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Late Irradiation Damage to the Skin Caused by Soft X-ray Radiation Therapy of Cutaneous Tumors

Late Irradiation Damage to the Skin Caused by Soft X-ray Radiation Therapy of Cutaneous Tumors Abstract Background: Although radiotherapy of skin tumors has lost its former preeminence, there is still need for this modality. The aim of this study was, therefore, to determine the frequency of radiogenic ulcers and tumors following soft x-ray therapy of skin lesions. Study Design: A total of 612 radiation sites in 522 patients were retrospectively analyzed by means of medical records. All patients received at least a total dose of more than 12 Gy and had a minimum follow-up time of 10 years. The average radiation dose was about 80 Gy, ranging from 56 to 184 Gy. Determined was occurrence of radiogenic tumors after more than 10 years and of ulcers during the entire follow-up period. The frequency of radiogenic tumors and ulcers was related to the total dose applied and the patient's age at the time of irradiation. Results: In the 612 radiation fields used, 58 ulcers (9.4%), 12 basal cell carcinomas (2%), and nine squamous cell carcinomas (1.5%) were observed. There was no relationship between the total dose of radiation and the frequency of tumors; in contrast, radiogenic ulcers increased with a higher total dose. Radiogenic ulcers occurred more often in patients who were of a younger age at the time of irradiation. Conclusions: The risk of developing radiogenic ulcers and tumors after soft x-ray therapy is not very high. Since most of the ulcers can be prevented by modern dose recommendation (time dose fractionation factor), soft xray therapy can be considered as a safe and effective means of therapy, especially in older patients.(Arch Dermatol. 1995;131:182-186) References 1. Frieber A. Cancroid des rechten Handrückens nach langdauernder Einwirkung von Röntgenstrahlen . Fortschr Rontgenstr. 1902;6:106. 2. Goldschmidt H. Dermatologische Röntgentherapie und Radiokarzinogenese . Hautarzt. 1982;33:183-190. 3. Goldschmidt H. Dermatologic radiotherapy: the risk-benefit ratio . Arch Dermatol. 1986;122:1385-1388.Crossref 4. Rudolph R. Goldschmidt H. Radiodermatitis and other adverse sequelae of cutaneous irradiation . In: Goldschmidt H, ed. Physical Modalities in Dermatologic Therapy . New York, NY: Springer Verlag NY Inc; 1978. 5. Goldschmidt H, Sherwin WK. Reactions to ionizing radiation . J Am Acad Dermatol. 1980;3:551-579.Crossref 6. Albert RE, Shor RE. Carcinogenic effect of radiation on the human skin . In: Upton AC, Albert RE, Burns FJ, Shore RE, eds. Radiation Carcinogenesis: Current Oncology . New York, NY: Elsevier Science Publishing Co Inc; 1986:33-345. 7. Gladstein AH. Radiation protection . In: Goldschmidt H, ed. Physical Modalities in Dermatologic Therapy . New York, NY: Springer Verlag NY Inc; 1978:39-48. 8. Goldschmidt H. Ionizing radiation in dermatology . In: Moschella SL, Pillsbury DM, Hurley HJ, eds. Dermatology . Philadelphia, Pa: WB Saunders Co; 1975:1660-1690. 