title: RTOG, CTCAE and WHO criteria for acute radiation dermatitis correlate with cutaneous blood flow measurements.
abstract: BACKGROUND
  Various clinician-assessed scoring criteria have been used to grade acute radiation dermatitis. However, it is not known whether these scoring criteria correlate with changes in objective skin biophysical parameters and patient-reported symptoms following radiotherapy. We seek to correlate three different clinician-assessed scoring criteria with skin biophysical changes and patient-reported symptoms in breast cancer patients undergoing radiotherapy.
  
  
  METHODS
  A prospective cohort study was performed in a university hospital medical center. The severity of acute radiation dermatitis in 101 breast cancer patients was graded using the RTOG, CTCAE and WHO clinical scoring criteria. We also measured various skin biophysical parameters (skin blood flow, pigmentation, hydration, and pH) by non-invasive techniques before and after radiotherapy. Patient-reported breast symptoms (pain, itching, local heat, and tightness) were evaluated using a questionnaire.
  
  
  RESULTS
  The three different clinician-assessed scoring criteria correlated most strongly with changes in cutaneous blood flow following radiotherapy for breast cancer (correlation coefficient 0.70 for RTOG, 0.68 for CTCAE, and 0.50 for WHO). All three scoring criteria also showed moderate correlation with changes in skin pigmentation (correlation coefficients 0.4-0.5), but showed no significant correlation with skin hydration or pH (correlation coefficients <0.2). The scoring criteria correlated poorly with patient-reported breast symptoms (correlation coefficients <0.3).
  
  
  CONCLUSIONS
  The three clinician-assessed scoring criteria (especially the RTOG and CTCAE criteria) show strong correlation with cutaneous blood flow measurements, but correlate less well with other skin biophysical parameters and patient-reported symptoms.
authors.affiliation: Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Huang
authors.affiliation: Department of General Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; National Sun Yat-Sen University - Kaohsiung Medical University Joint Research Center, Kaohsiung, Taiwan.
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Hou
authors.affiliation: Institute of Occupational Safety and Health, Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Kuei-Hau
authors.initials: KH
authors.lastname: Luo
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan.
authors.forename: Shu-Yi
authors.initials: SY
authors.lastname: Wei
authors.affiliation: Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Ming-Yii
authors.initials: MY
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Suh-Jen
authors.initials: SJ
authors.lastname: Su
authors.affiliation: Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Hung-Ying
authors.initials: HY
authors.lastname: Kuo
authors.affiliation: Translational Research Center, Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Shyng-Shiou F
authors.initials: SS
authors.lastname: Yuan
authors.affiliation: Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Gwo-Shing
authors.initials: GS
authors.lastname: Chen
authors.affiliation: Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: stephenhu30@hotmail.com.
authors.forename: Stephen Chu-Sung
authors.initials: SC
authors.lastname: Hu
authors.affiliation: National Sun Yat-Sen University - Kaohsiung Medical University Joint Research Center, Kaohsiung, Taiwan; Institute of Occupational Safety and Health, Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D011446:Prospective Studies; D011855:Radiodermatitis / Q000503:physiopathology*; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply* / Q000737:chemistry; D012880:Skin Pigmentation / Q000528:radiation effects; D011795:Surveys and Questionnaires
keywords: Breast neoplasms; Microcirculation; Patient outcome assessment; Radiodermatitis; Radiotherapy; Skin pigmentation