Abstract：

 Objective: To validate the efficacy of a radiodermatitis management protocol (which involves preventive measures, the application of preventive creams and the use of a non-adhesive, foam dressing with a silicone contact layer) at a radiation oncology department in southern Spain.

Method: An observational study was carried out on consecutive patients undergoing radiation therapy for sarcomas, ear nose and throat, breast, cervix and lung cancers, excluding patients with other tumours and those who stopped radiation treatment, or who died during its course. Variables that were assessed included: average healing time, general progression of the injury, degree of trauma caused by removing the dressing, convenience and comfort, patient’s aesthetic perception, ease of use for health professionals,adaptability, and the length of time for which the dressing stays in place.

Results: 20 patients were included in the study and radiodermatitis was resolved in 100% (20/20). Optimal progression of all lesions was observed. No infections occurred, and the average total healing time ranged from one to two weeks, even during radiation therapy Patients reported a high level of satisfaction with the dressing, which scored highly in terms of convenience and comfort, atraumatic dressing, ease of use, adaptability, patients’ aesthetic perception and adhesive durability.

Conclusion: Our action protocol is effective in the prevention and treatment of radiodermatitis. We achieved optimal results in the current study, which supports the continued use of the test dressing in our department.

Keywords：radiodermatitis, radiotherapy, dressing, foam pain, comfort.

INTRODUCTION:

Skin changes are an unavoidable consequence of radiation therapy.The increasing use of treatment regimens that simultaneously combine radiotherapy and chemotherapy, together with the prescription of progressively higher chemotherapy doses, mean that skin toxicity continues to be an important problem in clinical practice.

The occurrence and severity of this toxicity will vary depending on the patient and treatment. Patient-dependent factors include: age, nutritional status, toxic habits and concurrent diseases (such as diabetes, anaemia and scleroderma). Treatmentdependent factors include: total dose, volume of tissue treated, fraction size of dose delivered with each treatment, concomitant chemotherapy and previous surgery.Acute skin effects usually occur within the first 7–10 days after commencement of radiotherapy. Radiodermatitis is classified into four grades according to the Radiation Therapy Oncology Group (RTOG) (Table 1). Treatment for these patients must be focused on restoring skin integrity, avoiding infections, reducing pain and improving quality of life, thereby allowing patients to complete radiation therapy without any interruptions due to skin toxicity. There are many action protocols and therapeutic regimens for managing radiodermatitis. However, few studies and tests have been done on the use of dressings.

The main objective was to measure healing (defined as complete re-epithelialisation of the wound) and injury progression during radiation therapy. Secondary objectives were the measurement of: trauma caused by foam dressing removal, convenience and comfort, the patient’s aesthetic perception, ease of use, adaptability and length of time for which the dressing stays in place. These were all considered important as inadequate treatment of moist/wet radiodermatitis may cause treatment discontinuation, with a subsequent impact on disease progression. 

Cases：

The inner malleolar region in a 27-year-old woman following a 48 Gy bolus of a total 60 Gy treatment dose for osteosarcoma of the right ankle (a). The skin reaction showed level 2 moist/wet desquamation (RISRAS scale) and was initially treated with Sativa Soft. Treatment was initiated with foam dressing on 8 October (b). The dressing was changed daily with Blastoestimulina. By 5 November (c) (19 days after finishing radiotherapy) the skin reaction had improved to level 1 erythema (RISRAS scale).

Radiation reaction in a 50-year-old man’s neck (a) after receiving 48 Gy of a total dose of 70 Gy during treatment for larynx cancer. Skin showed level 2 moist/wet desquamation (RISRAS scale) and was initially treated with Ureadin. On 8 October treatment was initiated with foam dressing(b). The dressing showed good adaptability (c) and was changed daily with Blastoestimulina. By 20 October (d), still undergoing treatment with 58 Gy radiation, the skin reaction had improved to level 1 erythema (RISRAS scale).

Conclusion

Using foam dressings in accordance with the presented action protocol, it was possible to significantly reduce the discomfort arising from radiodermatitis, wound healing times were shortened and healing was achieved for level 2 and level 3 radiodermatitis with moist desquamation, even during ongoing radiation therapy. In addition, patients’ quality of life was improved, and it was not necessary to interrupt any patient’s radiotherapy due to skin toxicity. The professionals who used the dressing found it both useful and easy to use.

Pérez, Y. L., Carmona, J. A., Lupiáñez Pérez, I., & Mata García, C. (2011). Prevention and treatment of radiodermatitis using a nonadhesive foam dressing. journal of wound care, 20(3).