Managing Patients With Chronic Radiation Dermatitis and Fibrosis

Guidelines for the diagnosis, management, and treatment of chronic radiation dermatitis or fibrosis are useful in the context of multidisciplinary cancer care.

A multidisciplinary panel has developed an international, consensus-based approach for the terminology, risk factors, treatment, and management of chronic radiation dermatitis and fibrosis (CRDF), according to a paper published in the British Journal of Dermatology.

The panel of 27 providers, including 25 physicians and 2 nurse practitioners, participated in the Delphi method survey, which involved 2 independent rounds of questionnaires followed by a consensus meeting. The physicians included 19 dermatologists and 6 oncologists, 2 of whom were radiation oncologists.

Strong consensus was achieved if 70% or more of the respondents strongly agreed or agreed with a statement, and moderate consensus was reached if 50% to 69% of respondents strongly agreed or agreed with a statement. Statements with moderate consensus were reviewed for modification and inclusion in the second round.

The process included 63 questions/statements in the first round and 27 in the second round. Strong consensus was achieved for 15 statements, moderate consensus for 16 statements, and 32 statements failed to reach consensus and were eliminated, respectively.

Any patient receiving a significant dose of radiation to the skin should discuss the possibility of developing [chronic radiation dermatitis and fibrosis].

Treatment features that increase the risk for CRDF that reached strong consensus include re-radiation, initial radiation dose, and radiation volume, with the risk for toxicity positively associated with radiation dose. Patient features that increase the risk for CRDF reaching strong consensus include anatomical location, underlying connective tissue diseases, and smoking history. The head/neck and breast/chest were considered to be the anatomical sites associated with the greatest risk for CRDF.

A majority of panelists agreed that CRDF begins 90 days after cessation of radiation therapy and encompasses various morphologies that range from dermal atrophy to vascular changes. A recommendation for sunscreen after radiotherapy to protect the skin against ultraviolet-induced radiation changes was made with strong consensus.

Moderate consensus (61%) was reached for the use of topical and/or intralesional corticosteroids and oral pentoxifylline (57%) for managing patients with CRDF. In addition, 58% of panelists believe that physical therapy and range of motion exercises are helpful for contractures, fibrosis, epidermal atrophy, and dermal atrophy. Combination therapy involving oral pentoxifylline, oral vitamin E, and physical therapy achieved moderate consensus, with 54% of panelists supporting this first-line approach for contractures, fibrosis, epidermal atrophy, and dermal atrophy.

Strong consensus (96%) was achieved for laser therapy in the management of CRDF. For vascular changes, 92% of the panelists believe that a vascular laser such as 595-nm pulsed dye laser was an appropriate first-line treatment. Strong consensus also was reached for fractional ablative laser therapy for skin contractures (90%) and fibrosis/induration (75%).

“Any patient receiving a significant dose of radiation to the skin should discuss the possibility of developing CRDF,” stated the researchers. “Thus, guidelines and best practices for the diagnosis, management, and treatment of chronic radiation dermatitis or fibrosis are useful, particularly in the context of multidisciplinary cancer care.”

Disclosure: Several of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Wilson BN, Shah R, Menzer C, et al. Consensus on the clinical management of chronic radiation dermatitis and radiation fibrosis: a Delphi survey. Br J Dermatol. Published online September 1, 2022. doi:10.1111/bjd.21852