Vol 70, No 1 (2020)
Review paper
Published online: 2020-03-03
What is new when it comes to acute and chronic radiation-induced dermatitis in head and neck cancer patients?
Nowotwory. Journal of Oncology 2020;70(1):9-15.
Abstract
Head and neck cancer is a serious clinical and social problem. Surgery and radiotherapy play the most important role in treatment and give the chance of cure. Optimal treatment of patients with head and neck cancer should provide for the maximum destruction of cancerous tissue, saving as much healthy tissue as possible. Despite this, due to radiotherapy still almost 90% of patients develop skin symptoms. It seems that the mechanism of radiodermatitis is quite clear, but studies assume that its pathogenesis is not fully understood and there is much to be clarified. Acute and chronic dermatitis caused by radiotherapy is usually diagnosed according to clinical criteria. It seems that it would be useful to have a photographic classification that would facilitate and unify the clinical evaluation. In this article we shall summarize the current knowledge about the mechanisms of formation, risk factors, clinical classifications and methods for the prevention and treatment of acute and chronic radiation dermatitis. We have included clinical photos that depict individual stages according to the clinical classification of RTOG.
Keywords: acute and chronic radiation induced dermatitis
References
- Wierzbicka M, Bień S, Osuch-Wójcikiewicz E, et al. The recommendations of diagnostic and therapeutic in the treatment of head and neck cancers. Pol. Przegląd Otorynolaryngol. ; 2011: 17–43.
- Biedka M, Dutsch-Wicherek M. Side effects of postoperative radiotherapy in patient with laryngeal cancer receiving immunosuppressive drugs after renal transplant. Otorynolaryngologia. 2015; 14(2): 108–116.
- Ziółkowska E, Biedka M, Windorbska W. Odczyn popromienny u chorych na raka regionu głowy i szyi: mechanizmy i konsekwencje. Otorynolaryngologia. 2011; 10(4): 147–153.
- Michalewska J. Odczyny popromienne w radioterapii oraz popromienne zapalenie skóry. Letters in Oncology Science. 2017; 14(4): 104–109.
- Hegedus F, Mathew LM, Schwartz RA. Radiation dermatitis: an overview. Int J Dermatol. 2017; 56(9): 909–914.
- Wheldon TE, Michalowski AS, Kirk J. The effect of irradiation on function in self-renewing normal tissues with differing proliferative organisation. Br J Radiol. 1982; 55(658): 759–766.
- Robijns J, Laubach HJ. Acute and chronic radiodermatitis. Journal of the Egyptian Womenʼs Dermatologic Society. 2018; 15(1): 2–9.
- Biernacka A, Dobaczewski M, Frangogiannis NG. TGF-β signaling in fibrosis. Growth Factors. 2011; 29(5): 196–202.
- de Andrade CB, Ramos IP, de Moraes AC, et al. Radiotherapy-Induced Skin Reactions Induce Fibrosis Mediated by TGF-β1 Cytokine. Dose Response. 2017; 15(2): 1559325817705019.
- Huang A, Glick SA. Genetic susceptibility to cutaneous radiation injury. Arch Dermatol Res. 2017; 309(1): 1–10.
- Flanders K, Major C, Arabshahi A, et al. Interference with Transforming Growth Factor-β/ Smad3 Signaling Results in Accelerated Healing of Wounds in Previously Irradiated Skin. The American Journal of Pathology. 2003; 163(6): 2247–2257.
- Perraud AL, Rao DM, Kosmacek EA, et al. The ion channel, TRPM2, contributes to the pathogenesis of radiodermatitis. Radiat Environ Biophys. 2019; 58(1): 89–98.
- Fallah M, Shen Y, Brodén J, et al. Plasminogen activation is required for the development of radiation-induced dermatitis. Cell Death Dis. 2018; 9(11): 1051.
- Bernier J, Russi EG, Homey B, et al. Management of radiation dermatitis in patients receiving cetuximab and radiotherapy for locally advanced squamous cell carcinoma of the head and neck: proposals for a revised grading system and consensus management guidelines. Ann Oncol. 2011; 22(10): 2191–2200.
