论著摘要 |【Radiomics-综述】慢性辐射诱发的皮炎:挑战和解决方案(双语版)

2018-01-24 10:40:05 admin 0
标签:   影像组学 放疗副作用 皮炎 综述

Chronic radiation-induced dermatitis: challenges and solutions.

发表日期: 2016.12.09   来源:Clin Cosmet Investig Dermatol. 2016 Dec 9;9:473-482.

作者:

Mateusz Spałek1.

作者介绍:

1. Department of Radiotherapy I, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.

摘要

慢性放射性皮炎是皮肤辐射的晚期副作用,可能会使患者的生活质量恶化。缺乏关于其发病率的精确数据;然而,几个风险因素可能会倾向于发展这种状况。它包括放射治疗剂量,分级,技术,并发全身治疗,合并症以及个人和遗传因素。慢性放射性皮炎主要是由促炎和促纤维细胞因子的不平衡引起的。临床表现包括皮肤外观,伤口,溃疡,坏死,纤维化和继发性癌变化。辐射最严重的并发症是广泛的辐射诱导纤维化(RIF)。RIF可以以许多方式表现,如皮肤硬结和退缩,淋巴水肿或关节运动的限制。慢性放射性皮炎的诊断通常通过临床检查进行。在临床表现不清楚的情况下,推荐进行活检和组织病理学检查,以排除继发性恶性肿瘤。 慢性放射性皮炎最有效的预防措施是采用适当的放射治疗技术避免对健康皮肤的不必要的照射。慢性放射性皮炎的治疗方法急需。大多数干预措施仅基于临床实践。脉络膜切除术可用脉冲染料激光治疗。慢性后照射伤口需要特殊的敷料。在坏死或严重溃疡的情况下,可以考虑外科手术。RIF的管理应该是复杂的。可用的方法是康复护理,药物治疗,高压氧疗和激光治疗。未来的挑战包括评估现代照射技术中的晚期皮肤毒性。应该特别注意基因组学和影像组学,让科学家和临床医生选择有发展慢性放射性皮炎风险的患者。强烈需要新的治疗方法和临床试验来提供更有效的治疗方法。

Abstact

Abstract:Chronic radiation dermatitis is a late side effect of skin irradiation, which may deteriorate patients’ quality of life. There is a lack of precise data about its incidence; however, several risk factors may predispose to the development of this condition. It includes radiotherapy dose, fractionation, technique, concurrent systemic therapy, comorbidities, and personal and genetic factors. Chronic radiation dermatitis is mostly caused by the imbalance of proinflammatory and profibrotic cytokines. Clinical manifestation includes changes in skin appearance, wounds, ulcerations, necrosis, fibrosis, and secondary cancers. The most severe complication of irradiation is extensive radiation-induced fibrosis (RIF). RIF can manifest in many ways, such as skin induration and retraction, lymphedema or restriction of joint motion. Diagnosis of chronic radiation dermatitis is usually made by clinical examination. In case of unclear clinical manifestation, a biopsy and histopathological examination are recommended to exclude secondary malignancy. The most effective prophylaxis of chronic radiation dermatitis is the use of proper radiation therapy techniques to avoid unnecessary irradiation of healthy skin. Treatment of chronic radiation dermatitis is demanding. The majority of the interventions are based only on clinical practice. Telangiectasia may be treated with pulse dye laser therapy. Chronic postirradiation wounds need special dressings. In case of necrosis or severe ulceration, surgical intervention may be considered. Management of RIF should be complex. Available methods are rehabilitative care, pharmacotherapy, hyperbaric oxygen therapy, and laser therapy. Future challenges include the assessment of late skin toxicity in modern irradiation techniques. Special attention should be paid on genomics and radiomics that allow scientists and clinicians to select patients who are at risk of the development of chronic radiation dermatitis. Novel treatment methods and clinical trials are strongly needed to provide more efficacious therapies.

关键词:

慢性辐射皮炎;晚期皮肤毒性;辐射诱发的纤维化;放疗副作用

Keywords:

chronic radiation dermatitis; late skin toxicity; radiation-induced fibrosis; radiotherapy side effects

阅读原文:PMID: 28003769  PMCID: PMC5161339  DOI: 10.2147/CCID.S94320


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