Skip to main content

Advertisement

SpringerLink
Log in

The effects on pain and activity of daily living caused by crusted exudation in patients with head and neck cancer treated with cetuximab and radiotherapy

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

To date, the specific role of “in-field” crusting exudation on pain and on activity of daily living (ADL) in head and neck cancer (HNSCC) patients undergoing treatment with cetuximab and radiochemotherapy has been neglected. The purpose of the study was to evaluate the role of crusting exudation on the severity of pain and ADL

Methods

Thirty-seven of the 45 HNSCC patients enrolled in the alternating radiotherapy, chemotherapy, and cetuximab trial were evaluated in this study. The main radiodermatitis signs (the intensity of erythema, the extension of dry, and moist desquamation and of necrosis)—including crusting exudation severity—pain, ADL, and radiodermatitis scores were registered at least weekly during and after treatment. The correlation between crusting exudation and pain or ADL was evaluated.

Results

The “in-field” crusting exudation score seemed to have the strongest correlation with pain (Spearman’s rho = 0.897; p < 0.001) and the most intense influence on it (Co-B = 0.715; 95% C.I. = 0.643–0.787). However, it seemed to have a weaker correlation with ADL than the other clinical radiodermatitis signs.

Conclusions

Crusts have the strongest correlation with pain in patients with Cetuximab-related radiation dermatitis. Moreover, the presence of crusts can lead operators to misclassify dermatitis as score 4, causing unnecessary delays or interruptions in treatment

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Harari PM, Huang S (2001) Head and neck cancer as a clinical model for molecular targeting of therapy: combining EGFR blockade with radiation. Int J Radiat Oncol Biol Phys 49:427–433

    Article  PubMed  CAS  Google Scholar 

  2. Tejwani A, Wu S, Jia Y et al (2009) Increased risk of high-grade dermatologic toxicities with radiation plus epidermal growth factor receptor inhibitor therapy. Cancer 115:1286–1299

    Article  PubMed  CAS  Google Scholar 

  3. Woodworth CD, Michael E, Marker D et al (2005) Inhibition of the epidermal growth factor receptor increases expression of genes that stimulate inflammation, apoptosis, and cell attachment. Mol Cancer Ther 4:650–658

    Article  PubMed  CAS  Google Scholar 

  4. Busam K, Capodieci P, Motzer R et al (2001) Cutaneous side-effects in cancer patients treated with the antiepidermal growth factor receptor antibody C225. Br J Dermatol 144:1169–1176

    Article  PubMed  CAS  Google Scholar 

  5. Albanell J, Rojo F, Averbuch S et al (2002) Pharmacodynamic studies of the epidermal growth factor receptor inhibitor ZD1839 in skin from cancer patients: histopathologic and molecular consequences of receptor inhibition. J Clin Oncol 20:110–124

    Article  PubMed  CAS  Google Scholar 

  6. Budach W, Bolke E, Homey B (2007) Severe cutaneous reaction during radiation therapy with concurrent cetuximab. N Engl J Med 357:514–515

    Article  PubMed  CAS  Google Scholar 

  7. Russi EG, Merlano MC, Comino A, Numico G (2007) Ultrathin hydrocolloid dressing in skin damaged from alternating radiotherapy and chemotherapy plus cetuximab in advanced head and neck cancer (G.O.N.O. AlteRCC Italian Trial): In Regard to Macmillan et al. (Int J Radiat Oncol Biol Phys 2007;68:864–872). Int J Radiat Oncol Biol Phys 69:638–639

    Article  PubMed  CAS  Google Scholar 

  8. Eaby B, Culkin A, Lacouture M (2008) An interdisciplinary consensus on managing skin reactions associated with human epidermal growth factor receptor inhibitors. Clin J Oncol Nurs 12:283–290

    Article  PubMed  Google Scholar 

  9. Melosky B, Burkes R, Rayson D et al (2009) Management of skin rash during egfr-targeted monoclonal antibody treatment for gastrointestinal malignancies: Canadian recommendations. Curr Oncol 16:16–26