- Brizel DM, Albers ME, Fisher SR, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998; 338(25): 1798–1804.
- Pignon JP, le Maître A, Maillard E, et al. MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009; 92(1): 4–14.
- Tobias JS, Monson K, Gupta N, et al. UK Head and Neck Cancer Trialists' Group. Chemoradiotherapy for locally advanced head and neck cancer: 10-year follow-up of the UK Head and Neck (UKHAN1) trial. Lancet Oncol. 2010; 11(1): 66–74.
- Kawamura M, Yoshimura M, Asada H, et al. A scoring system predicting acute radiation dermatitis in patients with head and neck cancer treated with intensity-modulated radiotherapy. Radiat Oncol. 2019; 14(1): 14.
- Wong RKS, Bensadoun RJ, Boers-Doets CB, 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. 2013; 21(10): 2933–2948.
- Radiation Therapy Oncology Group (RTOG). RTOG/EORTC Late Radiation Morbidity Scoring Schema. https://www.rtog.org/Research Associates/AdverseEventReporting/RTOGEORTCLateRadiationMorbidity ScoringSchema.aspx..
- Zenda S, Ota Y, Tachibana H, et al. A prospective picture collection study for a grading atlas of radiation dermatitis for clinical trials in head-and-neck cancer patients. J Radiat Res. 2016; 57(3): 301–306.
- Bonomo P, Desideri I, Loi M, et al. Management of severe bio-radiation dermatitis induced by radiotherapy and cetuximab in patients with head and neck cancer: emphasizing the role of calcium alginate dressings. Support Care Cancer. 2019; 27(8): 2957–2967.
- Russi EG, Bensadoun RJ, Merlano MC, et al. Bio-radiation dermatitis: the need of a new grading: in regard to Bernier et al: Ann Oncol 2011; 22(10): 2191-2200. Ann Oncol. 2013; 24(9): 2463–2465.
- O'Donovan A, Coleman M, Harris R, et al. Prophylaxis and management of acute radiation-induced skin toxicity: a survey of practice across Europe and the USA. Eur J Cancer Care (Engl). 2015; 24(3): 425–435.
- Lucey P, Zouzias C, Franco L, et al. Practice patterns for the prophylaxis and treatment of acute radiation dermatitis in the United States. Support Care Cancer. 2017; 25(9): 2857–2862.
- Narvaez C, Doemer C, Idel C, et al. Radiotherapy related skin toxicity (RAREST-01): Mepitel® film versus standard care in patients with locally advanced head-and-neck cancer. BMC Cancer. 2018; 18(1): 197.
- Wooding H, Yan J, Yuan L, et al. The effect of Mepitel Film on acute radiation-induced skin reactions in head and neck cancer patients: a feasibility study. Br J Radiol. 2018; 91(1081): 20170298.
- Zenda S, Yamaguchi T, Yokota T, et al. Topical steroid versus placebo for the prevention of radiation dermatitis in head and neck cancer patients receiving chemoradiotherapy: the study protocol of J-SUPPORT 1602 (TOPICS study), a randomized double-blinded phase 3 trial. BMC Cancer. 2018; 18(1): 873.
- Zhang X, Li H, Li Q, et al. Application of red light phototherapy in the treatment of radioactive dermatitis in patients with head and neck cancer. World J Surg Oncol. 2018; 16: 222.
- Ferreira EB, Vasques CI, Gadia R, et al. Topical interventions to prevent acute radiation dermatitis in head and neck cancer patients: a systematic review. Support Care Cancer. 2017; 25(3): 1001–1011.
- Bensadoun RJ, Humbert P, Krutman J, et al. Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel. Cancer Manag Res. 2013; 5: 401–408.
- Chapter 8. In: Wells M, MacBride S. ed. Radiation skin reactions. Churchill Livingstone, Elsevier, London 2003.
- Mendelsohn FA, Divino CM, Reis ED, et al. Wound care after radiation therapy. Adv Skin Wound Care. 2002; 15(5): 216–224.