Chronic radiation-induced dermatitis: challenges and solutions

Abstract

Chronic radiation dermatitis is a late side effect of skin irradiation, which may deteriorate patients’ quality of life. There is a lack of precise data about its incidence; however, several risk factors may predispose to the development of this condition. It includes radiotherapy dose, fractionation, technique, concurrent systemic therapy, comorbidities, and personal and genetic factors. Chronic radiation dermatitis is mostly caused by the imbalance of proinflammatory and profibrotic cytokines. Clinical manifestation includes changes in skin appearance, wounds, ulcerations, necrosis, fibrosis, and secondary cancers. The most severe complication of irradiation is extensive radiation-induced fibrosis (RIF). RIF can manifest in many ways, such as skin induration and retraction, lymphedema or restriction of joint motion. Diagnosis of chronic radiation dermatitis is usually made by clinical examination. In case of unclear clinical manifestation, a biopsy and histopathological examination are recommended to exclude secondary malignancy. The most effective prophylaxis of chronic radiation dermatitis is the use of proper radiation therapy techniques to avoid unnecessary irradiation of healthy skin. Treatment of chronic radiation dermatitis is demanding. The majority of the interventions are based only on clinical practice. Telangiectasia may be treated with pulse dye laser therapy. Chronic postirradiation wounds need special dressings. In case of necrosis or severe ulceration, surgical intervention may be considered. Management of RIF should be complex. Available methods are rehabilitative care, pharmacotherapy, hyperbaric oxygen therapy, and laser therapy. Future challenges include the assessment of late skin toxicity in modern irradiation techniques. Special attention should be paid on genomics and radiomics that allow scientists and clinicians to select patients who are at risk of the development of chronic radiation dermatitis. Novel treatment methods and clinical trials are strongly needed to provide more efficacious therapies.

Selection of Appropriate Wound Dressing for Various Wounds

“…The onset time of chronic dermatitis usually occurs after radiotherapy for a prolonged period of time (Spalek, 2016). Therefore, the application of modern dressings in radiation dermatitis is mostly focused on acute dermatitis.…”

Wound healing complications in oncological patients: perspectives for cellular therapy

“…This prolonged dermatitis is associated with overexpression of proinflammatory cytokines (TNF-α, IL-1, IL-6) and the activity of growth factors (TGF-β, PDGF and CTGF) promoting fibrosis through synthesis of extracellular matrix proteins and matrix metalloproteinases [39,51]. The increased level of TGF-β in serum of irradiated patients correlates with higher risk of fibrotic tissue formation [52].…”

“…Low levels of angiogenic factors (FGF, HGH, VEGF) in irradiated skin suggest that insufficiency in the production of these factors may be a culprit of disturbed angiogenesis [56]. Moreover, the prolonged inflammation and secretion of proinflammatory cytokines lead to leukocyte infiltration, causing other symptoms of skin inflammation such as atrophy of necrosis [39,51].…”

Radiodermatitis - review of treatment options

“…Radiotherapy should be started 6 to 8 weeks after the completion of the previous mode of treatment. About 95% of patients undergoing radiother-apy experience some of its complications, which are a major therapeutic problem and interfere with life quality of patients (1,2). Radiotherapy side effects can be divided into early or acute complications, which occur during the first six months from the beginning of radiation and they are usually reversible, and late complications, which occur from 6 months to several years and they are often irreversible.…”