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Response to the Comment on "Photobiomodulation therapy for the prevention of acute radiation dermatitis (RD) in head and neck cancer patients (DERMIS- HEAD trial)" by He et al

Tijdschriftbijdrage - Brief

Response to the Comment on ''Photobiomodulation therapy for the prevention of acute radiation dermatitis (RD) in head and neck cancer patients (DERMIS-HEAD trial)" by He et al. To the Editor We want to thank He et al. for the letter [1], allowing us to clarify some points of our paper [2]. 1) The DERMISHEAD trial described in this paper is the first double-blinded randomized controlled trial (RCT) in head and neck (HNC) cancer patients studying the effectiveness of photobiomodulation (PBM) in the prevention and management of acute radiodermatitis (ARD) [2]. All patients and outcome assessors were blinded to the intervention. The patients wore eye shields, and the control group received a placebo treatment. Only the device operator knew the allocation of the patients in the groups. In the study by Zhang et al. the patients nor the outcome assessors were blinded, which could have influenced the results [3]. 2) Regarding the study by Park et al., in our discussion section, we reported their data on the severity of ARD at the end of week 6, as this correlates to the end of radiotherapy (RT). Our final data of the DERMISHEAD paper was also collected at the end of RT. This time point correlates with weeks 6-7, depending on the total dose to the boost region. We did not include a follow-up moment. At the end of RT, 39% of the patients in the study by Park et al. had grade 2 ARD and no grade 3 ARD. The data that He et al. reports are the data of one-week follow-up, and indeed at this timepoint, the skin reactions aggravated up to 33% grade 2 and 9% grade 3 ARD [1,4]. 3) The timepoints on which the outcome measures were collected were based on the total dose delivered to the boost region. A dose of 40 Gy to the boost region correlates to fraction 20 or week of 4 RT. Our previous studies with breast cancer patients also selected fraction 20 of RT and final RT as time points [5,6]. In our case, it was not feasible for the study team to collect the skin reactions weekly. In literature is described that ARD grade 2-3 typically starts to occur after a moderately high dose has been delivered to the skin (e.g., 35-40 Gy in 2 Gy per fraction) [7-9]. We have chosen these doses as our target is to prevent the more severe types of ARD (grade 2-3) with PBM. In conclusion, further research is certainly needed to make hard conclusions regarding PBM and ARD. Future studies should incorporate a double-blind RCT design with a larger patient population, well-described and complete PBMT parameters, and a longer follow-up time. References [1] He J, Qian L, Gao J. Comment on ''Photobiomodulation therapy for the prevention of acute radiation dermatitis (RD) in head and neck cancer patients (DERMISHEAD trial)". Radiother Oncol 2021. [2] Robijns J, Lodewijckx J, Claes S, Van Bever L, Pannekoeke L, Censabella S, et al. Photobiomodulation therapy for the prevention of acute radiation dermatitis in head and neck cancer patients (DERMISHEAD trial). Radiother Oncol 2021;158:268-75. https://doi.
Tijdschrift: Radiotherapy and oncology
ISSN: 0167-8140
Volume: 169
Pagina's: 143 - 144
Jaar van publicatie:2022
Toegankelijkheid:Closed