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Treatment of radiation-induced mucocutaneous toxicity

  • M. Becker-SchiebeEmail author
  • F. Lordick
  • W. Hoffmann
Original article
  • 465 Downloads

Summary

During radiotherapy 80% to 90% of all patients will develop some degree of inflammation symptoms, such as erythema, dry or wet desquamation, skin folds, or mucositis depending on radiation-and patient-related factors and the extent of irradiated skin or mucosal areas. Up to now radiation induced local reactions represent still an important toxicity factor. Cutaneous and mucosal side effects may reduce the patient's compliance and can be limiting factors to follow radiotherapy protocols. Therefore, there is a high need for effective prophylactic and therapeutic treatments. Basically, guidelines recommend the avoidance of mechanical, chemical and thermal irritants, especially the exposure to high temperatures. To delay onset of radiodermatitis various preventive topicals may be applied like aqueous cream formula with or without antioxidative agents. In general, the treatment of radiodermatitis primarily should maintain moisture and skin permeability and consists of hydrophilic creams, antioxidative and anti-inflammatory topicals. Hydrocolloid dressings may reduce and improve wound healing in grade 2 and 3 reactions. Supportive therapy of radiation-induced mucositis includes the maintenance of oral care protocols and adequate nutrition during the course of treatment. A sufficient oral health status is one of the most important factors for prevention of severe oral complications. The MASCC guidelines recommend furthermore the use of non-medicated rinses with saline or sodium bicarbonate 4 to 6 times daily. Further approaches suggest the use of local anaesthetics and systemic analgesics for severe mucositis. Besides local preventive agents and supportive care protocols, modern radiation treatment techniques remain the most promising intervention in reducing the degree of skin reactions.

