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Open Access Highly Accessed Research article

Prevention and treatment of acute radiation-induced skin reactions: a systematic review and meta-analysis of randomized controlled trials

Raymond Javan Chan124*, Joan Webster234, Bryan Chung5, Louise Marquart6, Muhtashimuddin Ahmed7 and Stuart Garantziotis4

Author Affiliations

1 Cancer Care Services, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston Q4029, Australia

2 School of Nursing, Queensland University of Technology, Kelvin Grove Q4059, Australia

3 Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston Q4029, Australia

4 Centre for Health Practice Innovation, Griffith University, Nathan Q4111, Australia

5 Division of Plastic Surgery, QEII Health Science Centre, Halifax, Canada

6 Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Brisbane Q4029, Australia

7 Safety and Quality Unit, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston Q4029, Australia

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BMC Cancer 2014, 14:53  doi:10.1186/1471-2407-14-53

Published: 31 January 2014

Abstract

Background

Radiation-induced skin reaction (RISR) is a common side effect that affects the majority of cancer patients receiving radiation treatment. RISR is often characterised by swelling, redness, pigmentation, fibrosis, and ulceration, pain, warmth, burning, and itching of the skin. The aim of this systematic review was to assess the effects of interventions which aim to prevent or manage RISR in people with cancer.

Methods

We searched the following databases up to November 2012: Cochrane Skin Group Specialised Register, CENTRAL (2012, Issue 11), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), CINAHL (from 1981) and LILACS (from 1982). Randomized controlled trials evaluating interventions for preventing or managing RISR in cancer patients were included. The primary outcomes were development of RISR, and levels of RISR and symptom severity. Secondary outcomes were time taken to develop erythema or dry desquamation; quality of life; time taken to heal, a number of skin reaction and symptom severity measures; cost, participant satisfaction; ease of use and adverse effects. Where appropriate, we pooled results of randomized controlled trials using mean differences (MD) or odd ratios (OR) with 95% confidence intervals (CI).

Results

Forty-seven studies were included in this review. These evaluated six types of interventions (oral systemic medications; skin care practices; steroidal topical therapies; non-steroidal topical therapies; dressings and other). Findings from two meta-analyses demonstrated significant benefits of oral Wobe-Mugos E for preventing RISR (OR 0.13 (95% CI 0.05 to 0.38)) and limiting the maximal level of RISR (MD -0.92 (95% CI -1.36 to -0.48)). Another meta-analysis reported that wearing deodorant does not influence the development of RISR (OR 0.80 (95% CI 0.47 to 1.37)).

Conclusions

Despite the high number of trials in this area, there is limited good, comparative research that provides definitive results suggesting the effectiveness of any single intervention for reducing RISR. More research is required to demonstrate the usefulness of a wide range of products that are being used for reducing RISR. Future efforts for reducing RISR severity should focus on promising interventions, such as Wobe-Mugos E and oral zinc.

Keywords:
Radiation induced skin reactions; Radiation dermatitis; Systematic review; Meta-analysis; Randomized controlled trials