9. Goldschmidt H. Radiotherapy of skin cancer: modern indications and techniques . Cutis. 1976;17:253-261. 10. Kopf AW. Therapy of basal cell carcinoma . In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg JM, Austen KF, ed. Dermatology in General Medicine. New York, NY: McGraw-Hill International Book Co; 1971. 11. Goldschmidt H, Sherwin WK. Office radiotherapy of cutaneous carcinomas, I: radiation techniques: dose schedules and radiation protection . J Dermatol Surg Oncol. 1983;9:31-46.Crossref 12. Braun-Falco 0, Lucacs S. Dermatologische Röntgentherapie: ein Leitfaden für die Praxis . New York, NY: Springer-Verlag NY Inc; 1973. 13. Epstein E. Radiodermatitis . Springfield, III: Charles C Thomas Publisher; 1962. 14. Kohn H, Fry M. Radiation carcinogenesis . N Engl J Med. 1984;310:504-511.Crossref 15. Rowell NR. A follow-up study of superficial radiotherapy for benign dermatoses: recommendations for the use of x-rays in dermatology . Br J Dermatol. 1973;88:583-590.Crossref 16. Rowell NR. Adverse effects of superficial x-ray therapy and recommendation for safe use in benign dermatoses . J Dermatol Surg Oncol. 1978;4:630-634.Crossref 17. Sulzberger MB, Baer RL, Borota A. Do roentgen ray treatments as given by skin specialists produce cancers or other sequelae? Arch Dermatol Syphilol. 1952;65:639-655.Crossref 18. Martin H, Strong E, Spiro RH. Radiation induced skin cancer of the head and neck . Cancer. 1970;25:61-71.Crossref 19. Traenkle HL. Late radiation injury and cutaneous neoplasia . In: Helm F, ed. Cancer Dermatology . Philadelphia, Pa: Lea & Febiger; 1979. 20. International Commission on Radiological Protection (ICRP). Recommendations of the International Commission on Radiological Protection . Elmsford, NY: Pergamon Press Inc; 1977. Publication 26. 21. National Academy of Sciences—National Research Council. The effects on populations of exposure to low levels of ionizing radiation. In: Report of the Advisory Committee on the Biological Effects of Ionizing Radiation (BEIR). Washington, DC: US Government Printing Office; 1972. 22. Stout AP. Fibrosarcoma: the malignant tumor of fibroblasts . Cancer. 1948;1:30-63.Crossref 23. Gladstone WS, Jerr HD. Epidermoid carcinoma of the lower lip . AJR Am J Roentgenol. 1958;78:780-789. 24. Bart RS, Kopf AW, Petratos MA. x-Ray therapy of skin cancer: evaluation of a 'standardized' method for treating basal cell epitheliomas . In: Proceedings of the Sixth National Cancer Conference . Philadelphia, Pa: JB Lippincott; 1968. 25. Ehring F, Gattwinkel W. Die Strahlentherapie des Basalioms der Oberlippe . Hautarzt. 1974;25:368-372. 26. Orton CG, Ellis F. A simplification in the use of the NSD concept in practical radiotherapy . Br J Radiol. 1973;46:529-537.Crossref 27. Landthaler M, Braun-Falco O. Anwendung des TDF-Faktors in der Röntgenweichstrahlentherapie . Hautarzt. 1989;40:774-777. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Late Irradiation Damage to the Skin Caused by Soft X-ray Radiation Therapy of Cutaneous Tumors

