Acute Radiation Dermatitis Evaluation with Reflectance Confocal Microscopy: A Prospective Study

Juras Kišonas; Jonas Venius; Mindaugas Grybauskas; Daiva Dabkevičienė; Arvydas Burneckis; Ričardas Rotomskis

doi:10.3390/diagnostics11091670

Acute Radiation Dermatitis Evaluation with Reflectance Confocal Microscopy: A Prospective Study

Diagnostics (Basel). 2021 Sep 13;11(9):1670. doi: 10.3390/diagnostics11091670.

Authors

Juras Kišonas^{1

2}, Jonas Venius^{3

4}, Mindaugas Grybauskas¹, Daiva Dabkevičienė⁵, Arvydas Burneckis¹, Ričardas Rotomskis⁴

Affiliations

¹ Department of Radiation Oncology, National Cancer Institute, LT-08660 Vilnius, Lithuania.
² Department of Neurobiology and Biophysics, Vilnius University, LT-01513 Vilnius, Lithuania.
³ Medical Physics Department, National Cancer Institute, LT-08660 Vilnius, Lithuania.
⁴ Biomedical Physics Laboratory, National Cancer Institute, LT-08660 Vilnius, Lithuania.
⁵ Biobank, National Cancer Institute, LT-08660 Vilnius, Lithuania.

Abstract

Background: 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.

Methods: 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.

Results: 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_coef) alone and together with dermoscopically determined erythema (RCM-ERY_coef) were significantly associated with ARD severity grade. RCM_coef is a significant predictive factor for the clinical manifestation of ARD.

Conclusions: RCM features of irradiated skin appear earlier than clinical symptoms, have a characteristic course, and allow the severity of ARD to be predicted.

Keywords: acute radiation dermatitis; breast cancer; reflectance confocal microscopy.