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Nonmelanoma Skin Cancer Studies / Chemotherapy-related Skin Toxicity · Journal article
Frontiers in Oncology · August 10, 2026
Early or partial results. Treat as a signal, not a conclusion.
The CEA-RT is a newly developed 5-point visual grading scale for assessing radiation-induced erythema. While it demonstrates strong intra-rater reliability (98% within ±1 grade), inter-rater agreement is only fair and expert concordance is moderate (25–30% high, >50% moderate), indicating substantial variability among clinicians. The authors conclude the tool may be reliable for individual use but requires additional training, in vivo validation, and evaluation in diverse skin types before broader clinical application.
Reliability and validity assessment study. Radiation clinicians assessing radiation-induced dermatitis in skin cancer patients. Intervention: Clinician Erythema Assessment–Radiation Therapy (CEA-RT) 5-point visual grading scale. Compared with: Expert reference standard.
Intra-rater reliability: 98% of scores fell within ±1 grade with consistent regional grading Inter-rater agreement: fair, indicating variability among different clinicians Expert concordance: 25–30% of therapists achieved high concordance and over 50% showed moderate agreement
No comparison to objective measurement methods or established toxicity grading scales reported
The CEA-RT tool shows promise for standardizing radiotherapist assessment of radiation-induced erythema but should not be adopted for routine multi-clinician use without standardized training, as inter-rater agreement remains only fair. Further development and in vivo validation are necessary.
An investigational validation study of a newly developed assessment tool showing acceptable intra-rater but only fair inter-rater reliability, with moderate expert concordance; requires training and in vivo validation before clinical adoption.
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The CEA-RT tool shows promise for standardizing radiotherapist assessment of radiation-induced erythema but should not be adopted for routine multi-clinician use without standardized training, as inter-rater agreement remains only fair. Further development and in vivo validation are necessary.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Purpose Enhancing the quality of radiotherapy for skin cancer requires systematic evaluation of radiation-induced skin toxicity, particularly acute toxicity, which affects ~90% of patients receiving ionizing radiation. This study assessed the reliability of a newly developed visual grading tool, the Clinician Erythema Assessment–Radiation Therapy (CEA-RT), designed to help radiation clinicians evaluate early radiation dermatitis. Methods and materials The CEA-RT tool utilizes a 5-point scale. Its reliability was evaluated by analyzing intra-rater and inter-rater agreement among clinicians, as well as its concordance with an expert reference standard against a reference standard. The assessment was conducted using digital images. Results The study’s results showed high intra-rater reliability, with 98% of scores falling within ±1 grade and consistent grading for regions of interest (ROI). However, inter-rater agreement was only fair, indicating variability among different clinicians. Concordance with an expert reference standard against a reference standard was moderate, with 25–30% of therapists achieving high concordance and over 50% showing moderate agreement. Conclusions The findings support the CEA-RT scale as a reliable tool for individual use. However, study limitations included variable time gaps between sessions, recall bias, fatigue, and reliance on digital images. The results emphasize the need for additional training, in vivo validation, and inclusion of diverse skin types to improve overall accuracy and applicability.
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