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690140066010
Publisher site
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Abstract

Abstract Background: Although radiotherapy of skin tumors has lost its former preeminence, there is still need for this modality. The aim of this study was, therefore, to determine the frequency of radiogenic ulcers and tumors following soft x-ray therapy of skin lesions. Study Design: A total of 612 radiation sites in 522 patients were retrospectively analyzed by means of medical records. All patients received at least a total dose of more than 12 Gy and had a minimum follow-up time of 10 years. The average radiation dose was about 80 Gy, ranging from 56 to 184 Gy. Determined was occurrence of radiogenic tumors after more than 10 years and of ulcers during the entire follow-up period. The frequency of radiogenic tumors and ulcers was related to the total dose applied and the patient's age at the time of irradiation. Results: In the 612 radiation fields used, 58 ulcers (9.4%), 12 basal cell carcinomas (2%), and nine squamous cell carcinomas (1.5%) were observed. There was no relationship between the total dose of radiation and the frequency of tumors; in contrast, radiogenic ulcers increased with a higher total dose. Radiogenic ulcers occurred more often in patients who were of a younger age at the time of irradiation. Conclusions: The risk of developing radiogenic ulcers and tumors after soft x-ray therapy is not very high. Since most of the ulcers can be prevented by modern dose recommendation (time dose fractionation factor), soft xray therapy can be considered as a safe and effective means of therapy, especially in older patients.(Arch Dermatol. 1995;131:182-186) References 1. Frieber A. Cancroid des rechten Handrückens nach langdauernder Einwirkung von Röntgenstrahlen . Fortschr Rontgenstr. 1902;6:106. 2. Goldschmidt H. Dermatologische Röntgentherapie und Radiokarzinogenese . Hautarzt. 1982;33:183-190. 3. Goldschmidt H. Dermatologic radiotherapy: the risk-benefit ratio . Arch Dermatol. 1986;122:1385-1388.Crossref 4. Rudolph R. Goldschmidt H. Radiodermatitis and other adverse sequelae of cutaneous irradiation . In: Goldschmidt H, ed. Physical Modalities in Dermatologic Therapy . New York, NY: Springer Verlag NY Inc; 1978. 5. Goldschmidt H, Sherwin WK. Reactions to ionizing radiation . J Am Acad Dermatol. 1980;3:551-579.Crossref 6. Albert RE, Shor RE. Carcinogenic effect of radiation on the human skin . In: Upton AC, Albert RE, Burns FJ, Shore RE, eds. Radiation Carcinogenesis: Current Oncology . New York, NY: Elsevier Science Publishing Co Inc; 1986:33-345. 7. Gladstein AH. Radiation protection . In: Goldschmidt H, ed. Physical Modalities in Dermatologic Therapy . New York, NY: Springer Verlag NY Inc; 1978:39-48. 8. Goldschmidt H. Ionizing radiation in dermatology . In: Moschella SL, Pillsbury DM, Hurley HJ, eds. Dermatology . Philadelphia, Pa: WB Saunders Co; 1975:1660-1690. 9. Goldschmidt H. Radiotherapy of skin cancer: modern indications and techniques . Cutis. 1976;17:253-261. 10. Kopf AW. Therapy of basal cell carcinoma . In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg JM, Austen KF, ed. Dermatology in General Medicine. New York, NY: McGraw-Hill International Book Co; 1971. 11. Goldschmidt H, Sherwin WK. Office radiotherapy of cutaneous carcinomas, I: radiation techniques: dose schedules and radiation protection . J Dermatol Surg Oncol. 1983;9:31-46.Crossref 12. Braun-Falco 0, Lucacs S. Dermatologische Röntgentherapie: ein Leitfaden für die Praxis . New York, NY: Springer-Verlag NY Inc; 1973. 13. Epstein E. Radiodermatitis . Springfield, III: Charles C Thomas Publisher; 1962. 14. Kohn H, Fry M. Radiation carcinogenesis . N Engl J Med. 1984;310:504-511.Crossref 15. Rowell NR. A follow-up study of superficial radiotherapy for benign dermatoses: recommendations for the use of x-rays in dermatology . Br J Dermatol. 1973;88:583-590.Crossref 16. Rowell NR. Adverse effects of superficial x-ray therapy and recommendation for safe use in benign dermatoses . J Dermatol Surg Oncol. 1978;4:630-634.Crossref 17. Sulzberger MB, Baer RL, Borota A. Do roentgen ray treatments as given by skin specialists produce cancers or other sequelae? Arch Dermatol Syphilol. 1952;65:639-655.Crossref 18. Martin H, Strong E, Spiro RH. Radiation induced skin cancer of the head and neck . Cancer. 1970;25:61-71.Crossref 19. Traenkle HL. Late radiation injury and cutaneous neoplasia . In: Helm F, ed. Cancer Dermatology . Philadelphia, Pa: Lea & Febiger; 1979. 20. International Commission on Radiological Protection (ICRP). Recommendations of the International Commission on Radiological Protection . Elmsford, NY: Pergamon Press Inc; 1977. Publication 26. 21. National Academy of Sciences—National Research Council. The effects on populations of exposure to low levels of ionizing radiation. In: Report of the Advisory Committee on the Biological Effects of Ionizing Radiation (BEIR). Washington, DC: US Government Printing Office; 1972. 22. Stout AP. Fibrosarcoma: the malignant tumor of fibroblasts . Cancer. 1948;1:30-63.Crossref 23. Gladstone WS, Jerr HD. Epidermoid carcinoma of the lower lip . AJR Am J Roentgenol. 1958;78:780-789. 24. Bart RS, Kopf AW, Petratos MA. x-Ray therapy of skin cancer: evaluation of a 'standardized' method for treating basal cell epitheliomas . In: Proceedings of the Sixth National Cancer Conference . Philadelphia, Pa: JB Lippincott; 1968. 25. Ehring F, Gattwinkel W. Die Strahlentherapie des Basalioms der Oberlippe . Hautarzt. 1974;25:368-372. 26. Orton CG, Ellis F. A simplification in the use of the NSD concept in practical radiotherapy . Br J Radiol. 1973;46:529-537.Crossref 27. Landthaler M, Braun-Falco O. Anwendung des TDF-Faktors in der Röntgenweichstrahlentherapie . Hautarzt. 1989;40:774-777.

Journal

Archives of DermatologyAmerican Medical Association

Published: Feb 1, 1995

References