Dermatologic Toxicities of Radiation Therapy

Introduction

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  Radiation dermatitis is one of the earliest known side effects of radiation. Almost all patients receiving radiation therapy have some changes in the skin. Acute and/or chronic skin changes may occur, which may have implications for quality of life during and after completion of radiation. These dermatological reactions may lead to delay in treatment or diminished cosmesis and functional deficits.

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  Radiation is used as adjuvant therapy after surgery in many situations such as after breast conserving therapy or mastectomy to reduce the risk of local recurrence for breast cancer, or as definitive treatment for early stage medically inoperable lung cancer concurrent with chemotherapy for locally advanced lung cancer, as well as with or without chemotherapy in the treatment of sarcomas, thymomas, and lymphomas. Radiation is also used as external beam radiation therapy or brachytherapy for the treatment of skin cancers. These broad indications increase the sheer numbers of potential patients, many of whom will develop some form of radiation dermatitis.

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  Radiation effects to the skin are usually unavoidable, as the radiation must enter, exit, or be deposited near the skin to reach the target volume. Skin cells, because they originate from a rapidly reproducing differentiated stem cell, are relatively radiosensitive. The side effects can sometimes lead to interruption of therapy and be dose-limiting for tumor control and thus prevention and treatment strategies become extremely important.

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  In this chapter, we will discuss the clinical manifestations, mechanism of action, treatment, and prevention of radiation dermatitis.