Supportive Care in Cancer

, Volume 21, Issue 10, pp 2933–2948 | Cite as

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

  • Rebecca K. S. Wong
  • René-Jean Bensadoun
  • Christine B. Boers-Doets
  • Jane Bryce
  • Alexandre Chan
  • Joel B. Epstein
  • Beth Eaby-Sandy
  • Mario E. Lacouture
Review Article

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.

Keywords

Radiation dermatitis Guidelines Systematic review 

Notes

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.

References

  1. 1.
    Deng G, Cassileth BR (2008) Section: skin injury: acute dermatitis and chronic skin changes. (Section IV, Chapter 95) supportive care and quality of life. In: Principles and practice of radiation oncology, 5th edn. Lippincott Williams & Wilkins, Philadelphia, PN, pp 2016–2017Google Scholar
  2. 2.
    Gieringer M, Gosepath J, Naim R (2011) Radiotherapy and wound healing: principles, management and prospects. Oncol Rep 26:299–307PubMedGoogle Scholar
  3. 3.
    Chan RJ, Larsen E, Chan P (2012) Re-examining the evidence in radiation dermatitis management literature: an overview and a critical appraisal of systematic reviews. Int J Rad Oncol Biol Physic 84:e357–e362CrossRefGoogle Scholar
  4. 4.
    Bolderston A, Lloyd NS, Wong RK, Holden L, Robb-Blenderman L (2006) Supportive Care Guidelines Group of Cancer Care Ontario Program in Evidence-Based Care. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer 14:802–817CrossRefPubMedGoogle Scholar
  5. 5.
    McQuestion M (2006) Evidence-based skin care management in radiation therapy. Semin Oncol Nurs 22:163–173CrossRefPubMedGoogle Scholar
  6. 6.
    Wickline MM (2004) Prevention and treatment of acute radiation dermatitis: a literature review. Oncol Nurs Forum 31:237–247CrossRefPubMedGoogle Scholar
  7. 7.
    Salvo N, Barnes E, van Draanen J, Stacey E, Mitera G et al (2010) Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. Curr Oncol 17:94–112PubMedGoogle Scholar
  8. 8.
    CTC v2.0 and common terminology criteria for adverse events v4.0 (CTCAE). Available at: https://cabig-kc.nci.nih.gov/Vocab/KC/index.php/CTCAE. Accessed on July 26, 2011
  9. 9.
    Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346CrossRefPubMedGoogle Scholar
  10. 10.
    [No authors listed] (1995) LENT SOMA scales for all anatomic sites. Int J Radiat Oncol Biol Phys 31:1049–1091Google Scholar
  11. 11.
    Palazzi M, Tomatis S, Orlandi E, Guzzo M, Sangalli C et al (2008) Effects of treatment intensification on acute local toxicity during radiotherapy for head and neck cancer: prospective observational study validating CTCAE, version 3.0, scoring system. Int J Radiat Oncol Biol Phys 70(2):330–337CrossRefPubMedGoogle Scholar
  12. 12.
    Hoeller U, Tribius S, Kuhlmey A, Grader K, Fehlauer F, Alberti W (2003) Increasing the rate of late toxicity by changing the score? A comparison of RTOG/EORTC and LENT/SOMA scores. Int J Radiat Oncol Biol Phys 55:1013–1018CrossRefPubMedGoogle Scholar
  13. 13.
    Denis F, Garaud P, Bardet E, Alfonsi M, Sire C et al (2003) Late toxicity results of the GORTEC 94–01 randomized trial comparing radiotherapy with concomitant radiochemotherapy for advanced-stage oropharynx carcinoma: comparison of LENT/SOMA, RTOG/EORTC, and NCI-CTC scoring systems. Int J Radiat Oncol Biol Phys 55:93–98CrossRefPubMedGoogle Scholar
