A novel treatment to delay the onset of radiotherapy-induced skin reaction

WHAT IS RADIOTHERAPY-INDUCED SKIN REACTION? While radiotherapy treatment is vital for tumour management, it can cause severe skin reaction. All patients receiving external radiotherapy beam therapy (EBRT) are at risk of developing a reaction; the incidence is said to range from 85% (Robson and Cooper, 2009; Salvo et al, 2010) to 95% (McQuestion, 2011). Due to the appearance of RISR, it is easy to mistake for a burn injury; however, as Trueman (2013) states, the mechanisms, extent, duration and trajectory of injury is different (Table 1). External radiotherapy beam therapy destroys the cancer cells in the treatment area by either directly damaging cancer cell DNA, or by creating charged particles (free radicals) which damage DNA, thus causing cells to stop growing or die. The radiation damages the basal layer of the epidermis, and the subsequent imbalance between the normal production of cells in this layer and the destruction of cells at the skin surface causes radiation induced skin reaction (Trueman, 2011). Radiation is delivered in small doses (called fractions), which in theory allows time for healthy cells to recover between treatments; however, because each fraction damages cells, skin damage is cumulative. This damage is assessed using tools such as the RadiationInduced Skin Reaction Assessment Scale (RIRAS) (Noble-Adams, 1999), or the more commonly used Radiotherapy Oncology Group (RTOG) assessment tool (Cox et al, 1995; Glean, 2000) (Table 2). This development of skin damage can be summarised thus: 10–14 days from first dose, damaged basal cells migrate to the skin surface and erythema develops — RTOG 2 As more fractions are given, further skin damage occurs; new cells reproduce before old dead cells shed leading to dry desquamation — RTOG 2a In this article, the author discusses current topical treatments used in the treatment of radiotherapy-induced skin reaction (RISR) and discusses an alternative, Flamigel® RT (Flen Health UK). A moderate to severe radiotherapy-induced skin reaction may necessitate a break in treatment; this novel product can reduce the onset and severity of RISR, thus potentially ameliorating treatment breaks (Harris et al, 2011; Censabella et al, 2017). The author of this article experienced a mild RISR during radiotherapy treatment that developed at about day 7. While this did not delay treatment, the effects could at times be difficult to manage. The mild discomfort was tolerable, but the worst symptom was the itching.