In the Department of Infection Management, Guangzhou Red Cross Hospital, Medical College, Jinan University, Zexin Yao, MPH, is Postgraduate Student of Public Health and Preventive Medicine, Guangdong Pharmaceutical University. In the Department of Plastic Surgery, General Hospital of Southern Theater Command of PLA, Biao Cheng, MD, PhD, is Professor of Surgery, Wound Healing Unit. Acknowledgments: The authors thank all the patients who consented to the study and the anonymous reviewers for their helpful comments. This study was supported by a grant from the National Natural Science Foundation of China (81272105 and 81671924), National Key Research and Development Plan of China (2017YFC1103301), Science and Technology Key Project of Guangdong Province (2014B020212010), Science and Technology Planning Project of Guangdong Province of China (2015B020233012), and Military Medical Innovation Special Projects (18CXZ029). The authors have disclosed no other financial relationships related to this article. Submitted November 27, 2020; accepted in revised form January 26, 2021.
Adv Skin Wound Care. 2021 Dec 1;34(12):1-8. doi: 10.1097/01.ASW.0000797952.41753.f4.
Radiation-induced skin injuries such as lesions (RSLs) and dermatitis are the most common complication during radiotherapy (RT) for nasopharyngeal carcinoma, but little is known about risk factors unique to oncology. This study sought a greater understanding of these risk factors to stratify patients based on risk and guide clinical decision-making.
Investigators analyzed the data of 864 consecutive patients referred to the RT center of the Southern Theater General Hospital for a new RSL from 2013 to 2019. These patients were followed up for an average of approximately 16 months until their death or March 30, 2020, whichever came first. Multivariate logistic regression analysis and Cox proportional hazards model were used to identify predictors of grade 3 or 4 dermatitis.
The main causes of treatment interruption included dermatitis and oral mucositis. Significant patient-specific risk factors for RSLs included current smoking, current drinking, and lower Karnofsky Performance Scale score and significant procedure-specific risk factors included receiving intensity-modulated radiation therapy (IMRT), hyperfractionated RT, induction chemotherapy, multicycle chemotherapy, and taxol- and cisplatin-based drugs. The three factors that independently predicted risk of RSL were IMRT, lower Karnofsky Performance Scale score, and multicycle chemotherapy. Comparing predictive factors among patients with severe RSL revealed that patients who received IMRT were more likely to develop grade 3 or 4 dermatitis.
Oncology providers should note that IMRT is an aggressive technique with a trend toward increased RSL. Providers should pay special attention to adverse effects to skin in patients with nasopharyngeal carcinoma.
放疗（RT）所致皮肤损伤，如病变（RSLs）和皮炎，是鼻咽癌放疗最常见的并发症，但关于肿瘤学特有的危险因素知之甚少。本研究旨在深入了解这些危险因素，根据风险对患者进行分层，并指导临床决策。
研究人员分析了 2013 年至 2019 年期间，864 例因新出现的 RSL 而被转诊至南部战区总医院 RT 中心的连续患者数据。这些患者的平均随访时间约为 16 个月，直至死亡或 2020 年 3 月 30 日（以先到者为准）。采用多变量逻辑回归分析和 Cox 比例风险模型来识别 3 或 4 级皮炎的预测因素。
治疗中断的主要原因包括皮炎和口腔黏膜炎。RSLs 的显著患者特异性危险因素包括当前吸烟、当前饮酒以及 Karnofsky 表现状态评分较低，显著的治疗方案特异性危险因素包括接受调强放疗（IMRT）、超分割放疗、诱导化疗、多周期化疗和紫杉醇和顺铂类药物。独立预测 RSL 风险的三个因素是 IMRT、Karnofsky 表现状态评分较低和多周期化疗。比较重度 RSL 患者的预测因素发现，接受 IMRT 的患者更有可能发生 3 或 4 级皮炎。
肿瘤学提供者应注意，IMRT 是一种侵袭性技术，RSL 呈增加趋势。提供者应特别注意鼻咽癌患者的皮肤不良反应。