  14. 14.
    Kassam Z, Naidoo N, Wong KSR (2011) Chapter: radiation induced dermatologic reactions. Dermatologic conditions during cancer therapy. Dermatologic principles and practice in oncology, 1st edn. John Wiley & Sons, New Jersey, USAGoogle Scholar
  15. 15.
    National Guidelines Clearinghouse. (Accessed at http://www.guideline.gov/about/index.aspx.)
  16. 16.
    Richardson J, Smith JE, McIntyre M, Thomas R, Pilkington K (2005) Aloe vera for preventing radiation-induced skin reactions: a systematic literature review. Clin Oncol (R Coll Radiol) 17:478–484CrossRefGoogle Scholar
  17. 17.
    Kassab S, Cummings M, Berkovitz S, van Haselen R, Fisher P (2009) Homeopathic medicines for adverse effects of cancer treatments. Cochrane Database Syst Rev 15:CD004845Google Scholar
  18. 18.
    Nystedt KE, Hill JE, Mitchell AM, Goodwin F, Rowe LA et al (2005) The standardization of radiation skin care in British Columbia: a collaborative approach. Oncol Nurs Forum 32:1199–1205CrossRefPubMedGoogle Scholar
  19. 19.
    Bernier J, Bonner J, Vermorken JB, Bensadoun RJ, Dummer R et al (2008) Consensus guidelines for the management of radiation dermatitis and coexisting acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck. Ann Oncol 19:142–149CrossRefPubMedGoogle Scholar
  20. 20.
    Chan R, Webster J, Battistutta D, Chung B, Brooks L (2010) Interventions for preventing and managing radiation-induced skin reactions in cancer patients. Cochrane Database of Systematic ReviewsGoogle Scholar
  21. 21.
    Roy I, Fortin A, Larochelle M (2001) The impact of skin washing with water and soap during breast irradiation: a randomized study. Radiother Oncol 58:333–339CrossRefPubMedGoogle Scholar
  22. 22.
    Westbury C, Hines F, Hawkes E, Ashley S, Brada M (2000) Advice on hair and scalp care during cranial radiotherapy: a prospective randomized trial. Radiother Oncol 54:109–116CrossRefPubMedGoogle Scholar
  23. 23.
    Campbell IR, Illingworth MH (1992) Can patients wash during radiotherapy to the breast or chest wall? A randomized controlled trial. Clin Oncol (R Coll Radiol) 4:78–82CrossRefGoogle Scholar
  24. 24.
    Watson LC, Gies D, Thompson E, Thomas B (2012) Randomized control trial: evaluating aluminum- based antiperspirant use, axilla skin toxicity, and reported quality of life in women receiving external beam radiotherapy for treatment of stage 0, I, and II breast cancer. Int J Rad Oncol Biol Phys 83(1):e28–e34CrossRefGoogle Scholar
  25. 25.
    Théberge V, Harel F, Dagnault A (2009) Use of axillary deodorant and effect on acute skin toxicity during radiotherapy for breast cancer: a prospective randomized noninferiority trial. Int J Rad Oncol Biol Phys 75(4):1048–1052CrossRefGoogle Scholar
  26. 26.
    Bennett C (2009) An investigation into the use of a non-metallic deodorant during radiotherapy treatment: a randomised controlled trial. J Rad in Practice 8:3–9CrossRefGoogle Scholar
  27. 27.
    Gee A, Moffitt D, Churn M, Errington RD (2000) A randomized controlled trial to test a non-metallic deodorant used during a course of radiotherapy. J Rad in Practice 1:205–212CrossRefGoogle Scholar
  28. 28.
    Omidvari S, Saboori H, Mohammadianpanah M, Mosalaei A, Ahmadloo N et al (2007) Topical betamethasone for prevention of radiation dermatitis. Indian J Dermatol Venereol Leprol 73(3):209CrossRefPubMedGoogle Scholar
