Predictive factors of acute skin reactions to carbon ion radiotherapy for the treatment of malignant bone and soft tissu
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RESEARCH
Open Access
Predictive factors of acute skin reactions to carbon ion radiotherapy for the treatment of malignant bone and soft tissue tumors Yosuke Takakusagi1, Jun-ichi Saitoh1,2* , Hiroki Kiyohara1, Takahiro Oike1, Shin-ei Noda1, Tatsuya Ohno1 and Takashi Nakano1
Abstract Background: The skin is considered a critical organ at risk in carbon ion radiotherapy (CIRT) for locally advanced malignant bone and soft tissue tumors (MBSTs). The predictive factors for acute skin reactions after CIRT have not been investigated. The present study aimed to identify these factors and evaluate the correlation between the severity of acute skin reactions and skin dose parameters. Methods: CIRT with total doses of 64.0–70.4 Gy (relative biological effectiveness [RBE]) was administered to 22 patients with MBSTs. The skin-tumor distance (STD), maximum skin total dose (Dmax), and area of the skin receiving a total dose of X Gy (RBE) were evaluated. Results: All patients developed acute skin reactions after CIRT, including Grades 1 and 2 dermatitis in 15 (71%) and 6 (29%) patients, respectively. There was a significant difference in the STD between the two groups (P = 0.007), and the cut-off value of STD for predicting Grade 2 acute skin reactions was 11 mm. There was a significant difference in Dmax between the groups (P < 0.001), and the cut-off value of Dmax for predicting Grade 2 acute skin reactions was 52 Gy (RBE). Significant differences between the two groups were observed in terms of the area irradiated with 40 Gy (RBE) (S40), and the cut-off value of S40 for predicting Grade 2 acute skin reactions was 25 cm2. Conclusions: In acute skin reactions after CIRT for MBSTs, STD, Dmax, and S40 were found to be significant predictive factors for acute skin reactions. Keywords: Acute skin reactions, Carbon ions, Dermatitis, Malignant bone and soft tissue tumors, Predictive factors
Background Malignant bone and soft tissue tumors (MBSTs) remain an intractable cancer. Recently, the clinical outcome of surgery for MBSTs was improved due to advancements in combined treatment with chemotherapeutic agents such as gemcitabine, vinorelbine, and docetaxel, and improvements in diagnostic radiology [1–4]. Consequently, the local recurrence rate for MBSTs is reported to be less than 20% when the tumors are resected with satisfactory surgical margins [5–7]. However, when the tumors are locally advanced and/or they are located near critical organs such * Correspondence: [email protected] 1 Gunma University Heavy Ion Medical Center, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan 2 Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
as the spinal cord, resection with a satisfactory margin is often difficult, and the local recurrence rate remains as high as 50% [7–9]. Radiotherapy and/or chemotherapy are selected for the treatment of unresectable MBSTs. However, because MBSTs are relatively radioresistant, the local control rate of MBSTs treated
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