    Article  PubMed  CAS  Google Scholar 

  10. Pryor DI, Porceddu SV, Burmeister BH et al (2009) Enhanced toxicity with concurrent cetuximab and radiotherapy in head and neck cancer. Radiother Oncol 90:172–176

    Article  PubMed  CAS  Google Scholar 

  11. Merlano M, Russi E, Benasso M et al (2011) Cisplatin-based chemoradiation plus cetuximab in locally advanced head and neck cancer: a phase II clinical study. Ann Oncol 22:712–717

    Article  PubMed  CAS  Google Scholar 

  12. Studer G, Brown M, Salgueiro EB et al (2011) Grade 3/4 dermatitis in head and neck cancer patients treated with concurrent Cetuximab and IMRT. Int J Radiat Oncol Biol Phys 81:110–117

    Article  PubMed  Google Scholar 

  13. Lee N, Chuang C, Quivey JM et al (2002) Skin toxicity due to intensity-modulated radiotherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys 53:630–637

    Article  PubMed  Google Scholar 

  14. Curran D, Giralt J, Harari PM et al (2007) Quality of life in head and neck cancer patients after treatment with high-dose radiotherapy alone or in combination with cetuximab. J Clin Oncol 25:2191–2197

    Article  PubMed  CAS  Google Scholar 

  15. Joshi SS, Ortiz S, Witherspoon JN et al (2010) Effects of epidermal growth factor receptor inhibitor-induced dermatologic toxicities on quality of life. Cancer 116:3916–3923

    Article  PubMed  Google Scholar 

  16. Wagner LI, Lacouture ME (2007) Dermatologic toxicities associated with EGFR inhibitors: the clinical psychologist’s perspective. Impact on health-related quality of life and implications for clinical management of psychological sequelae. Oncology (Williston Park) 21(11 Suppl 5):34–36

    Google Scholar 

  17. Page DL, Fleming ID, Fritz A et al (2002) AJCC cancer staging manual, 6th edn. Springer, New York

    Google Scholar 

  18. Merlano M, Benasso M, Corvò R et al (1996) Five-year update of a randomized trial of alternating radiotherapy and chemotherapy compared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck. J Natl Cancer Inst 88:583–589

    Article  PubMed  CAS  Google Scholar 

  19. Common Terminology Criteria for Adverse Events v3.0 (CTCAE), U.S. Department of Health and Human Services, National Institutes of Health National Cancer Institute (2006) https://webapps.ctep.nci.nih.gov/webobjs/ctc/webhelp/welcome_to_ctcae.htm. Accessed April 12, 2011

  20. Noble-Adams R (1999) Radiation-induced skin reactions. 2: development of a measurement tool. Br J Nurs 8:1208–1211

    PubMed  CAS  Google Scholar 

  21. Noble-Adams R (1999) Radiation-induced skin reactions. 3: evaluating the RISRAS. Br J Nurs 8:1305–1312

    PubMed  CAS  Google Scholar 

  22. MacBride SK, Wells ME, Hornsby C et al (2008) A case study to evaluate a new soft silicone dressing, mepilex lite, for patients with radiation skin reactions. Cancer Nurs 31:E8–E14

    Article  PubMed  Google Scholar 

  23. Wells M, MacBride S (2004) Radiation skin reactions. In: Faithful S, Wells M (eds) Supportive care in radiotherapy. Churchill Livingstone, Edinburgh, pp 135–159

    Google Scholar 

  24. Simon R (1989) Optimal two-stage designs for phase II clinical trials. Control Clin Trials 10:1–10

    Article  PubMed  CAS  Google Scholar 

  25. Bölke E, Gerber PA, Lammering G et al (2008) Development and management of severe cutaneous side effects in head-and-neck cancer patients during concurrent radiotherapy and cetuximab. Strahlenther Onkol 184:105–110