  29. 29.
    Shukla PN, Gairola M, Mohanti BK, Rath GK (2006) Prophylactic beclomethasone spray to the skin during postoperative radiotherapy of carcinoma breast: a prospective randomized study. Indian J Cancer 43:180–184CrossRefPubMedGoogle Scholar
  30. 30.
    Boström A, Lindman H, Swartling C, Berne B, Bergh J (2001) Potent corticosteroid cream (mometasone furoate) significantly reduces acute radiation dermatitis: results from a double-blind, randomized study. Radiother Oncol 59:257–265CrossRefPubMedGoogle Scholar
  31. 31.
    Schmuth M, Wimmer MA, Hofer S, Sztankay A, Weinlich G et al (2002) Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study. Br J Dermatol 146:983–991CrossRefPubMedGoogle Scholar
  32. 32.
    Miller RC, Schwartz DJ, Sloan JA, Griffin PC, Deming RL et al (2011) Mometasone furoate effect on acute skin toxicity in breast cancer patients receiving radiotherapy: a phase III double-blind, randomized trial from the North Central Cancer Treatment Group N06C4. Int J Radiat Oncol Biol Phys 79:1460–1466CrossRefPubMedGoogle Scholar
  33. 33.
    Fenig E, Brenner B, Katz A, Sulkes J, Lapidot M et al (2001) Topical biafine and lipiderm for the prevention of radiation dermatitis: a randomized prospective trial. Oncol Rep 8:305–309PubMedGoogle Scholar
  34. 34.
    Rizza L, D’Agostino A, Girlando A, Puglia C (2010) Evaluation of the effect of topical agents on radiation-induced skin disease by reflectance spectrophotometry. J Pharm Pharmacol 62:779–785PubMedGoogle Scholar
  35. 35.
    Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X (2004) Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol 22:1447–1453CrossRefPubMedGoogle Scholar
  36. 36.
    Gosselin TK, Schneider SM, Plambeck MA, Rowe K (2010) A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy. Oncol Nurs Forum 37:619–626CrossRefPubMedGoogle Scholar
  37. 37.
    Fisher J, Scott C, Stevens R, Marconi B, Champion L et al (2000) Randomized phase III study comparing best supportive care to biafine as a prophylactic agent for radiation-induced ski n toxicity for women undergoing breast irradiation: Radiation Therapy Oncology Group (RTOG) 97–13. Int J Radiat Oncol Biol Phys 48:1307–1310CrossRefPubMedGoogle Scholar
  38. 38.
    Abbas H, Bensadoun RJ (2012) Trolamine emulsion for the prevention of radiation dermatitis in patients with squamous cell carcinoma of the head and neck. Support Care Cancer 20(1):185–190CrossRefPubMedGoogle Scholar
  39. 39.
    Elliott EA, Wright JR, Swann RS, Nguyen-Tân F, Takita C et al (2006) Phase III trial of an emulsion containing trolamine for the prevention of radiation dermatitis in patients with advanced squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group Trial 99–13. J Clin Oncol 24:2092–2097CrossRefPubMedGoogle Scholar
  40. 40.
    Williams MS, Burk M, Loprinzi CL, Hill M, Schomberg PJ et al (1996) Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys 36:345–349CrossRefPubMedGoogle Scholar
  41. 41.
    Olsen DL, Raub W Jr, Bradley C, Johnson M, Macias JL et al (2001) The effect of aloe vera gel/mild soap versus mild soap alone in preventing skin reactions in patients undergoing radiation therapy. Oncol Nurs Forum 28:543–547PubMedGoogle Scholar
  42. 42.
