Barbara Fowble - Skin Care in Radiation Oncology: A Practical Guide
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This book serves as a practical guide for the prevention and treatment of radiation dermatitis. Skin toxicity caused by radiation treatment is common among cancer patients and minimizing the frequency and severity of these reactions improves quality of life and prevents interruptions that can compromise local-regional control. Each chapter is devoted to a specific disease site, such as the head and neck, breast, gastrointestinal, genitourinary, gynecologic, and central nervous system. Pediatric malignancies and wound care for locally advanced cancers are also discussed. For each topic, the range and frequency of the observed skin reactions, factors influencing these reactions, the typical course of each reaction and its resolution, and the interventions used are presented. This book provides evidence where it exists for the specific interventions and an extensive illustration program depicts the various reactions and their response to treatment protocols. Skin Care in Radiation Oncology: A Practical Guide presents a framework for patient care in an era of advancing technology and systemic and targeted therapies and is a valuable resource for radiation oncologists, dermatologists, and residents.
Barbara Fowble: author's other books
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Barbara Fowble
Patricia Eifel
Dwight E. Heron
Leslie
Chamberlain Daniel MD
Sharad P. Paul
Jr. Cognetta
Simon Lo
Jennifer T. Huang
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Springer International Publishing Switzerland 2016
Barbara Fowble , Sue S. Yom , Florence Yuen and Sarah Arron (eds.) Skin Care in Radiation Oncology 10.1007/978-3-319-31460-0_11. Scope of the Problem
Barbara Fowble 1
(1)
Department of Radiation Oncology, University of California San Francisco, 1600 Divisadero St. H1031, San Francisco, CA 94115, USA
Barbara Fowble
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Keywords
Radiation treatment Radiation dermatitis Moist desquamation Dry desquamation Erythema Hyperpigmentation Hypopigmentation Telangiectasia Fibrosis Edema Ulceration Beam energy Dose and fractionation Bolus Intensity-modulated radiation Radiosensitizers Chemotherapy Targeted agentsIn 2015 it is estimated that 1,658,370 individuals i n the United States will be given a new diagnosis of cancer [] reported moist desquamation in 36% of anal cancer patients, 29% of head and neck cancer patients, and 27% of breast cancer patients. Symptoms include pruritus, dryness, a burning sensation, swelling, increased warmth, tightness, tenderness, discomfort, and pain. The usual course of acute radiation dermatitis is the appearance of distinct erythema during the second and third week of treatment, dry desquamation during the later weeks of treatment, and moist desquamation at the end of treatment or within 1 week of treatment completion. Acute reactions peak the first 13 weeks after treatment is completed. Most acute reactions are reversible. Late reactions include changes in pigmentation (hyperpigmentation or hypopigmentation), telangiectasia, fibrosis, edema, atrophy, and ulceration. The frequency and severity of the reactions vary.
Factors which contribute to acute skin reactions are divided into patient related and treatment related. Patient-related factors include the anatomic site, sex, body mass index, age, ethnicity, sun-reactive skin type, bra or breast size, comorbidities including collagen vascular disease and HIV, smoking, and genetic mutations [].
Therefore, it is not surprising that recommendations for the prevention and/or management of acute radiation dermatitis have been driven by anecdotal evidence, physician or patient preference, experience, tradition, testimonials, word of mouth, or information obtained from internet searches []. The panel supported the recommendation for skin washing with or without a mild soap, the use of antiperspirants, and the use of topical prophylactic corticosteroids to decrease discomfort and itching. The panel concluded that silver sulfadiazine decreased the dermatitis score and is strongly recommended against the use of trolamine and aloe vera for prophylaxis. No recommendation was made for the use of topical sucralfate, hyaluronic acid, ascorbic acid, silver leaf dressing, Theta-Cream, dexpanthenol, and calendula for prophylaxis, given what was considered insufficient or weak evidence. Pulsed dye laser was recommended for the treatment of telangiectasia.
Despite the lack of consensus regarding best practice, there are some general principles of skin care management [].
Numerous products and agents are available for the prevention and treatment of acute radiation dermatitis. A practice survey from the United Kingdom []. An aqueous cream and aloe were the two most commonly used products for prophylaxis. However, the most common product used for erythema was an aqueous cream followed by hydrocortisone. Silicone dressing was the most common dressing used for moist desquamation. Hydrogel dressing was the second most common.
In light of the above findings, we recognized the need for a practical guide for the prevention and treatment of radiation dermatitis. The guide is based on our clinical experience and observations as well as evidence where it exists. It is not meant to be an exhaustive review of the literature. Nor is it meant to endorse a particular product or agent. We have documented the typical and not so typical reactions seen and the results of our interventions. Each chapter is devoted to a specific disease site. We have included separate chapters for pediatrics and wound care for locally advanced cancers. For each disease site, we present the range and frequency of the observed reactions, factors influencing these reactions, the typical course of each reaction and its resolution, and the interventions used. Our objective is to provide a framework on which to build strategies that will mitigate radiation dermatitis in an era of advancing and evolving technology and the increasing complexity of combining radiation with new systemic and targeted therapies.
References
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Hoopfer D, Holloway C, Gabos Z, Alidrisi M, Chafe S, Krause B, et al. Three-arm randomized phase III trial: quality aloe and placebo cream versus powder as skin treatment during breast cancer radiation therapy. Clin Breast Cancer. 2014;15(3):18190. doi: 10.1016/j.clbc.2014.12.006 . CrossRef PubMed
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