title: Late side-effects with cosmetic relevance following soft X-ray therapy of cutaneous neoplasias.
abstract: BACKGROUND
  Cosmetic changes are to be expected after radiotherapy for skin tumours.
  
  
  OBJECTIVE
  This study aimed to answer the questions: How frequent are cosmetic changes after soft X-ray therapy? Do treatment parameters, tumour thickness, localization and size of the irradiated field have a major influence? Were patients irritated by the visual appearance of the irradiated field?
  
  
  METHODS
  In total, 2474 examinations of 1149 irradiated fields were performed.
  
  
  RESULTS
  Hypopigmentation was found in 64.7% of examinations more than 90 days after therapy, teleangiectases in 43.1%, erythema in 24.8%, and hyperpigmentation in 16.8%. The frequency of hypopigmentation, teleangiectases and hyperpigmentation increased with time from X-ray exposure; more than 4 years after therapy hypopigmentation was diagnosed in 91.8% and teleangiectases in 82.2% of examinations. Total dose, the time-dose-fractionation factor (TDF), field size and dose per fraction were significantly related to the frequency of cosmetic changes. Incidence rates of cosmetic changes differed by less than 15% if different treatment conditions were compared: thicker vs. thinner tumours, larger vs. smaller fields, higher vs. lower total doses, doses per fraction, and TDF. Frequencies of hypopigmentation, teleangiectases, erythema and hyperpigmentation differed by more than 15% between some localizations on the head. Women reported irritation by the visual appearance of the irradiated field in 12.6% of 1116 interviews, and men in 4.4% of 1284 interviews.
  
  
  CONCLUSIONS
  Cosmetic changes after soft X-ray therapy are relatively frequent. Treatment parameters, tumour thickness and field size have only a minor influence. Few patients, but more women than men, were irritated by the visual appearance of the irradiated field.
authors.affiliation: Fachklinik Hornheide, Dorbaumstrasse 300, D-48157 Münster, Germany. drrainerrupprecht@yahoo.de
authors.forename: R
authors.initials: R
authors.lastname: Rupprecht
authors.forename: A
authors.initials: A
authors.lastname: Lippold
authors.forename: C
authors.initials: C
authors.lastname: Auras
authors.forename: G
authors.initials: G
authors.lastname: Bramkamp
authors.forename: C
authors.initials: C
authors.lastname: Breitkopf
authors.forename: H-J
authors.initials: HJ
authors.lastname: Elsmann
authors.forename: Em
authors.initials: E
authors.lastname: Habenicht
authors.forename: V
authors.initials: V
authors.lastname: Jasnoch
authors.forename: H
authors.initials: H
authors.lastname: Müller-Pannes
authors.forename: K-W
authors.initials: KW
authors.lastname: Schulte
authors.forename: L
authors.initials: L
authors.lastname: Suter
mesh_terms: D016009:Chi-Square Distribution; D002921:Cicatrix / Q000209:etiology; D004890:Erythema / Q000209:etiology; D004954:Esthetics; D005260:Female; D006801:Humans; D017496:Hypopigmentation / Q000209:etiology; D008297:Male; D011855:Radiodermatitis / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012867:Skin / Q000528:radiation effects*; D012878:Skin Neoplasms / Q000532:radiotherapy*; D013684:Telangiectasis / Q000209:etiology