    Heggie S, Bryant GP, Tripcony L, Keller J, Rose P et al (2002) A phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue. Cancer Nurs 25:442–451CrossRefPubMedGoogle Scholar
  43. 43.
    Maiche A, Isokangas OP, Gröhn P (1994) Skin protection by sucralfate cream during electron beam therapy. Acta Oncol 33:201–203CrossRefPubMedGoogle Scholar
  44. 44.
    Evensen JF, Bjordal K, Jacobsen AB, Løkkevik E, Tausjø JE (2001) Effects of Na-sucrose octasulfate on skin and mucosa reactions during radiotherapy of head and neck cancers—a randomized prospective study. Acta Oncol 40:751–755CrossRefPubMedGoogle Scholar
  45. 45.
    Wells M, Macmillan M, Raab G, MacBride S, Bell N et al (2004) Does aqueous or sucralfate cream affect the severity of erythematous radiation skin reactions? A randomised controlled trial. Radiother Oncol 73:153–162CrossRefPubMedGoogle Scholar
  46. 46.
    Primavera G, Carrera M, Berardesca E, Pinnaró P, Messina M, Arcangeli G (2006) A double-blind, vehicle-controlled clinical study to evaluate the efficacy of MAS065D (XClair), a hyaluronic acid-based formulation, in the management of radiation-induced dermatitis. Cutan Ocul Toxicol 25:165–171CrossRefPubMedGoogle Scholar
  47. 47.
    Liguori V, Guillemin C, Pesce GF, Mirimanoff RO, Bernier J (1997) Double-blind, randomized clinical study comparing hyaluronic acid cream to placebo in patients treated with radiotherapy. Radiother Oncol 42:155–161CrossRefPubMedGoogle Scholar
  48. 48.
    Leonardi MC, Gariboldi S, Ivaldi GB, Ferrari A, Serafini F et al (2008) A double-blind, randomised, vehicle-controlled clinical study to evaluate the efficacy of MAS065D in limiting the effects of radiation on the skin: interim analysis. Eur J Dermatol 18:317–321PubMedGoogle Scholar
  49. 49.
    Løkkevik E, Skovlund E, Reitan JB, Hannisdal E, Tanum G (1996) Skin treatment with bepanthen cream versus no cream during radiotherapy—a randomized controlled trial. Acta Oncol 35:1021–1026CrossRefPubMedGoogle Scholar
  50. 50.
    Kirova YM, Fromantin I, De Rycke Y, Fourquet A, Morvan E, Padiglione S, Falcou MC, Campana F, Bollet MA (2011) Can we decrease the skin reaction in breast cancer patients using hyaluronic acid during radiation therapy? Results of phase III randomized trial. Rad Oncol 100:205–209CrossRefGoogle Scholar
  51. 51.
    Aquino-Parsons C, Lomas S, Smith K, Hayes J, Lew S et al (2010) Phase III study of silver leaf nylon dressing vs standard care for reduction of inframammary moist desquamation in patients undergoing adjuvant whole breast radiation therapy. J Med Imaging Radiat Sci 41:215–221CrossRefGoogle Scholar
  52. 52.
    Diggelmann KV, Zytkovicz AE, Tuaine JM, Bennett NC, Kelly LE, Herst PM (2010) Mepilex Lite dressings for the management of radiation-induced erythema: a systematic inpatient controlled clinical trial. Br J Radiol 83:971–978CrossRefPubMedGoogle Scholar
  53. 53.
    Hemati S, Asnaashari O, Sarvizadeh M, Motlagh BN, Akbari M, Tajvidi M, Gookizadeh A (2012) Topical silver sulfadiazine for the prevention of acute dermatitis during irradiation for breast cancer support care cancer 20:1613–1618Google Scholar
  54. 54.
    Halperin EC, Gaspar L, George S, Darr D, Pinnell S (1993) A double-blind, randomized, prospective trial to evaluate topical vitamin C solution for the prevention of radiation dermatitis. CNS Cancer Consortium. Int J Radiat Oncol Biol Phys 26:413–416CrossRefPubMedGoogle Scholar
