A Clinical Study to Evaluate Dermatologic Sequelae Associated with Radiation Therapy

Background: Radiation effects on normal skin is a subject of prime importance since we are bound to irradiate the skin in most of the cases treated with external beam radiotherapy even if it is not the site of tumor, and also being very radiosensitive it is vulnerable to develop radiation induced injury. This study aims to assess the various cutaneous manifestations of radiation therapy and grade the severity of the possible manifestations, which is lacking in our part of the world. Objectives of the study: To evaluate different types of cutaneous manifestations secondary to radiation therapy in patients receiving treatment for various malignancies. Methods: Source of data consisted of sixty cases receiving radiotherapy, attending the outpatient and inpatient department of Radiation Oncology in Victoria hospital attached to Bangalore Medical College and Research Institute, Bangalore. The enrolled patients were subjected to a detailed history and clinical examination at the onset of radiotherapy and at regular dosage intervals of 20G, 40G and 60G (if applicable). The development of any cutaneous manifestations, its time of onset, its grading and its progression was noted using a predesigned pro-forma. Relevant investigations were done in doubtful cases. Results: In the study, the age of patients ranged from 23- 84 years, with mean age being 54.58 years. A female predominance was noted with 66.7% females and 33.3% males. In our study, majority of the subjects were receiving radiation therapy for carcinoma (Ca) breast (38.3%). Other indications included Ca head and neck (33.3%), Ca pelvis (16.7) and Ca of the gastrointestinal tract (11.7%). Among the 60 patients the maximum dose of radiation given was 66Gy and the minimum dose was 40Gy. In our study of 60 patients who were followed up from the beginning of radiotherapy upto the end, 76.66% ( n =46) developed cutaneous adverse effects secondary to radiation therapy. Among the skin manifestations, hyperpigmentation was the commonest which was seen in 61.7% of the patients followed by skin ulceration which was seen in 21.7% of the patients. The other skin manifestation were xerosis (11.66%), alopecia (3.4%), mucositis (3.3%), infections (3.3%), pruritus (1.7%), pain of skin (1.7%), atrophy (1.7%), maculopapular rash (1.7%) and purpura (1.7%). Conclusion: This study highlights the importance of grading of radiation dermatitis and gives an insight towards prevention and possible appropriate management.