    Article  PubMed  Google Scholar 

  26. Noble-Adams R (1999) Radiation-induced reactions. 1: an examination of the phenomenon. Br J Nurs 8:1134–1140

    PubMed  CAS  Google Scholar 

  27. Pastore S, Mascia F, Mariotti F et al (2005) ERK1/2 regulates epidermal chemokine expression and skin inflammation. J Immunol 174:5047–5056

    PubMed  CAS  Google Scholar 

  28. Pastore S, Mascia F, Mariani V, Girolomoni G (2008) The epidermal growth factor receptor system in skin repair and inflammation. J Invest Dermatol 128:1365–1374

    Article  PubMed  CAS  Google Scholar 

  29. Common Terminology Criteria for Adverse Events (CTCAE) and Common Toxicity Criteria (CTC) v. 4. U.S.Department of Health and Human Services, National Institutes of Health National Cancer Institute (2009) http://evs.nci.nih.gov/ftp1/CTCAE/About.html. Accessed July 10, 2010

  30. Fayers P, Weeden S, Curran D, on behalf of the EORTC Quality of Life Study Group (1998) EORTC QLQ-C30 reference values. EORTC, Brussels

    Google Scholar 

  31. National Cancer Institure, Center for Bioinformatics (2010) CTCAE: redesign and life cycle management. http://evs.nci.nih.gov/ftp1/CTCAE/Documentation/CTCAE_Governance_2010-03-11.pdf. Accessed 19 December 2010

  32. Bernier J, Russi EG, Homey B et al (2011) Management of radiation dermatitis in patients receiving cetuximab and radiotherapy for locally advanced squamous cell carcinoma of the head and neck: proposals for a revised grading system and consensus management guidelines. Ann Oncol 22:2191–2200

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Luigi Russi and Terry Sullivan revised the English text of the manuscript.

Funding

This study was partly supported by Lega Tumori sezione di Cuneo.

Disclosures

None.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Santa Croce General Hospital, 14, corso Giolitti, 12100, Cuneo, Italy

    Elvio G. Russi

  2. Department of Medical Oncology, Santa Croce General Hospital, Cuneo, Italy

    Marco C. Merlano & Ida Colantonio

  3. Department of Medical Oncology, “U. Parini” Hospital, Aosta, Italy

    Gianmauro Numico

  4. Department of Radiation Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy

    Renzo Corvò

  5. Department of Medical Oncology, “S. Paolo” Hospital, Savona, Italy

    Marco Benasso

  6. Department of Radiation Oncology, Santa Croce General Hospital, Cuneo, Italy

    Riccardo Vigna-Taglianti & Antonella Melano

  7. Department of Oncology, University of Messina, Messina, Italy

    Nerina Denaro

  8. Department of Radiation Oncology, University of Messina, Messina, Italy

    Stefano Pergolizzi

  9. Department of Medical Physic, Santa Croce General Hospital, Cuneo, Italy

    Francesco Lucio

  10. Department of Histopathology, Santa Croce General Hospital, Cuneo, Italy

    Rodolfo Brizio

  11. Department of Radiotherapy, University of Turin, Turin, Italy

    Umberto Ricardi

Authors
  1. Elvio G. Russi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco C. Merlano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gianmauro Numico
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Renzo Corvò
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marco Benasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Riccardo Vigna-Taglianti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonella Melano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nerina Denaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stefano Pergolizzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ida Colantonio
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Francesco Lucio
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rodolfo Brizio
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Umberto Ricardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elvio G. Russi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Russi, E.G., Merlano, M.C., Numico, G. et al. The effects on pain and activity of daily living caused by crusted exudation in patients with head and neck cancer treated with cetuximab and radiotherapy. Support Care Cancer 20, 2141–2147 (2012). https://doi.org/10.1007/s00520-011-1324-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-011-1324-4

Keywords

Search

Navigation