  55. 55.
    Fife D, Rayhan DJ, Behnam S, Ortiz A, Elkeeb L et al (2010) A randomized, controlled, double-blind study of light emitting diode photomodulation for the prevention of radiation dermatitis in patients with breast cancer. Dermatol Surg 36:1921–1927. doi: 10.1111/j.1524-4725.2010.01801 CrossRefPubMedGoogle Scholar
  56. 56.
    Miko Enomoto T, Johnson T, Peterson N, Homer L, Walts D, Johnson N (2005) Combination glutathione and anthocyanins as an alternative for skin care during external-beam radiation. Am J Surg 189:627–630, discussion 630–631CrossRefPubMedGoogle Scholar
  57. 57.
    Röper B, Kaisig D, Auer F, Mergen E, Molls M (2004) Thêta-Cream versus bepanthol lotion in breast cancer patients under radiotherapy. A new prophylactic agent in skin care? Strahlenther Onkol 180:315–322CrossRefPubMedGoogle Scholar
  58. 58.
    Maiche AG, Gröhn P, Mäki-Hokkonen H (1991) Effect of chamomile cream and almond ointment on acute radiation skin reaction. Acta Oncol 30:395–396CrossRefPubMedGoogle Scholar
  59. 59.
    Jensen JM, Gau T, Schultze J, Lemmnitz G, Fölster-Holst R, May T, Abels C, Proksch E (2011) Treatment of acute radiodermatitis with an oil-in-water emulsion following radiation therapy for breast cancer. Strahlenther und Onkologie 187:378–384, 187CrossRefGoogle Scholar
  60. 60.
    Kaul R, Mishra BK, Sutradar P, Choudhary V, Gujral MS (1999) The role of Wobe-Mugos in reducing acute sequela of radiation in head and neck cancers—a clinical phase-III randomized trial. Indian J Cancer 36:141–148PubMedGoogle Scholar
  61. 61.
    Gujral MS, Patnaik PM, Kaul R, Parikh HK, Conradt C et al (2001) Efficacy of hydrolytic enzymes in preventing radiation therapy-induced side effects in patients with head and neck cancers. Cancer Chemother Pharmacol 47(Suppl):S23–S28CrossRefPubMedGoogle Scholar
  62. 62.
    Dale PS, Tamhankar CP, George D, Daftary GV (2001) Co-medication with hydrolytic enzymes in radiation therapy of uterine cervix: evidence of the reduction of acute side effects. Cancer Chemother Pharmacol 47(Suppl):S29–S34CrossRefPubMedGoogle Scholar
  63. 63.
    Lievens Y, Haustermans K, Van den Weyngaert D, Van den Bogaert W, Scalliet P et al (1998) Does sucralfate reduce the acute side-effects in head and neck cancer treated with radiotherapy? A double-blind randomized trial. Radiother Oncol 47:149–153CrossRefPubMedGoogle Scholar
  64. 64.
    Lin LC, Que J, Lin LK, Lin FC (2006) Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. Int J Radiat Oncol Biol Phys 65:745–750CrossRefPubMedGoogle Scholar
  65. 65.
    Aygenc E, Celikkanat S, Kaymakci M, Aksaray F, Ozdem C (2004) Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study. Otolaryngol Head Neck Surg 130:351–356CrossRefPubMedGoogle Scholar
  66. 66.
    Shell JA, Stanutz F, Grimm J (1986) Comparison of moisture vapor permeable (MVP) dressings to conventional dressings for management of radiation skin reactions. Oncol Nurs Forum 13:11–16PubMedGoogle Scholar
  67. 67.
    Mak SS, Molassiotis A, Wan WM, Lee IY, Chan ES (2000) The effects of hydrocolloid dressing and gentian violet on radiation-induced moist desquamation wound healing. Cancer Nurs 23:220–229CrossRefPubMedGoogle Scholar
  68. 68.
