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Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group

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Abstract

Radiation dermatitis (RD) results from radiotherapy and often occurs within the first 4 weeks of treatment, although late effects also occur. While RD may resolve over time, it can have a profound effect on patients’ quality of life and lead to dose modifications. A study group of international, interdisciplinary experts convened to develop RD prevention and treatment guidelines based on evidence from randomized, controlled trials. Evidence-based recommendations were developed after an extensive literature review. Randomized, controlled trials with standardized measurement of outcomes were considered the best evidence, and a majority of the recommendations were formulated from this literature. The adoption of washing with water, with or without a mild soap, and allowing the use of antiperspirants is supported by randomized trials. Use of topical prophylactic corticosteroids (mometasone) is recommended to reduce discomfort and itching. There is some evidence that silver sulfadiazine cream can reduce dermatitis score. There is insufficient evidence to support, and therefore the panel recommends against the use of trolamine, topical sulcrate, hyaluronic acid, ascorbic acid, silver leaf dressing, light-emitting diode lasers, Theta cream, dexpanthenol, calendula, proteolytic enzymes, sulcralfate, oral zinc, and pentoxifylline. Moreover, there is no evidence to support the superiority for any specific intervention in a reactive fashion. For patients with established radiation-induced telangiectasia and fibrosis, the panel suggests the use of pulse dye laser for visual appearance, and the use of pentoxifylline and vitamin E for the reduction of fibrosis.

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Conflict of interest statement

This project was supported by unrestricted grants from Bristol-Myers Squibb, Evolife, OSI Pharmaceuticals, Inc., and Amgen, Inc. R.K.S.W., R.J.B, J.B., A.C., J.B.E., M.E.L., and B.E.S. have no financial relationships to declare. C.B.B.D. serves as a consultant/advisory role to Amgen, Inc., AstraZeneca, Bayer, GlaxoSmithKline, Merck and Co. Inc., Merck Sharp & Dohme, Novartis, Pfizer Inc., Roche, and Wyeth. Sponsors did not contribute to the development of this manuscript. The authors had full control over the summaries and recommendations made in this manuscript. There are no primary data presented in this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Center, University of Toronto, 610 University Avenue, Toronto, M5G 2M9, Canada

    Rebecca K. S. Wong

  2. Centre Hospitalier Universitaire de Poitiers, Poitiers, Cedex, France

    René-Jean Bensadoun

  3. Leiden University Medical Center, Leiden, Holland, The Netherlands

    Christine B. Boers-Doets

  4. Istituto Nazionale dei Tumori, Napoli, Italy

    Jane Bryce

  5. National University of Singapore and National Cancer Centre Singapore, Singapore, Singapore

    Alexandre Chan

  6. City of Hope National Medical Center, Durate, CA, and Cedars-Sinai Health System, Los Angeles, CA, USA

    Joel B. Epstein

  7. Memorial Sloan-Kettering, New York, NY, USA

    Mario E. Lacouture

  8. University of Pennsylvania, Philadelphia, PA, USA

    Beth Eaby-Sandy

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  1. Rebecca K. S. Wong
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Wong, R.K.S., Bensadoun, RJ., Boers-Doets, C.B. et al. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer 21, 2933–2948 (2013). https://doi.org/10.1007/s00520-013-1896-2

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