Jolien Robijns

Prevention of acute radiodermatitis by photobiomodulation: A randomized, placebo-controlled trial in breast cancer patients (TRANSDERMIS trial): PHOTOBIOMODULATION PREVENTS RADIODERMATITIS

Acute radiodermatitis (RD) is a distressing and painful skin reaction that occurs in 95% of the patients undergoing radiotherapy (RT). The aim of this study was to evaluate the effectiveness of photobiomodulation therapy (PBMT) in the prevention of acute RD in breast cancer (BC) patients undergoing RT.

Letter regarding “Same strategy for pitfalls of radiotherapy in different anatomical districts”

We read with great interest the article entitled, BSame strategy for pitfalls of radiotherapy in different anatomical districts^ authored by Gobbo and colleagues [1]. This paper described the importance of radiodermatitis (RD) being an unresolved and distressing clinical issue in patients undergoing radiotherapy (RT). They concluded that high power laser therapy (HPLT) was beneficial for the management of radiodermatitis (RD). However, we are concerned with a number of clinical and methodological issues of this article such as the study protocol and the presentation of their results. We already have a few years of experience in the research on the use of low-level light therapy (LLLT) for the prevention and management of oral mucositis and RD in breast cancer patients [2–4]. In a recent study of our research group, we were able to show that the LLLT has a beneficial effect on RD by preventing the aggravation of the skin reactions [3].We strongly believe that laser therapy, especially LLLT, will become a major breakthrough in the prevention and treatment of RD. Therefore, we would like to offer the authors our comments on their study about the management of RD with HPLT in breast cancer patients. First of all, they do not state which inclusion and exclusion criteria they used to select their patient group. It is known from literature that several patientand treatment-related risk factors determine the severity of RD [5]. The authors also do not show the percentages of these patientand treatment-related characteristics in their result section. Secondly, we would like to comment on the starting point of HPLT in their study protocol. They state that 12 patients started with HPLT after the end of RT and 15 patients during their RT. They do not specify which criteria they use to define the start of HPLT. As known from literature, the radiation dose determines the severity of RD [5]. Therefore, in our opinion, the authors cannot properly compare the degree of RD between the patients in this study setting. Thirdly, the results that they present could be more detailed. The authors only show RD severity, pain, itching, and bleeding scores before the start of HPLT. The data of these parameters during and after HPLT are not presented. The authors only show significant pvalues of the pain, itching, and bleeding scores. Further, they state that the patients’ skin reactions completely healed in the follow-up period, and thereby, they refer us to remarkable photographs in their article. From these photographs, it is not clear during which phase of RT and how long after the end of RT they have been taken. A more detailed timestamp of the pictures would clarify the results. In conclusion, this study showed some disadvantages in their study design and outcome assessment, which reduced the reliability of their conclusion. However, like we mentioned before, we strongly support all new prevention and treatment options for RD, especially concerning laser therapy. Therefore, we believe that a randomized controlled trial would be the best way to prove the beneficial effect of HPLT for the treatment of RD. * Jolien Robijns Jolien.robijns@uhasselt.be