Salvo N, Barnes E, van Draanen J, Stacey E, Mitera G, Breen D, Giotis A, Czarnota G, Pang J, De Angelis C, et al.
Current oncology (Toronto, Ont.). Date of publication 2010 Aug 1;volume 17(4):94-112.
1. Curr Oncol. 2010 Aug;17(4):94-112.
Prophylaxis and management of acute radiation-induced skin reactions: a
systematic review of the literature.
Salvo N(1), Barnes E, van Draanen J, Stacey E, Mitera G, Breen D, Giotis A,
Czarnota G, Pang J, De Angelis C.
Author information:
(1)Department of Pharmacy, Edmond Odette Cancer Centre, Sunnybrook Health
Sciences Centre, Toronto, ON.
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.
PMCID: PMC2913836
PMID: 20697521
