Acute skin toxicity management in head and neck cancer patients treated with radiotherapy and chemotherapy or EGFR inhibitors: Literature review and consensus

Abstract

The adverse effects of radiation therapy, often integrated with chemotherapy and/or targeted therapies, on the skin include severe acute and chronic dermatitis associated with pain, discomfort, itching, and burning, and may heavily affect patients' quality of life. The management of these skin adverse effects in head and neck cancer patients (HNCPs) are very heterogeneous due to the lack of shared rigorous classification systems and evidence based treatments. A multidisciplinary group of head and neck cancer specialists from Italy met with the aim of reaching a consensus on a clinical definition and management of dermatitis in HNCPs treated with radiotherapy with or without systemic therapies in order to improve skin toxicity management. The Delphi Appropriateness Method was used. External expert reviewers then evaluated the conclusions carefully according to their area of expertise. This paper offers contains seven clusters of statements about the management of dermatitis in HNCPs and a review of recent literature on these topics.

Skin toxicity and quality of life during treatment with panitumumab for RAS wild-type metastatic colorectal carcinoma: results from three randomised clinical trials

“…Adverse events during cancer treatment can have a negative effect on quality of life (QoL) [9, 10], and optimal therapy, therefore, involves a balance between efficacy and safety [11]. Dermatological toxicities such as papulopustular rash (acneiform eruption), erythema, and skin fissures are common side effects of targeted cancer agents such as EGFR inhibitors [12], as EGFR is involved in the normal development and physiology of the epidermis.…”

Advanced Squamous Cell Carcinoma of the Head and Neck: The Current Role of Cetuximab

“…Recently, consensus reports have been published on the clinical definition and management of dermatitis in patients treated with RT with or without systemic therapies in order to improve skin toxicity management; those papers offer statements about the management of dermatitis and a review of the recent literature on these topics [52,53,54,55]. In patients with untreated recurrent or metastatic SCCHN, the most common grade 3 or 4 adverse events in the CT-alone and CTX groups were anemia (19 and 13%, respectively), neutropenia (23 and 22%, respectively), and thrombocytopenia (11% in both groups).…”

Consenso multidisciplinario y multiinstitucional de la utilidad del cetuximab en el tratamiento de los pacientes con carcinoma epidermoide de cabeza y cuello

“…En resumen, la información disponible actualmente permite concluir que la dermatitis asociada a biorradioterapia es un evento predecible, manejable y reversible, cuyo correcto manejo no afecta la continuidad de la terapia ni su desenlace clínico. Russi, et al 43 y Bernier, et al 44 exponen consideraciones de manejo y educación a los pacientes que se resumen en las tablas 4 y 5.…”