Intervention for acute radiotherapy induced skin reactions in cancer patients: the development of a clinical guideline recommended for use by the college of radiographers

Abstract

The aim of this retrospective study is to develop an evidence-based approach to managing radiation induced skin reactions. A Clinical Guideline Development Group was established to undertake a systematic review of literature and a survey of cancer centres with the objectives of highlighting and recommending best practice. Thirty-one papers were reviewed using the United States Health Care Policy and Research and Scottish Intercollegiate Guidelines Network criteria and 42 United Kingdom Cancer Centres responded with a mix of guidelines and information about skin care assessment and advice. The evidence base for the findings is mainly levels II, III and IV.Although perceived as common, the incidence of skin reactions has not been quantified. There is little evidence of consistent assessment of acute reactions and the survey data shows that the use of a scoring tool such as the Radiation Oncology Group criteria (RTOG/EORTC 1985) is rare. It also demonstrates that advice to patients is variable and sometimes contradictory. Appropriate and timely information is essential to relieve anxiety and reduce problems.There appears to be a place for the use of creams in the management of early (RTOG/EORTC 0,1, 2a) skin reactions and in delaying the onset of subsequent skin breakdown, however this evidence is not clear and several of the studies identified some allergic reactions to creams. The intervention used varies between departments and individual patients and is ad hoc rather than based on firm evidence.For reactions graded RTOG/EORTC 2b and 3, evidence from wound care literature suggests the use of hydrocolloids or hydrogels which are founded on moist wound healing principles. No evidence could be found to support the management of RTOG 4.The study recommends the development of a clinical guideline encompassing factors affecting the onset of reactions, assessment and management principles, and patient information and makes suggestions for much needed further research.

Topical application of a sandal wood oil and turmeric based cream prevents radiodermatitis in head and neck cancer patients undergoing external beam radiotherapy: a pilot study

“…[3][4][5][6][7][8][9] Generally, dermatitis manifests within a few days to weeks after the start of radiation therapy, with toxicity increasing in 2-3 weeks and accumulating across the course of radiation treatment. [3][4][5][6][7][8][9] Dermatitis varies in severity from moderate to severe erythema and moist scaling, and the signs and symptoms may include skin dryness, itching, discomfort, pain, warmth and burning, which may persist up to 4 weeks after the end of treatment ( Figure 1). …”

“…3,4,9 The intrinsic factors include age, general health, ethnic origin, co-existing diseases, ultraviolet (UV) exposure, hormonal status, comorbidities such as diabetes, hypertension and genetic factors, 9 whereas the extrinsic factors include dose, volume and number of fractions of radiation, radiosensitizers, concurrent chemotherapy and the site of treatment. 9 In the early stages, the skin changes can include oedema, erythema, dry desquamation and moist desquamation, while in the late stages the adverse effects mostly include pigmentation changes, telangiectasias, hair loss, atrophy, fibrosis and ulceration. [3][4][5][6][7][8][9][10] Severe acute dermatitis invariably needs cessation of the planned radiation therapy, as this can aggravate the skin damage and increase chances of topical and systemic infection, all of which can increase the morbidity and complicate the clinical condition of a patient.…”

“…9 In the early stages, the skin changes can include oedema, erythema, dry desquamation and moist desquamation, while in the late stages the adverse effects mostly include pigmentation changes, telangiectasias, hair loss, atrophy, fibrosis and ulceration. [3][4][5][6][7][8][9][10] Severe acute dermatitis invariably needs cessation of the planned radiation therapy, as this can aggravate the skin damage and increase chances of topical and systemic infection, all of which can increase the morbidity and complicate the clinical condition of a patient. [3][4][5][6][7][8][9][10] Mechanistically, the ionizing radiation-induced skin damage can be attributed to either a direct effect or an indirect effect resulting from the hydrolysis of water and inflammation-induced secondary injury.…”

“…[3][4][5][6][7][8][9][10] Severe acute dermatitis invariably needs cessation of the planned radiation therapy, as this can aggravate the skin damage and increase chances of topical and systemic infection, all of which can increase the morbidity and complicate the clinical condition of a patient. [3][4][5][6][7][8][9][10] Mechanistically, the ionizing radiation-induced skin damage can be attributed to either a direct effect or an indirect effect resulting from the hydrolysis of water and inflammation-induced secondary injury. 11 The low linear energy transfer (LET) energy sources commonly used in cancer treatment (such as X-rays and g irradiation) predominantly mediate the damage via indirect effects, where the superfluous generation of free radicals resulting from the radiolysis of water causes damage to macromolecules such as DNA, proteins and lipids.…”

Safety and Efficacy of PTCTS Cosmetic Gel: Study on Human Radiodermatitis Lesions

“…Moist desquamation occurs when clonogenic cells in the basal layer are sterilized, thus rendering cells unable to repopulate in time to replace the damaged tissue. Consequently, the epidermis becomes broken [10] [11]. Small areas of moist desquamation tend to heal from the basal layer, whereas large areas of broken epidermis require cells to migrate from the surrounding epidermis [11].…”