Il problema della bio- radiodermatite

1. Il problemadella bio-radiodermatite E. Maranzano E. Russi

2. Radioterapia associata a CT incidenza dermatite da radiazione Author Dose RT inizio G3 CT EGFRI N-pz G>3 Adelstein 03 Intergroup 70 Gy DDP 95 brac.B 7.3% ECOG 3303 70 Gy DDP CET 69 pts 15% Argiris ASCO 2008 70 Gy TPEXPEE CET 39 27% Wong 2006 70 Gy- 5 Fu, Hydr-Paclitaxel 59 63%

3. Erythema Dry desquamation Moist Desquamation Necrosis Skin fold Other than Skin fold

4. A What CTCAE-grade are these? …. B 38 Gy 42 Gy C 44 Gy

5. N Engl J Med 2007;357:514–5. ….. And this ? necrosis or ulceration of full thickness dermis? ….

6. Complete loss of the epidermis Mixed perivascular and interstitial inflammatory infiltrate (Lymphocyte,histiocytes, neuthrophils and eosynophyls) N Engl J Med 2007;357:514–5. ….. And this ? necrosis or ulceration of full thickness dermis? ….

7. Strahlenther Onkol 2008;184:105–10 N Engl J Med 2007;357:514–5. 3 m. later

8. Radioterapia associata a EGFRiincidenza dermatite da radiazione Author Dose RT inizio G3 CT EGFRI N-pz G>3 Bonner 2006 - - Cet 208 23% Giro 2009 44,8 Gy - Cet 71 49% Pryor 2009 45 Gy - Cet 13 77% ALTERCC Merlano dati personali >66 Gy 5Fu +DDP Cet 45 97% prospettico retrospettivi

9. The proposed scale maintains the original grading of the CTCAE v4.0, with the exception of the removal of grade 5 (“death”).

10. Erythema Dry desquamation Moist Desqumation Necrosis Skin fold Other than Skin fold Dry desquamation with Non-Hemorrhagic crusts mostly confined to skin fold Non-Hemorrhagic crustsother than in skin fold and mostly confined to skin fold; Bleeding by minor trauma Extensive confluent hemorrhagic crusts (>50 of involved field) Bernier, Russi, Homey,Merlano et. Al. Annals 2011

12. 1 CTCAE v. 4 Adv. Event according to MEdDRA-rationale- The major change in v.4 is that each CTCAE term is a Medical Dictionary for Regulatory Activities (MedDRA) Lowest-Level Term *preparing a meal, shopping, using telephone. § bathing, dressing, self feeding, using the toilet

16. Jerarchical

19. It does not provide severity grading of the terms

20. CTCAE v. 4 Adv. Event according to MEDRA-rationale- The major change in v.4 is that each CTCAE term is a Medical Dictionary for Regulatory Activities (MedDRA) Lowest-Level Term *preparing a meal, shopping, using telephone. § bathing, dressing, self feeding, using the toilet

21. CTCAE v. 4 Adv. Event according to MEDRA-rationale- RT BIO The major change in v.4 is that each CTCAE term is a Medical Dictionary for Regulatory Activities (MedDRA) Lowest-Level Term *preparing a meal, shopping, using telephone. § bathing, dressing, self feeding, using the toilet

22. CTCAE v. 4 Adv. Event according to MEDRA-rationale- RT BIO The major change in v.4 is that each CTCAE term is a Medical Dictionary for Regulatory Activities (MedDRA) Lowest-Level Term *preparing a meal, shopping, using telephone. § bathing, dressing, self feeding, using the toilet

23. CTCAE v. 4 Adv. Event according to MEDRA-rationale- RT BIO The major change in v.4 is that each CTCAE term is a Medical Dictionary for Regulatory Activities (MedDRA) Lowest-Level Term *preparing a meal, shopping, using telephone. § bathing, dressing, self feeding, using the toilet

24. CTCAE v. 4 Adv. Event according to MEDRA-rationale- Systemic involvement RT BIO Systemic inflammatory response syndrome The major change in v.4 is that each CTCAE term is a Medical Dictionary for Regulatory Activities (MedDRA) Lowest-Level Term *preparing a meal, shopping, using telephone. § bathing, dressing, self feeding, using the toilet

25. 2014 in press

26. Ann Oncol 2013;24(9):2463–5.

27. GRAZIE