Consensus Guidelines for the Management of Radiation Dermatitis
Consensus Guidelines for the Management of Radiation Dermatitis
Background: Radiation dermatitis occurs to some degree in most patients receiving radiotherapy, with or without chemotherapy. Patients with squamous cell carcinoma of the head and neck (SCCHN) who receive radiotherapy in combination with epidermal growth factor receptor (EGFR) inhibitors, such as cetuximab, may develop a characteristic acne-like rash in addition to dermatitis.
Design: An advisory board of 11 experienced radiation oncologists, medical oncologists and dermatologists discussed the management options for skin reactions in patients receiving EGFR inhibitors and radiotherapy for SCCHN. Skin toxicity was categorised according to the National Cancer Institute—Common Terminology Criteria for Adverse Events (version 3) grading.
Results: Both general and grade-specific approaches for the management of dermatitis in this patient group are presented. It was concluded that where EGFR inhibitor-related acne-like rash and dermatitis coexist within irradiated fields, management should be based on the grade of dermatitis: for grade 1 (or no dermatitis), treatment recommendations for EGFR-related acne-like rash outside irradiated fields should be followed; for grades 2 and above, treatment recommendations for dermatitis were proposed.
Conclusions: This paper presents comprehensive consensus guidelines for the treatment of dermatitis in patients with SCCHN receiving EGFR inhibitors in combination with radiotherapy.
External beam radiotherapy is the main nonsurgical treatment in patients with locoregionally advanced head and neck cancers. The acute side-effects of radiation therapy are well documented and include dermatitis, mucositis, xerostomia, weight loss, dysphagia, taste alteration, nausea and vomiting, pain and asthenia. When given without chemotherapy, altered fractionation regimens, including accelerated and hyperfractionated regimens, alone or combined, have largely replaced conventional radiation fractionation (70 Gy in 2 Gy fractions over a 7-week period). Reducing overall treatment time and/or increasing total radiation dose have improved locoregional control, although effects on overall survival were less significant. The improvements in locoregional control, however, are achieved at the expense of an increase in acute toxicity. In a randomised phase III Radiation Therapy Oncology Group (RTOG) study (RTOG 9003), the incidence of grade 3 or worse acute side-effects was 35% for conventional fractionation and 54.5%, 50.4% and 58.8% for hyperfractionation, split-course accelerated fractionation and accelerated fractionation with concomitant boost, respectively.
Abstract and Introduction
Abstract
Background: Radiation dermatitis occurs to some degree in most patients receiving radiotherapy, with or without chemotherapy. Patients with squamous cell carcinoma of the head and neck (SCCHN) who receive radiotherapy in combination with epidermal growth factor receptor (EGFR) inhibitors, such as cetuximab, may develop a characteristic acne-like rash in addition to dermatitis.
Design: An advisory board of 11 experienced radiation oncologists, medical oncologists and dermatologists discussed the management options for skin reactions in patients receiving EGFR inhibitors and radiotherapy for SCCHN. Skin toxicity was categorised according to the National Cancer Institute—Common Terminology Criteria for Adverse Events (version 3) grading.
Results: Both general and grade-specific approaches for the management of dermatitis in this patient group are presented. It was concluded that where EGFR inhibitor-related acne-like rash and dermatitis coexist within irradiated fields, management should be based on the grade of dermatitis: for grade 1 (or no dermatitis), treatment recommendations for EGFR-related acne-like rash outside irradiated fields should be followed; for grades 2 and above, treatment recommendations for dermatitis were proposed.
Conclusions: This paper presents comprehensive consensus guidelines for the treatment of dermatitis in patients with SCCHN receiving EGFR inhibitors in combination with radiotherapy.
Introduction
External beam radiotherapy is the main nonsurgical treatment in patients with locoregionally advanced head and neck cancers. The acute side-effects of radiation therapy are well documented and include dermatitis, mucositis, xerostomia, weight loss, dysphagia, taste alteration, nausea and vomiting, pain and asthenia. When given without chemotherapy, altered fractionation regimens, including accelerated and hyperfractionated regimens, alone or combined, have largely replaced conventional radiation fractionation (70 Gy in 2 Gy fractions over a 7-week period). Reducing overall treatment time and/or increasing total radiation dose have improved locoregional control, although effects on overall survival were less significant. The improvements in locoregional control, however, are achieved at the expense of an increase in acute toxicity. In a randomised phase III Radiation Therapy Oncology Group (RTOG) study (RTOG 9003), the incidence of grade 3 or worse acute side-effects was 35% for conventional fractionation and 54.5%, 50.4% and 58.8% for hyperfractionation, split-course accelerated fractionation and accelerated fractionation with concomitant boost, respectively.
