Comprehensive Approach in Management of Radiation-induced Skin Injury: A Systematic Review

Background: Cancer as a second-leading cause of death and major global public-health crisis is expected to increase within next decades with high mortality rate. Radiotherapy is one of its widely-applied treatment modalities leads to a rise in cancer-survival rates. Despite the proven effectiveness of radiotherapy, extensive concerns around developing adverse effects on irradiated tissues by using this method have emerged. Regarding the significance of the skin as the largest organ and protective body barrier, radiation-induced skin injuries (RSI) are mainly focused. Among these dermatological toxicities, radiodermatitis (RD) is the most common side-effect experienced in ۹۰-۹۵% of patients undergoing radiotherapy, that finally result in treatment breaks, decreases disease control rates, and major life-quality consequences. Hence, its management is crucial but challenging since it ranges from erythema and dry scaling in acute phase to chronic manifestations including skin fibrosis and nonhealing wounds. Considering radiodermatitis pathological mechanisms including vascular injuries and disrupted cell division process, various products and bio-modalities have been studied in the literature to minimize radiodermatitis. Therefore, this study was conducted to review updated research-evidence and serve as fundamental guideline for practical management of RSI. Methods and materials: An electronic-based literature search was conducted in the databases EMBASE, MEDLINE, and SID besides Google Scholar search engine. The Preferred Reporting Items for Systematic Reviews and Meta-analyses ۲۰۲۰ (PRISMA) guidelines were followed. Literature about the subject were searched with proper MESH terms/keywords in both English and Persian languages for period between January ۲۰۲۰ and January ۲۰۲۴. This review included all abstract-available previously-published articles associated with RSI management in patients with cancers within mentioned period and omitted non-English/Persian studies besides non-human ones. CONSORT and STROBE guidelines were used to evaluate experimental and observational studies respectively. Results: Based on our inclusion and exclusion criteria, ۱۳۲ eligible articles were included from retrieved literature which comprise systematic/narrative reviews, clinical trials, retrospective and prospective cohort studies, case-control studies, and case reports. Generally, the major portion of data was collected from RSI occurrence among patients with breast and head - neck cancers respectively. All studies evaluated efficacy of specific intervention for treatment or prevention of RSI but some methodological challenges resulting in a doubtful quality of evidence. Explored management approaches are categorized in therapeutic strategies including topical applications (pharmaceutical and natural agents), bio-physical therapy, biological methods (Stem cell-based therapies

کلیدواژه ها:

Radiation-induced skin injuries ، Radiodermatitis ، Cancer ، Radiotherapy ، Management