Acute Radiation-Induced Skin Reaction in Nasopharyngeal Carcinoma Radiotherapy Patients: A Study Looking for Blood Biochemical Indices as Risk Factors

Abstract

Objectives: Acute radiation-induced skin reaction is a common complication related to nasopharyngeal carcinoma patients. The purpose of this study was to identify risk factors that help to predict the incidence of acute radiation-induced skin reaction and discriminate between moderate and severe acute radiation-induced skin reaction in nasopharyngeal carcinoma patients undergoing radiotherapy. Methods: This is a cross-sectional study including 110 patients with nasopharyngeal carcinoma. Patients were assessed for acute radiation-induced skin reactions by the Radiation Therapy Oncology Group criteria and the Radiotherapy-Induced Skin Reaction Assessment Scale during the final radiotherapy session. Demographic, clinical and blood test index data were collected before and during the radiotherapy. Risk factors associated with the development and severity of radiation-induced skin reaction were determined by univariate and multivariate binary logistic regression. Results: Acute radiation skin reactions were observed in 66 (60%) of the nasopharyngeal carcinoma radiotherapy patients and 14 (21.2%) of them were graded ≥2 skin reactions (moderate and severe acute skin reaction). Univariate analysis of risk factors (gender, age, smoking history, diabetes, the T helper/T suppressor lymphocyte (Th/Ts) ratio and red blood cell counts before radiation) for skin reactions revealed that age, smoking history, stage (I–III), induction chemotherapy, platelet counts, neutrophil ratio and albumin level in mid-radiotherapy were significantly associated with moderate and severe acute skin reaction. After a variable selection process with a logistic regression, Th/Ts ratio before radiotherapy remained significantly associated with acute skin reactions (OR (odds ratio) 2.29, 95% CI (confidence interval) 1.09–4.79, p < 0.05). Serum albumin level <35 g/L in mid-radiotherapy was a significant risk factor related to moderate to severe acute radiation skin damage (OR 6.61, 95% CI 1.31–33.43, p < 0.05). Conclusions: Based on the results of Th/Ts contributed to skin radiosensitivity and albumin level helped to predict the severity. To monitor T helper/T suppressor lymphocyte ratio before radiotherapy and albumin during mid-radiotherapy is a good strategy that may help decreasing the risk of acute radiation skin injury and severe acute radiation skin reactions for nasopharyngeal carcinoma patients who received radiotherapy.