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Title: Thermal Skin Damage During Reirradiation and Hyperthermia Is Time-Temperature Dependent

Abstract

Purpose: To investigate the relationship of thermal skin damage (TSD) to time–temperature isoeffect levels for patients with breast cancer recurrence treated with reirradiation plus hyperthermia (reRT + HT), and to investigate whether the treatment history of previous treatments (scar tissue) is a risk factor for TSD. Methods and Materials: In this observational study, temperature characteristics of hyperthermia sessions were analyzed in 262 patients with recurrent breast cancer treated in the AMC between 2010 and 2014 with reirradiation and weekly hyperthermia for 1 hour. Skin temperature was measured using a median of 42 (range, 29-82) measurement points per hyperthermia session. Results: Sixty-eight patients (26%) developed 79 sites of TSD, after the first (n=26), second (n=17), third (n=27), and fourth (n=9) hyperthermia session. Seventy percent of TSD occurred on or near scar tissue. Scar tissue reached higher temperatures than other skin tissue (0.4°C, P<.001). A total of 102 measurement points corresponded to actual TSD sites in 35 of 79 sessions in which TSD developed. Thermal skin damage sites had much higher maximum temperatures than non-TSD sites (2.8°C, P<.001). Generalized linear mixed models showed that the probability of TSD is related to temperature and thermal dose values (P<.001) and that scar tissue is more at risk (odds ratiomore » 0.4, P<.001). Limiting the maximum temperature of a measurement point to 43.7°C would mean that the probability of observing TSD was at most 5%. Conclusion: Thermal skin damage during reRT + HT for recurrent breast cancer was related to higher local temperatures and time–temperature isoeffect levels. Scar tissue reached higher temperatures than other skin tissue, and TSD occurred at lower temperatures and thermal dose values in scar tissue compared with other skin tissue. Indeed, TSD developed often on and around scar tissue from previous surgical procedures.« less

Authors:
 [1];  [1];  [2]; ; ; ; ; ;  [1]
  1. Department of Radiation Oncology, Academic Medical Center (AMC), Amsterdam (Netherlands)
  2. Clinical Research Unit, Academic Medical Center (AMC), Amsterdam (Netherlands)
Publication Date:
OSTI Identifier:
22649937
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 98; Journal Issue: 2; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANIMAL TISSUES; HYPERTHERMIA; MAMMARY GLANDS; NEOPLASMS; PATIENTS; PLANT TISSUES; SKIN; TEMPERATURE RANGE 0400-1000 K

