Abstract
Radiation therapy is a common treatment for cancer patients. One of the most common side effects of radiation is acute skin reaction (radiation dermatitis) that ranges from a mild rash to severe ulceration. Approximately 85% of patients treated with radiation therapy will experience a moderate-to-severe skin reaction. Acute radiation-induced skin reactions often lead to itching and pain, delays in treatment, and diminished aesthetic appearance-and subsequently to a decrease in quality of life. Surveys have demonstrated that a wide variety of topical, oral, and intravenous agents are used to prevent or to treat radiation-induced skin reactions. We conducted a literature review to identify trials that investigated products for the prophylaxis and management of acute radiation dermatitis. Thirty-nine studies met the pre-defined criteria, with thirty-three being categorized as prophylactic trials and six as management trials.For objective evaluation of skin reactions, the Radiation Therapy Oncology Group criteria and the U.S. National Cancer Institute Common Toxicity Criteria were the most commonly used tools (65% of the studies). Topical corticosteroid agents were found to significantly reduce the severity of skin reactions; however, the trials of corticosteroids evaluated various agents, and no clear indication about a preferred corticosteroid has emerged. Amifostine and oral enzymes were somewhat effective in preventing radiation-induced skin reactions in phase II and phase III trials respectively; further large randomized controlled trials should be undertaken to better investigate those products. Biafine cream (Ortho-McNeil Pharmaceuticals, Titusville, NJ, U.S.A.) was found not to be superior to standard regimes in the prevention of radiation-induced skin reactions (n = 6).In conclusion, the evidence is insufficient to support the use of a particular agent for the prevention and management of acute radiation-induced skin reactions. Future trials should focus on comparing agents and approaches that, in phase I and II trials, suggest efficacy. These future phase III randomized controlled trials must clearly distinguish between preventive and management strategies for radiation-induced dermatitis. Only then can evidence-based guidelines be developed, with the hope of standardizing the approach across centres and of improving the prevention and management of radiation-induced dermatitis.
Highlights
The goal of radiotherapy is to provide maximum benefit to the patient with minimal side effects 1
Skin reactions related to radiation therapy usually manifest within 1–4 weeks of radiation start, persist for the duration of radiation therapy, and may require 2–4 weeks to heal after completion of therapy 5
Acute radiation dermatitis is the combined result of a decrease in functional stem cells, changes in the skin’s endothelial cells, inflammation, and skin-cell necrosis and death 7
Summary
The goal of radiotherapy is to provide maximum benefit to the patient with minimal side effects 1. Even with the most modern radiotherapy techniques, up to 90% of patients will experience a dose-dependent skin reaction at the treated area 1–4. The severity of the reaction is related to the dose per fraction, total dose delivered, use of bolus or other beam-modifying devices, size of the treatment field, site treated, use of concurrent chemotherapy or other agents, and individual susceptibility 8. Areas of the body that contain skin folds, such as the groin, are at higher risk of developing a reaction because of a phenomenon called the “bolus effect”; these areas are more likely to receive a higher dose of radiation and more prone to bacterial contamination 9. Prescribed treatment at low doses (
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