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01-08-2019 | Original Article

Management of severe bio-radiation dermatitis induced by radiotherapy and cetuximab in patients with head and neck cancer: emphasizing the role of calcium alginate dressings

Authors: Pierluigi Bonomo, Isacco Desideri, Mauro Loi, Lucia Pia Ciccone, Monica Lo Russo, Carlotta Becherini, Daniela Greto, Gabriele Simontacchi, Nicola Pimpinelli, Lorenzo Livi

Published in: Supportive Care in Cancer | Issue 8/2019

Abstract

Purpose

Severe bio-radiation dermatitis may develop in patients treated with concurrent radiotherapy and cetuximab for head and neck squamous cell carcinoma. The aim of our work was to report on the impact of a grade-specific management approach on treatment tolerability.

Methods

Concomitant radiotherapy and cetuximab was prescribed for patients deemed ineligible for cisplatin-based chemoradiation. Since 2014, an advanced wound care nursing team was established in our clinic to implement a standardized policy for skin toxicity. A central role of calcium alginate dressings was defined in our management algorithm. The correlation between patient, disease, and treatment features with severe bio-radiation dermatitis and treatment tolerability was evaluated.

Results

Between 2007 and 2018, 51 patients were treated at our center with radiotherapy and cetuximab. The incidence of G3/G4 bio-radiation dermatitis was 43.1%. Comparing two consecutive cohorts of 26 and 25 patients treated before and after January 2014, respectively, the adoption of a grade-specific dermatitis management allowed to improve treatment tolerability. A mean radiation treatment interruption of 8.42 days (SD, 6.73; 95% CI 5.7–11.1) was reduced to 0.86 days (SD, 2.66; 95% CI − 0.28–2.02) in the more recent group (p < 0.0001). Mean relative dose intensity of cetuximab was also significantly higher (86.3% vs 74.5%, p = 0.0226).

Conclusions

Routine involvement of an advanced wound care management team and early consideration for calcium alginate dressings in case of moist desquamation should be warranted to ensure high compliance to radiotherapy and cetuximab in patients with head and neck cancer.

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Title: Management of severe bio-radiation dermatitis induced by radiotherapy and cetuximab in patients with head and neck cancer: emphasizing the role of calcium alginate dressings
Authors: Pierluigi Bonomo
Isacco Desideri
Mauro Loi
Lucia Pia Ciccone
Monica Lo Russo
Carlotta Becherini
Daniela Greto
Gabriele Simontacchi
Nicola Pimpinelli
Lorenzo Livi
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 8/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-018-4606-2

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