Late side-effects with cosmetic relevance following soft X-ray therapy of cutaneous neoplasias.
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.
Rupprecht
R
R
Fachklinik Hornheide, Dorbaumstrasse 300, D-48157 Münster, Germany. drrainerrupprecht@yahoo.de
Lippold
A
A
Auras
C
C
Bramkamp
G
G
Breitkopf
C
C
Elsmann
H-J
HJ
Habenicht
Em
E
Jasnoch
V
V
Müller-Pannes
H
H
Schulte
K-W
KW
Suter
L
L
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