Fatores de risco para desenvolvimento de radiodermite em mulheres com câncer de mama
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Data
2019-02-27
Autores
Cavalcante, Loren Giagio
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A radioterapia tem demonstrado importante papel no controle loco-regional e à distância no tratamento de câncer de mama com aumento da taxa de sobrevida. Entretanto a radiodermite é um evento adverso com alta incidência nos tratamentos desta neoplasia. O objetivo deste estudo é avaliar a incidência de radiodermite e os fatores associados a sua gravidade e ao momento de ocorrência deste efeito colateral durante a radioterapia de mulheres com câncer de mama. Método: Estudo de coorte prospectivo e analítico, conduzido no Setor Técnico de Radioterapia do Hospital das Clínicas da Faculdade de Medicina de Botucatu – Unesp. Foram incluídas 117 pacientes com câncer de mama no período de fevereiro a setembro de 2017, com idade superior a 18 anos. As pacientes foram avaliadas na admissão e a cada cinco aplicações de radioterapia até o término do tratamento. Foram utilizados os testes de Qui-quadrado ou Exato de Fisher para as variáveis categóricas e Teste T para amostras independentes para as variáveis contínuas paramétricas e Kruskall-Wallis para as não paramétricas. Para a avaliação dos fatores de risco aplicou-se o modelo de regressão logística e modelo de regressão proporcional de Cox. Foram considerados significativos os valores de p menores que 0,05. Resultados: A taxa de incidência de radiodermite em topografia mamária foi de 98,2% e demonstrou que para cada ponto a mais do IMC aumenta-se em 14% a chance de ocorrência de radiodermite nos graus II a IV [OR = 1,14 (IC95% 1,04 – 1,26); p=0,004] e que o uso de estatina concomitante à radioterapia aumenta quatro vezes o risco destas lesões cutâneas em graus maiores [OR = 4,27 (IC95% 1,11 – 16,42); p=0,035]. O uso exclusivo do hidrogel para hidratação da pele foi um fator independente para retardar o início da radiodermite quando comparado com as pacientes que utilizaram hidrogel associado a cremes hidratantes [HR = 0,55 (IC95% 0,36 – 0,82); p=0,004]. Para a radioterapia realizada em topografia de fossa supraclavicular a taxa de incidência foi de 97,5% e que a presença de hipotireoidismo foi um fator independente para reduzir o tempo livre de radiodermite [HR=5,22 (1,09 – 24,90); p=0,04], enquanto que, o uso exclusivo do hidrogel aumentou o tempo livre de radiodermite [HR= 0,38 (0,18 – 0,79); p=0,009]. Conclusão. Houve elevada incidência da radiodermite nos tratamentos de câncer de mama, tanto em topografia mamária quanto na fossa supraclavicular. Aumento do IMC e uso de estatina são fatores independentes ao desenvolvimento de radiodermite em graus maiores na mama e o uso exclusivo do hidrogel foi fator protetor. Pacientes com hipotireoidismo apresentam radiodermite mais precoce na fossa supraclavicular enquanto que o uso exclusivo do hidrogel atrasa seu surgimento. A identificação destes fatores permite melhorar o manejo clínico desta importante toxicidade cutânea da radioterapia.
