Kišonas Juras, Venius Jonas, Grybauskas Mindaugas, Dabkevičienė Daiva, Burneckis Arvydas, Rotomskis Ričardas
Department of Radiation Oncology, National Cancer Institute, LT-08660 Vilnius, Lithuania.
Department of Neurobiology and Biophysics, Vilnius University, LT-01513 Vilnius, Lithuania.
Diagnostics (Basel). 2021 Sep 13;11(9):1670. doi: 10.3390/diagnostics11091670.
During radiotherapy (RT), most breast cancer patients experience ionizing radiation (IR)-induced skin injury-acute radiation dermatitis (ARD). The severity of ARD is determined by a physician according to CTCAE or RTOG scales, which are subjective. Reflectance confocal microscopy (RCM) is a noninvasive skin imaging technique offering cellular resolution. Digital dermoscopy (DD) performed in conjugation with RCM can provide more information regarding skin toxicity. The purpose of this study is to create an RCM and DD features-based ARD assessment scale, to assess the association with CTCAE scale and possible predictive value.
One hundred and three breast cancer patients during RT were recruited; every week, clinical symptoms of ARD (CTCAE scale) were evaluated and RCM, together with digital dermoscopy (DD), was performed.
According to RCM; after 2 RT weeks, exocytosis and/or spongiosis were present in 94% of patients; after 3 weeks, mild contrast cells (MMCs) were detected in 45%; disarrayed epidermis (DE) was present in 66% of patients after 4 weeks and in 93% after 5 weeks; abnormal dermal papillae (ADP) were present in 68% of patients after 5 weeks. The coefficients of RCM features (RCM) alone and together with dermoscopically determined erythema (RCM-ERY) were significantly associated with ARD severity grade. RCM is a significant predictive factor for the clinical manifestation of ARD.
RCM features of irradiated skin appear earlier than clinical symptoms, have a characteristic course, and allow the severity of ARD to be predicted.
在放射治疗（RT）期间，大多数乳腺癌患者会经历电离辐射（IR）引起的皮肤损伤——急性放射性皮炎（ARD）。ARD的严重程度由医生根据CTCAE或RTOG量表来确定，这些量表具有主观性。反射式共聚焦显微镜（RCM）是一种提供细胞分辨率的非侵入性皮肤成像技术。与RCM联合进行的数字皮肤镜检查（DD）可以提供更多关于皮肤毒性的信息。本研究的目的是创建一个基于RCM和DD特征的ARD评估量表，以评估其与CTCAE量表的相关性及可能的预测价值。
招募了103名接受RT的乳腺癌患者；每周评估ARD的临床症状（CTCAE量表），并进行RCM以及数字皮肤镜检查（DD）。
根据RCM；放疗2周后，94%的患者出现胞吐和/或海绵形成；3周后，45%的患者检测到轻度对比细胞（MMC）；4周后，66%的患者出现表皮紊乱（DE），5周后为93%；5周后，68%的患者出现异常真皮乳头（ADP）。单独的RCM特征（RCM）以及与皮肤镜检查确定的红斑一起（RCM-ERY）与ARD严重程度分级显著相关。RCM是ARD临床表现的一个重要预测因素。
受照射皮肤的RCM特征比临床症状出现得更早，具有特征性病程，并能够预测ARD的严重程度。
