.
放射治疗是乳腺癌常见的辅助治疗方法。急性放射性皮炎是常见的副作用。我们推测是否有可能通过捕捉局部温度升高来作为放疗诱发炎症状态的替代指标。我们设计了一项前瞻性、观察性、单中心研究，以获取放疗过程中治疗侧乳房温度升高的数据，确定其与皮炎发生之间可能存在的关联，并研究温度升高对未来放射性皮炎发生的预测价值。
在马提尼克大学医院接受乳腺癌治疗过程中进行新辅助或辅助放疗的所有患者均被纳入研究。每周由两名经过培训的研究人员对患者进行检查，以确定是否发生放射性皮炎，并根据放射肿瘤学组、不良事件通用术语标准第4.0版和赖特量表进行分级。使用校准后的TE-Q1相机（Thermal Expert，i3systems，韩国大田）在严格控制的条件下拍摄躯干正面热图像。我们研究了受照射乳房或胸壁与对侧区域之间的温度差异。对于每张热图像，我们测量了所考虑区域的最高温度差异、最低温度差异以及平均温度差异。我们每周研究这些参数随时间的变化，测量记录到的最大差异及其与急性放射性皮炎强度的相关性。
连续纳入64例患者。对于所有患者，我们注意到放疗过程中温度升高。与无或轻度皮炎的患者相比，放射性皮炎2级及以上患者两侧乳房之间的最高、最低和平均温度差异更大。问卷调查显示，较高的温度也与不适感增加显著相关（P<0.05）。
正如放射性皮炎所涉及的炎症现象所预期的那样，所有患者在放疗过程中均出现了明显的温度升高。此外，重度放射性皮炎与局部温度的进一步升高密切相关，这可能与强烈的炎症反应有关。最后，预先设定1.4°C的阈值，可以预测放射性皮炎的发生，在我们的研究人群中，其阳性和阴性预测值分别为70%和77%，这很有意思。我们注意到这些结果需要在专门的研究中得到证实。