Introduction. The radiotherapy has an important role in locoregional and distant control of the neoplasia, increasing the disease-free and overall survival rates. However, the radiodermatitis is an adverse effect with high incidence in this treatment. The aim of this study is to evaluate the incidence of radiodermatitis in women with breast cancer, identify the factors associated with its severity, and determine the time this side effect occurs during radiotherapy. Methods. This was a prospective and analytical cohort study which was carried out in the Radiotherapy Sector of the Hospital das Clínicas de Botucatu, Botucatu Medical School (Brazil). One hundred seventeen patients included were women over 18 years of age who were diagnosed with breast cancer and admitted to the service from February to September 2017. The patients were evaluated at the time of inclusion in the study, before radiotherapy was started, and around every fifth application (with an evaluation window varying from three to seven applications) until the end of treatment. Chi-square or Fisher's exact tests were used for categorical variables and T-Test for independent samples for parametric continuous variables and Kruskall-Wallis for non-parametric variables. For the assessment of risk factors, the logistic regression and the Cox proportional regression model was used. P values lower than 0.05 were considered significant. Results. The incidence rate of radiodermatitis in breast area was 98.2% and it were demonstrated that for each additional point of Body Mass Index (BMI) the chance of occurrence of radiodermatitis in grades II to IV increases by 14% [OR = 1.14 (CI95% 1.04 – 1.26); p=0.004] and the use of statin increases the risk of severe skin lesions by four times [OR = 4.27 (CI95% 1.11 – 16.42); p=0.035]. The exclusive use of hydrogel for skin hydration was an independent factor to delay the onset of radiodermatitis when compared to patients using hydrogel associated with moisturising creams [HR = 0.55 (CI95% 0.36 – 0.82); p=0.004]. To the radiotherapy performed in the supraclavicular fossa the incidence rate of radiodermatitis was 97.5% and the hypothyroidism was an independent factor to decrease the free time of radiodermatitis [HR=5.22 (1.09 – 24.90); p=0.04] while the exclusive use of hydrogel for skin hydration increases the free time of radiodermatitis [HR= 0.38 (0.18 – 0.79); p=0.009]. Conclusions. The incidence rate of radiodermatitis was high to both radiation sites, breast and supraclavicular fossa. High BMI and use of statin are independent risk factors to severe radiodermititis in breast area and the exclusive use of hydrogel was a protector factor. Patients with hypothyroidism have radiodermatitis more earlier in the supraclavicular fossa while the exclusive use of hydrogel delays its onset. The identification of these factors allows to improve the clinical management of this important cutaneous toxicity of radiotherapy.
Introduction. The radiotherapy has an important role in locoregional and distant control of the neoplasia, increasing the disease-free and overall survival rates. However, the radiodermatitis is an adverse effect with high incidence in this treatment. The aim of this study is to evaluate the incidence of radiodermatitis in women with breast cancer, identify the factors associated with its severity, and determine the time this side effect occurs during radiotherapy. Methods. This was a prospective and analytical cohort study which was carried out in the Radiotherapy Sector of the Hospital das Clínicas de Botucatu, Botucatu Medical School (Brazil). One hundred seventeen patients included were women over 18 years of age who were diagnosed with breast cancer and admitted to the service from February to September 2017. The patients were evaluated at the time of inclusion in the study, before radiotherapy was started, and around every fifth application (with an evaluation window varying from three to seven applications) until the end of treatment. Chi-square or Fisher's exact tests were used for categorical variables and T-Test for independent samples for parametric continuous variables and Kruskall-Wallis for non-parametric variables. For the assessment of risk factors, the logistic regression and the Cox proportional regression model was used. P values lower than 0.05 were considered significant. Results. The incidence rate of radiodermatitis in breast area was 98.2% and it were demonstrated that for each additional point of Body Mass Index (BMI) the chance of occurrence of radiodermatitis in grades II to IV increases by 14% [OR = 1.14 (CI95% 1.04 – 1.26); p=0.004] and the use of statin increases the risk of severe skin lesions by four times [OR = 4.27 (CI95% 1.11 – 16.42); p=0.035]. The exclusive use of hydrogel for skin hydration was an independent factor to delay the onset of radiodermatitis when compared to patients using hydrogel associated with moisturising creams [HR = 0.55 (CI95% 0.36 – 0.82); p=0.004]. To the radiotherapy performed in the supraclavicular fossa the incidence rate of radiodermatitis was 97.5% and the hypothyroidism was an independent factor to decrease the free time of radiodermatitis [HR=5.22 (1.09 – 24.90); p=0.04] while the exclusive use of hydrogel for skin hydration increases the free time of radiodermatitis [HR= 0.38 (0.18 – 0.79); p=0.009]. Conclusions. The incidence rate of radiodermatitis was high to both radiation sites, breast and supraclavicular fossa. High BMI and use of statin are independent risk factors to severe radiodermititis in breast area and the exclusive use of hydrogel was a protector factor. Patients with hypothyroidism have radiodermatitis more earlier in the supraclavicular fossa while the exclusive use of hydrogel delays its onset. The identification of these factors allows to improve the clinical management of this important cutaneous toxicity of radiotherapy.
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Palavras-chave
Câncer de mama, Enfermagem, Fatores de risco, Radiodermite, Breast cancer, Nursing, Risk factors, Radiodermatitis