Skin Reactions during Radiation Therapy

Radiation therapy is a cancer treatment that uses radiation to kill cancerous cells. It is used for many cancer types including breast cancer. This treatment has many side effects, depending on the location of the treatment field on the body (e.g., when two skin surfaces are in contact with each other). The common and general ones are fatigue, skin problems and hair loss. Depending on the severity, all these reduce the quality of life for the patient whose body is already going through a lot of trauma.

Dermatitis which describes skin-related irritation can occur in 90–95% of patients undergoing radiation therapy. The kind of skin issues that occur includes a type of skin rash called erythema where blood capillaries get inflamed. This can lead to scaly, flaking, broken skin called dry squamation. A severe reaction could lead to moist squamation in patches or in folds and creases. In the case of moist squamation, the epidermal layer gets removed, exposing the dermal layer, thus leading to severe blisters, pain and potentially infections. With the possibility of these severe symptoms, it is important to understand and address dermatitis in the best possible ways.

Current Treatments for Radiation Dermatitis

While there are different strategies being explored to minimize dermatitis or treat it post-therapy, there are no specific guidelines for clinicians to manage or prevent this condition. There are interventions involved in preventing or reducing the occurrence of dermatitis like switching and using alternate radiation techniques, including those with low-level lasers. There are post-therapy symptomatic treatments such as using steroidal or nonsteroidal topical agents, topical emollients, barrier films and dressings as well as following proper care of the skin.

In analyzing the many different techniques used, a review concluded that steroid creams are useful for patients at high risk for skin infections but under specific conditions of cancer and radiation therapy type. Topical emollients as an effective treatment strategy do not have enough evidence. An alternative to radiation therapy called photobiomodulation therapy has been shown to have potential but needs further research.

Use of Boron-Based Gel as a Pre-Treatment Intervention

Apart from the above-mentioned interventions to help reduce or treat radiation dermatitis, the use of a boron-based gel has been recently studied. In a phase III clinical trial study conducted for the first time, the authors tested the effectiveness of using a boron-based gel in reducing the different skin reactions to radiation therapy in breast cancer patients. They particularly used a Carbopol gel containing 3% sodium pentaborate pentahydrate.

The trial involved testing breast cancer patients who were undergoing the same kind of radiation therapy. The gel was applied on the site of radiation 15 mins before each radiation therapy session. The gel with the boron-based compound was used on some patients, while other patients (the control group) got the same gel without the boron compound. Neither the clinicians nor the patients were informed about what was being administered. The skin condition was recorded in these patients at the beginning of the treatment and was followed up and checked after 25 days. The patients who were given the boron-based gel had only 9.9% chance of getting dermatitis compared to 98.7% of patients in the control group. This reduction was seen in all types of reactions from erythema, dry squamation or moist squamation. Moreover, the skin toxicity in patients in the treatment group was also lower.

The treatment was proven to have significant potential in taking forward. Since the gel is applied before the radiation therapy, the compliance was also high. The main problem with the study was that the patient-reported outcome was not collected. Further, long-term issues of using the boron-based gel need to be studied.

How Can This Help a Radiation Therapy Patient?

Radiation therapy is one of the common treatments for cancer including breast cancer. There are reports of high chances of getting radiation dermatitis with radiation therapy which additionally depends on the history of the patient. Unfortunately, these skin reactions reduce the quality of life and discourage patients from continuing with therapy. This can be highly detrimental to their health. Understanding these side effects and possible treatment options is important. The patient can discuss the possible interventions for dermatitis, including this new study, with their oncologist. Together they can create a pre- and post-therapy treatment plan which will require proper monitoring. These interventions can significantly improve the quality of life of the patient and the adherence to the radiation therapy procedure.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.