Review of the Terminology Describing Ionizing Radiation-Induced Skin Injury: A Case for Standardization

Abstract

Ionizing radiation causes injury to the skin that produces a complex clinical presentation that is managed by various paradigms without clear standards. The situation is further complicated by the fact that clinicians and researchers often use different terms and billing codes to describe the spectrum of cutaneous injury. There is, however, general agreement between the two most commonly-used diagnostic scales, the Radiation Therapy Oncology Group and the Common Terminology Criteria for Adverse Events, and in their use to describe skin injury following radiation therapy. These scales are typically used by radiation oncologists to quantify radiation dermatitis, a component of the radiation-related disorders of the skin and subcutaneous tissue family of diagnoses. In rare cases, patients with severe injury may require treatment by wound care or burn specialists, in which case the disease is described as a “radiation burn” and coded as a burn or corrosion. Further compounding the issue, most US government agencies use the term Cutaneous Radiation Injury to indicate skin damage resulting from large, whole-body exposures. In contrast, the US Food and Drug Administration approves products for radiation dermatitis or “burns caused by radiation oncology procedures.” A review of the literature and comparison of clinical presentations shows that each of these terms represents a similar injury, and can be used interchangeably. Herein we provide a comparative review of the commonly used terminology for radiation-induced skin injury. Further, we recommend standardization across clinicians, providers, and researchers involved in the diagnosis, care, and investigation of radiation-induced skin injury. This will facilitate collaboration and broader inclusion criteria for grant-research and clinical trials and will assist in assessing therapeutic options particularly relevant to patient skin pigmentation response differences.

Radiation and Chemical Program Research for Multi-Utility and Repurposed Countermeasures: A US Department of Health and Human Services Agencies Perspective

“…The origin of these terms either from clinical use or animal model research has played a role, and now a broader recognition of the need to reconcile terminologies has been proposed by BARDA and others. 5 This approach extends the application of the MCM to clinical conditions seen in routine health care like RD. A direct benefit would be bolstering the market sustainability and product access for use in mitigation of injuries from nuclear fallout exposure to the broader population without the need for stockpile and distribution.…”

“…Whereas mild injuries to the skin, a common side effect seen in patients undergoing cancer radiation therapy, are termed radiation dermatitis (RD), the term for skin injuries from accidental exposure to the skin, arguably from larger exposures, is cutaneous radiation injury (CRI). The origin of these terms either from clinical use or animal model research has played a role, and now a broader recognition of the need to reconcile terminologies has been proposed by BARDA and others 5. This approach extends the application of the MCM to clinical conditions seen in routine health care like RD.…”

Review of optical reporters of radiation effects in vivo: tools to quantify improvements in radiation delivery technique

“… 105 Within this area, one issue is that multiple terms are often used interchangeably to describe similar skin conditions, such as cutaneous radiation injury, local radiation injury, RD, radiation-induced skin injuries, burns caused by radiation oncology procedures, and radiation burns. 106 Differences in response are known to have a dose response, although the biological heterogeneity of these responses does make it challenging to use them as a metric of dose, and of course mouse skin response does not translate quantitatively to humans. RD has been used to study patients receiving protons versus photon therapy, for example, 107 to quantitatively compare their value in skin sparing.…”

Effects of Radiation-Induced Skin Injury on Hyaluronan Degradation and Its Underlying Mechanisms

“…In addition, some researchers have suggested variations in the distribution of HA in human skin and mature, hypertrophic, and keloid scars [37]. The level of HA is critical to the formation of scar tissue and the production of inflammation in keloid lesions [9]. Subsequently, we aimed to assess the potential role of the MEK5/ERK5 pathway in HA degradation mechanisms.…”