    Macmillan MS, Wells M, MacBride S, Raab GM, Munro A, MacDougall H (2007) Randomized comparison of dry dressings versus hydrogel in management of radiation-induced moist desquamation. Int J Radiat Oncol Biol Phys 68:864–872CrossRefPubMedGoogle Scholar
  69. 69.
    Gollins S, Gaffney C, Slade S, Swindell R (2008) RCT on gentian violet versus a hydrogel dressing for radiotherapy-induced moist skin desquamation. J Wound Care 17:268–270, 272, 274–275.Google Scholar
  70. 70.
    Delaney G, Fisher R, Hook C, Barton M (1997) Sucralfate cream in the management of moist desquamation during radiotherapy. Australas Radiol 41:270–275CrossRefPubMedGoogle Scholar
  71. 71.
    Omidvari S, Shafizad A, Razmjou-Ghalaei S, Hamid N, Niloofar A, et al. Efficacy of topical honey, topical hydrocortisone 1% and simple washing on healing of radiation-induced dermatitis in breast cancer patients. Arabic J Isfahan Medical School 28:114Google Scholar
  72. 72.
    Schreck U, Paulsen F, Bamberg M, Budach W (2002) Intraindividual comparison of two different skin care conceptions in patients undergoing radiotherapy of the head-and-neck region. Creme or powder? Strahlenther Onkol 178:321–329CrossRefPubMedGoogle Scholar
  73. 73.
    Nymann P, Hedelund L, Haedersdal M (2009) Intense pulsed light vs. long-pulsed dye laser treatment of telangiectasia after radiotherapy for breast cancer: a randomized split-lesion trial of two different treatments. Br J Dermatol 160:1237–1241CrossRefPubMedGoogle Scholar
  74. 74.
    Lanigan SW, Joannides T (2003) Pulsed dye laser treatment of telangiectasia after radiotherapy for carcinoma of the breast. Br J Dermatol 148:77–79CrossRefPubMedGoogle Scholar
  75. 75.
    Delanian S, Balla-Mekias S, Lefaix JL (1999) Striking regression of chronic radiotherapy damage in a clinical trial of combined pentoxifylline and tocopherol. J Clin Oncol 17:3283–3290PubMedGoogle Scholar
  76. 76.
    Okunieff P, Augustine E, Hicks JE, Cornelison TL, Altemus RM et al (2004) Pentoxifylline in the treatment of radiation-induced fibrosis. J Clin Oncol 22:2207–2213CrossRefPubMedGoogle Scholar
  77. 77.
    Dodd MJ (1984) Patterns of self-care in patients receiving radiation therapy. Oncol Nurs Forum 1:23–30Google Scholar
  78. 78.
    O’Rourke ME (1987) Enhanced cutaneous effects in combined modality therapy. Oncol Nurs Forum 14:31–35PubMedGoogle Scholar
  79. 79.
    Somerfield M, Padberg J, Pfister D et al (2000) ASCO clinical practice guidelines: process, progress, pitfalls, and prospects. Classic Papers Curr Comments 4:881–886Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Rebecca K. S. Wong
    • 1
  • René-Jean Bensadoun
    • 2
  • Christine B. Boers-Doets
    • 3
  • Jane Bryce
    • 4
  • Alexandre Chan
    • 5
  • Joel B. Epstein
    • 6
  • Beth Eaby-Sandy
    • 8
  • Mario E. Lacouture
    • 7
  1. 1.Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer CenterUniversity of TorontoTorontoCanada
  2. 2.Centre Hospitalier Universitaire de PoitiersPoitiersFrance
  3. 3.Leiden University Medical CenterLeidenThe Netherlands
  4. 4.Istituto Nazionale dei TumoriNapoliItaly
  5. 5.National University of Singapore and National Cancer Centre SingaporeSingaporeSingapore
  6. 6.City of Hope National Medical Center, Durate, CA, and Cedars-Sinai Health SystemLos AngelesUSA
  7. 7.Memorial Sloan-KetteringNew YorkUSA
  8. 8.University of PennsylvaniaPhiladelphiaUSA

Personalised recommendations