Radiodermatitis: severity, predictive factors and discontinuation of radiotherapy in patients with anal and rectal cancer

Bastos, Larissa Jucá Dantas; Lanzillotti, Regina Serrão; Brandão, Marcos Antônio Gomes; da Silva, Rafael Celestino; Simões, Fabiana Verdan

doi:10.1590/1980-220X-REEUSP-2021-0378en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2021-0378en copy

Radiodermatitis: severity, predictive factors and discontinuation of radiotherapy in patients with anal and rectal cancer

Radiodermitis: gravedad, factores predictivos y suspensión de la radioterapia en pacientes con cáncer anal y rectal

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to determine the prevalence of radiodermatitis, severity grades and predictive factors of its occurrence in patients with anal and rectal cancer followed up by the nursing consultation, and to analyze the association of severity grades of radiodermatitis with temporary radiotherapy interruption.

Method:

a quantitative, cross-sectional and retrospective study, carried out with 112 medical records of patients with anal and rectal cancer undergoing curative radiotherapy followed up in the nursing consultation. Data were collected using a form and analyzed using analytical and inferential statistics.

Results:

99.1% of patients had radiodermatitis, 34.8% of which were severe. The predictive factors were female sex, age greater than 65 years, anal canal tumor, treatment with cobalt device and IMRT technique. Treatment interruption occurred in 13% of patients, associated with severe radiodermatitis.

Conclusion:

there was a high prevalence of radiodermatitis, mainly severe, which resulted in treatment interruption.

DESCRIPTORS
Radiodermatitis; Rectal Neoplasms; Prevalence; Nursing Care

	Radiodermatitis grades
Variables	Grades 0–2		Grades 3–4		OR (95% CI)*	p**
	n	%	n	%
Sex
Male	35	77.8	10	22.2	1.0
Female	38	56.7	29	43.3	2.60 (1.05–6.36)	0.038
Age
Up to 64 years	43	75.4	14	24.6	1.0
65 years and older	30	54.5	25	45.5	2.56 (1.15–5.72)	0.020
Education
Educated	71	66.4	36	33.6	1.0
Uneducated	2	40.0	3	60.0	2.96 (0.47–18.51)	0.227
Skin color
White	32	72.7	12	27.3	1.0
Non-white	41	60.3	27	39.7	1.76 (0.77–3.99)	0.177
Marital coexistence
Yes	38	74.5	13	25.5	1.0
No	35	57.4	26	42.6	2.17 (0.97–4.88)	0.058
Smoking
Never smokers	41	71.9	16	28.1	1.0
Former smokers	19	59.4	13	40.6	1.75 (0.70–4.37)	0.228
Smokers	10	58.8	7	41.2	1.79 (0.58–5.53)	0.309
Alcohol use
No	38	62.3	23	37.7	1.0
Yes	32	71.1	13	28.9	0.67 (0.29–1.53)	0.343
Comorbidity
No	29	65.9	15	34.1	1.0
Yes	42	65.6	22	34.4	1.01 (0.45–2.27)	0.976
Tumor stage
1	4	57.1	3	42.9	1.0
2	55	72.4	21	27.6	0.51 (0.11–2.47)	0.402
3	14	48.3	15	51.7	1.42 (0.27–7.54)	0.675
Tumor site
Rectum	58	78.4	16	21.6	1.0
Anal canal	15	39.5	23	60.5	5.56 (2.37–13.06)	<0.0001
Diarrhea report
No	46	66.7	23	33.3	1.0
Yes	27	62.8	16	37.2	1.19 (0.54–2.63)	0.675

	Radiodermatitis grades
Variables	Grades 0–2		Grades 3–4
	n	%	n	%	OR (95% CI)*	p**
Device type
Linear accelerator	66	70.2	28	29.8	1.0
Cobalt	7	38.9	11	61.1	3.70 (1.30–10.54)	0.011
Total dose
4,200 to 5,000 cGy	16	59.3	11	40.7	1.0
5,400 to 6,000 cGy	57	67.1	28	32.9	0.72 (0.29–1.74)	0.459
Technique type
2D or 3D	42	75.0	14	25.0	1.0
IMRT and VMAT	31	55.4	25	44.6	2.42 (1.09–5.40)	0.029
Combined CT **
No	12	70.6	5	29.4	1.0
Yes	58	63.0	34	37.0	1.41 (0.46–4.34)	0.551

	Treatment interruption
Variables	Yes		No
	n	%	n	%	OR (95% CI)*	p**
Radiodermatitis grades
Grades 0–2***	0	–	73	100
Grades 3–4	15	38.5	24	61.5	–	<0.0001
Device type
Linear accelerator	11	11.7	83	88.3	1.0
Cobalt	4	22.2	14	77.8	0.46 (0.13–1.66)	0.230

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Rafael Celestino da Silva Rua Afonso Cavalcanti, nº 275, Cidade Nova 20211-110 – Rio de Janeiro, RJ, Brazil rafaenfer@yahoo.com.br