Citation Formats

Bakker, Akke, E-mail: akke.bakker@amc.uva.nl, Kolff, M. Willemijn, Holman, Rebecca, Leeuwen, Caspar M. van, Korshuize-van Straten, Linda, Kroon-Oldenhof, Rianne de, Rasch, Coen R.N., Tienhoven, Geertjan van, and Crezee, Hans. Thermal Skin Damage During Reirradiation and Hyperthermia Is Time-Temperature Dependent. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2017.02.009.
Bakker, Akke, E-mail: akke.bakker@amc.uva.nl, Kolff, M. Willemijn, Holman, Rebecca, Leeuwen, Caspar M. van, Korshuize-van Straten, Linda, Kroon-Oldenhof, Rianne de, Rasch, Coen R.N., Tienhoven, Geertjan van, & Crezee, Hans. Thermal Skin Damage During Reirradiation and Hyperthermia Is Time-Temperature Dependent. United States. doi:10.1016/J.IJROBP.2017.02.009.
Bakker, Akke, E-mail: akke.bakker@amc.uva.nl, Kolff, M. Willemijn, Holman, Rebecca, Leeuwen, Caspar M. van, Korshuize-van Straten, Linda, Kroon-Oldenhof, Rianne de, Rasch, Coen R.N., Tienhoven, Geertjan van, and Crezee, Hans. Thu . "Thermal Skin Damage During Reirradiation and Hyperthermia Is Time-Temperature Dependent". United States. doi:10.1016/J.IJROBP.2017.02.009.
@article{osti_22649937,
title = {Thermal Skin Damage During Reirradiation and Hyperthermia Is Time-Temperature Dependent},
author = {Bakker, Akke, E-mail: akke.bakker@amc.uva.nl and Kolff, M. Willemijn and Holman, Rebecca and Leeuwen, Caspar M. van and Korshuize-van Straten, Linda and Kroon-Oldenhof, Rianne de and Rasch, Coen R.N. and Tienhoven, Geertjan van and Crezee, Hans},
abstractNote = {Purpose: To investigate the relationship of thermal skin damage (TSD) to time–temperature isoeffect levels for patients with breast cancer recurrence treated with reirradiation plus hyperthermia (reRT + HT), and to investigate whether the treatment history of previous treatments (scar tissue) is a risk factor for TSD. Methods and Materials: In this observational study, temperature characteristics of hyperthermia sessions were analyzed in 262 patients with recurrent breast cancer treated in the AMC between 2010 and 2014 with reirradiation and weekly hyperthermia for 1 hour. Skin temperature was measured using a median of 42 (range, 29-82) measurement points per hyperthermia session. Results: Sixty-eight patients (26%) developed 79 sites of TSD, after the first (n=26), second (n=17), third (n=27), and fourth (n=9) hyperthermia session. Seventy percent of TSD occurred on or near scar tissue. Scar tissue reached higher temperatures than other skin tissue (0.4°C, P<.001). A total of 102 measurement points corresponded to actual TSD sites in 35 of 79 sessions in which TSD developed. Thermal skin damage sites had much higher maximum temperatures than non-TSD sites (2.8°C, P<.001). Generalized linear mixed models showed that the probability of TSD is related to temperature and thermal dose values (P<.001) and that scar tissue is more at risk (odds ratio 0.4, P<.001). Limiting the maximum temperature of a measurement point to 43.7°C would mean that the probability of observing TSD was at most 5%. Conclusion: Thermal skin damage during reRT + HT for recurrent breast cancer was related to higher local temperatures and time–temperature isoeffect levels. Scar tissue reached higher temperatures than other skin tissue, and TSD occurred at lower temperatures and thermal dose values in scar tissue compared with other skin tissue. Indeed, TSD developed often on and around scar tissue from previous surgical procedures.},
doi = {10.1016/J.IJROBP.2017.02.009},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 98,
place = {United States},
year = {Thu Jun 01 00:00:00 EDT 2017},
month = {Thu Jun 01 00:00:00 EDT 2017}
}
  • The interaction between hyperthermia and X irradiation in the expression of injury to skin was investigated in the tail of adult mice. The X-ray treatments when given alone resulted in skin reactions which ranged in severity from ''no observable gross injury'' to ''moist desquamation over most of the tail,'' the peak reaction occurring at approximately 20 days. When hyperthermia was given alone, the maximal reaction observed was ''foci of moist desquamation, accompanied by severe erythema and edema'' which, in contrast to the radiation response, peaked 1 to 2 days after treatment. For the combined treatments, hyperthermia at a temperature betweenmore » 43.0 and 44.5/sup 0/ for 30 min was given either 3, 6, 9, or 10 days after X irradiation. When the interval was 3 days, there appeared to be no interaction between the treatments. As the interval was lengthened, so the hyperthermia was given 6 or more days after irradiation, i.e., within 7 days of the time of appearance of gross radiation injury, the severity of the observed skin reaction was greater than the individual responses following either treatment given alone. Using a 9-day interval, it could be seen that both the thermal and radiation reactions were enhanced in a dose-dependent manner. The peak times for each reaction were not significantly altered by the additional treatment. The results are discussed with reference to possible modes of interaction between X irradiation and hyperthermia in an in vivo system.« less
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  • This article reports the clinical results of the combined treatment of radiation and localized microwave hyperthermia to treat multiple metastatic melanoma tumors. The response of normal skin to the treatment was measured by evaluating the degree of erythema using a numerical scoring system. Tumor response to the treatment was assessed by measuring tumor diameter at follow-up visits. Whenever possible, thermal enhancement ratios for normal skin and tumor tissue were evaluated. The manuscript discusses problems associated with obtaining useful clinical data.
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