Keywords

Irradiation mucositis radiodermatitis 

References

  1. Becker-Schiebe M, Mengs U, Schaefer M, Bulitta M, Hoffmann W. Topical use of a silymarin-based preparation to prevent radiodermatitis: results of a prospective study in breast cancer patients. Strahlenther Onkol, 187: 485–91, 2011PubMedCrossRefGoogle Scholar
  2. Ben-Josef E, Han S, Tobi M, et al. Intrarectal application of amifostine for the prevention of radiation induced rectal injury. Semin Radiat Oncol, 12: 81–5, 2002PubMedCrossRefGoogle Scholar
  3. Bolderston A, Lloyd N, Wong R, Holden L, Robb-Blenderman L. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Supportive Care Cancer, 14: 802–17, 2006CrossRefGoogle Scholar
  4. Cox JD, Stetz J, Pajak TF. 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: 1341–6, 1995PubMedCrossRefGoogle Scholar
  5. Diggelmann K, Zytkovicz AE, Tuaiine JM, Bennett NC, et al. Mepilex Lite dressing for the management of radiation induced erythema: a systematic inpatient controlled clinical trial. Brit J Radiol, 83: 971–8, 2010PubMedCrossRefGoogle Scholar
  6. Falkowski, Trouillas P, Duroux JL, Bonnetblanc JM, Clavère P. Radiodermatitis prevention with sucralfate in breast cancer: fundamental and clinical studies. Support Care Cancer, 19: 57–65, 2011PubMedCrossRefGoogle Scholar
  7. Hoffmann W, Rodemann HP, Schmidberger H, Weiss E, Bamberg M. Enhanced muco-cutaneous toxicity of radiotherapy in a patient with chronic GVHD and secondary malignancy. Annal Oncol, 5: 377–9, 1994Google Scholar
  8. Keefe DM, Schubert MM, Elting SE, et al. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer, 109: 820–31, 2007PubMedCrossRefGoogle Scholar
  9. Lalla RV, Schubert MM, Bensadoun RJ, Keefe D. Anti-inflammatory agents in the management of alimentary mucositis. Support Care Cancer, 14: 558–65, 2006PubMedCrossRefGoogle Scholar
  10. López E, Núñez MI, Guerrero MR, et al. Breast cancer acute radiotherapy morbidity evaluated by different scoring systems. Breast Cancer Res Treat, 73: 127–34, 2002PubMedCrossRefGoogle Scholar
  11. Mak SS, Lolassiotis A, Wan W, et al. The effects of hydrocolloid dressing and gentian violet on radiation induced moist desquamation wound healing. Canc Nurs, 23: 220–9, 2000CrossRefGoogle Scholar
  12. McGuire DB, Correa ME, Johnson J, Wienandts P. The role of basic oral care and good clinical practice principles in the management of oral mucositis. Support Care Cancer, 14: 541–7, 2006PubMedCrossRefGoogle Scholar
  13. Moran MS, Haffty BG. Radiation techniques and toxicities for locally advanced breast cancer. Semin Radiat Oncol, 19(4): 244–55, 2009PubMedCrossRefGoogle Scholar
  14. Pignol J, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 26: 2085–92, 2008PubMedCrossRefGoogle Scholar
  15. Pommier P, Gomez F, Sunyach MP, D'Hombres A, Carrie C, Montbarbon X. 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(8): 1447–53, 2004PubMedCrossRefGoogle Scholar
  16. Röper B, Kaisig D, Auer F, Mergen E, Molls M. Thêta-Cream versus Bepanthol lotion in breast cancer patients under radiotherapy. A new prophylactic agent in skin care? Strahlenther Onkol, 180(5): 315–22, 2004PubMedCrossRefGoogle Scholar
  17. Rosenthal DI, Trotti A. Strategies for managing radiation induced mucositis in head and neck cancer patients. Semin Radiat Oncol, 19: 29–34, 2009PubMedCrossRefGoogle Scholar
  18. Roy I, Fortin A, Larochelle M. The impact of skin washing with water and soap during breast irradiation. A randomized study. Radiother Oncol, 58: 333–9, 2001PubMedCrossRefGoogle Scholar
  19. Rubenstein E, Peterson D, Schubert M, et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer, 100(Suppl.): 2026–46, 2004PubMedCrossRefGoogle Scholar
  20. Safra t, Gutman G, Fishlev G, et al. Improved quality of life with hyperbaric oxygen therapy in patients with persistent pelvic radiation-induced toxicity. Clin Oncol, 20: 284–7, 2008CrossRefGoogle Scholar
  21. Sauer R (Koordinator Leitlinie Mammakarzinom), Budach W, Dunst J, Feyer P, Haase W, Harms W, Sautter-Bihl M, Souchon R, Wenz F. Leitlinien in der Radioonkologie. Leitlinie Radiotherapie des Mammakarzinoms. Strahlenther Onkol, 182(1): 17–8, 2006Google Scholar
  22. Shukla PN, Gairola M, Mohanti BK, Rath GK. Prophylactic beclomethasone spray to the skin during postoperative radiotherapy of carcinoma breast: A prospective randomized study. Indian J Cancer, 43(4): 180–4, 2006PubMedCrossRefGoogle Scholar
  23. Stokman MA, Spijkervet FK, Burlage FR, et al. Oral mucositis and selective elimination of oral flora in head and neck cancer patients receiving radiotherapy: A double-blind randomised clinical trial. Br J Cancer, 88: 1012–6, 2003PubMedCrossRefGoogle Scholar
  24. Vera-Llonch M, Oster G, Hagiwara M, et al. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer, 106: 329–36, 2006PubMedCrossRefGoogle Scholar
  25. Von Bultzingslowen I, Brennan MT, Spijkervet FK, et al. Growth factors and cytokines in the prevention and treatment of oral and gastrointestinal mucositis Support Care Cancer, 14: 519–27, 2006Google Scholar
  26. Zimmermann J, Budach W, Dörr W. Individual skin care during radiotherapy. Strahlenther Onkol, 174: 74–7, 1998PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Radiotherapy and RadiooncologyKlinikum BraunschweigBraunschweigGermany
  2. 2.3rd Medical Department (Hematology and Medical Oncology)Klinikum BraunschweigBraunschweigGermany

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