[ RadSafe ] LED Pulses Reduce Radiation Effects on Skin in Breast Cancer Patients

[Susan Gawarecki]

ASLMS: LED Pulses Reduce Radiation Effects on Skin in Breast Cancer Patients
http://www.medpagetoday.com/HematologyOncology/BreastCancer/dh/3033
By Neil Osterweil, Senior Associate Editor, MedPage Today

BOSTON, April 7 - Following radiotherapy for breast cancer, women 
exposed to pulses of low-energy non-thermal light-emitting diode (LED) 
photomodulation had significantly less dermatitis than controls.

Eighteen of 19 women who had radiotherapy for breast cancer followed by 
LED photomodulation had only mild or no radiation dermatitis, an adverse 
effect that can affect regimen schedules, said M. Maitland DeLand, M.D., 
of Louisiana State University and a radiation oncologist of Lafayette, La.

In contrast, all 28 controls not given the LED treatment had some degree 
of skin reactions following radiotherapy, she said at the American 
Society for Laser Medicine and Surgery meeting here.

LED photomodulation is widely used in cosmetic dermatology for improving 
skin healing and appearance. The apparatus consists of light-emitting 
diodes in a specific array that emit a non-thermal, low energy light at 
a pulsating frequency.

"The pulses stimulate at the cellular level skins cells such as 
fibroblasts to repair themselves to build up the collagen," Dr. DeLand 
said in an interview. "The other thing is that they interfere with the 
inflammatory pathways that break down the skin and cause erythema."

Dr. DeLand said that radiation-induced dermatitis occurs to some degree 
in about 80% to 90% of women during adjuvant radiotherapy following 
lumpectomy.

The reactions may include dryness, epilation and faint erythema early in 
the course of therapy, often progressing to mild, moderate or 
significant erythema, dryness, hyperemia, dry desquamation and skin 
thickening after two to 4.5 weeks of therapy. In the most severe cases, 
patchy and confluent moist desquamation with loss of epidermal barrier 
and delayed healing.

Women with severe dermatitis have raw, painful skin and may require 
interruption of therapy, she added.

Dr. DeLand and colleagues looked at the potential for LED 
photomodulation to ameliorate skin reactions in women who received 
intensity modulated radiation therapy following breast conserving 
surgery in women with stage I or II disease.

All women had single lymph node sampling or axillary dissection, and 
some had received chemotherapy prior to radiotherapy.

At total of 19 women received daily radiation therapy followed by LED 
treatment, in which 100 pulses of light at 0.15 joules/cm2 for 250 ms 
each are delivered to the irradiated breast (the treatment takes about 
one minute). Women in this group used only a dry skin ointment 
(Aquaphor) after their daily sessions.

Controls were 28 age-matched women who underwent the same radiation 
therapy protocol but no LED photomodulation. These women also were 
allowed to used Aquaphor and other creams as required for cutaneous 
reactions.

All patients had weekly evaluation of the irradiated skin.

The investigators found that seven of the women who had received LED 
photomodulation had no skin reactions, 11 had only mild (Grade 1) 
reactions, and one had moderate (Grade 2) radiation-induced dermatitis.

In addition, none of the patients who underwent photomodulation 
experienced moist skin reactions, although one patient in this group had 
inflammation severe enough to require interruption of radiotherapy. One 
patient with a grade I reaction also required interruption of therapy 
due to an intermammary yeast infection.

Among patients who received the LED therapy but still had grade I 
reactions, the reactions were delayed one to two weeks beyond the time 
that erythema would be expected to develop, the investigators noted.

In contrast, Dr. DeLand said, all patients in the control group had some 
type of skin reaction following radiation. Four patients had mild 
radiation dermatitis, 18 and moderate dermatitis and six had serious 
skin reactions.

Nineteen of the 28 patients who did not receive LED photomodulation 
required temporary interruption of therapy because of erythematous 
reactions and moist desquamation.

Dr. DeLand said that although her colleagues in dermatology and cosmetic 
surgery are well versed in the skin-repair properties of 
photomodulation, many of her radiation oncology colleagues were 
unfamiliar with it.

"The important thing for my breast cancer patients is that they've been 
through surgery, some of them have infections, and then they get chemo, 
and especially when they get a taxane or an Adriamycin 
[doxorubicin]-based drug, that photosensitizes the skin, and when you 
start doing the radiation their skin reaction is typically worse.

"So many of those women, their skin breaks down -- it peels -- and if 
you've ever had a moist skin reaction, you know that it's miserable, " 
Dr. DeLand said.

In all, six of the women in the LED treatment group were available for 
follow-up at three months, and five were available at six months post 
therapy. In all of these patients the surgical scar was barely visible, 
skin texture and pigment were excellent, and the breast tissue was 
smooth and supple, without dryness, she noted.

In contrast, at three months after therapy, women who did not receive 
LED photomodulation have typical late radiation effects, including 
atrophy, telangectasias, and hyper- or hypo-pigmentation. Some women 
also had radiation-induced fibrosis, with long-term induration, edema, 
and dermal thickening.

When LED photomodulation is used with a neutral pH moisturizer to keep 
skin from drying out, it offers a "quick, painless and effective 
solution to combat the skin reactions that may interrupt and compromise 
treatment," she said.

Dr. DeLand disclosed that she had free use of the LED photomodulation 
system for the study, but has no financial interest in the company that 
makes it.

Primary source: American Society for Laser Medicine and Surgery
Source reference:
DeLand MM. "Pilot Study of LED Photomodulation to Reduce Inflammation 
Following Radiation Treatment of Breast Cancer." Late-breaking abstract 
presented April 7, 2006.