Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-23T12:39:36.687Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluating the relevance of dosimetric considerations to patient instructions regarding skin care during radiation therapy

Published online by Cambridge University Press:  11 June 2013

Lyndon Morley ,
Angela Cashell ,
Annette Sperduti ,
Maurene McQuestion  and
James C. L. Chow
Lyndon Morley*
Affiliation:
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
Angela Cashell
Affiliation:
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Annette Sperduti
Affiliation:
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
Maurene McQuestion
Affiliation:
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
James C. L. Chow
Affiliation:
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
*
Correspondence to: Lyndon Morley, Department of Radiation Therapy, Princess Margaret Cancer Centre, 610 University Avenue, Room 2B-615, Toronto, Ontario, Canada M5G 2M9. Tel: 416-946-4501, ext. 4889. Fax: 416-946-2019. E-mail: lyndon.morley@rmp.uhn.on.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Patient teaching in radiation therapy may include restrictions on applying skin products owing to concerns that the presence of such materials may increase skin dose. These restrictions may create unnecessarily complicated and conflicting self-care instructions.

Purpose

To determine what thickness of skin product is necessary to produce a clinically meaningful dose increase to the skin, and provide recommendations for evidence-based patient instructions.

Methods

Dosimetric measurements and Monte Carlo simulations were used to calculate skin dose under 0–1·5 mm thicknesses of two common classes of skin product for a variety of treatment geometries. The thickness of product required to produce a clinically significant dose increase to the skin was determined.

Results

The thickness of product required to create a clinically meaningful dose increase was >0·7 mm for 10 × 10 cm2 fields and >1·5 mm for 1 × 1 cm2 fields. A typical application of product would be only 0·3 mm.

Conclusion

It seems unrealistic to anticipate patients using sufficiently large quantities of skin product to be of clinical concern. We therefore recommend that there are no dosimetric reasons to restrict the use of these types of skin products during radiation therapy for common treatment scenarios.

Keywords

medical dosimetrypatient educationpatient teachingradiation therapyradiation skin doseself-care instructionsside-effect managementskin care during radiation therapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 3 , September 2014 , pp. 294 - 301
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Chan, R J, Larsen, E, Chan, P. Re-examining the evidence in radiation dermatitis management literature: an overview and a critical appraisal of systematic reviews. Int J Radiat Oncol Biol Phys 2012; 84 (3): e357–e362.CrossRefGoogle Scholar
2.Dendaas, N. Toward evidence and theory-based skin care in radiation oncology. Clin J Oncol Nurs 2012; 16 (5): 520–525.Google Scholar
3.D'Haese, S, Van Roy, M, Bate, T, Bijdekerke, P, Vinh-Hung, V. Management of skin reactions during radiotherapy in Flanders (Belgium): a study of nursing practice before and after the introduction of a skin care protocol. Eur J Oncol Nurs 2010; 14 (5): 367–372.Google Scholar
4.Lee, N, Chuang, C, Quivey, J Met al. Skin toxicity due to intensity-modulated radiotherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys 2002; 53 (3): 630–637.Google Scholar
5.McQuestion, M. Evidence-based skin care management in radiation therapy. Semin Oncol Nurs 2006; 22 (3): 163–173.Google Scholar
6.McQuestion, M. Evidence-based skin care management in radiation therapy: clinical update. Semin Oncol Nurs 2011; 27 (2): e1–e17.Google Scholar
7.Rizza, L, D'Agostino, A, Girlando, A, Puglia, C. Evaluation of the effect of topical agents on radiation-induced skin disease by reflectance spectrophotometry. J Pharm Pharmacol 2010; 62 (6): 779–785.Google Scholar
8.Gosselin, T K, Schneider, S M, Plambeck, M A, Rowe, K. A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy. Oncol Nurs Forum 2010; 37 (5): 619–626.Google Scholar
9.Harris, R. Summary of Interventions for Acute Radiotherapy-Induced Skin Reactions in Cancer Patients: A Clinical Guideline recommended for use by The Society and College of Radiographers, Society of Radiographers (http://www.sor.org), 2011; 1–5.Google Scholar
10.Harris, R, Probst, H, Beardmore, Cet al. Radiotherapy skin care: a survey of practice in the UK. Radiography 2012; 18 (1): 21–27.CrossRefGoogle Scholar
11.Mannix, C M, Bartholomay, M M, Doherty, C S, Lewis, M, Bilodeau, M L. A feasibility study of low-cost, self-administered skin care interventions in patients with head and neck cancer receiving chemoradiation. Clin J Oncol Nurs 2012; 16 (3): 278–285.Google Scholar
12.Nystedt, K E, Hill, J E, Mitchell, A Met al. The standardization of radiation skin care in British Columbia: a collaborative approach. Oncol Nurs Forum 2005; 32 (6): 1199–1205.Google Scholar
13.Roy, I, Fortin, A, Larochelle, M. The impact of skin washing with water and soap during breast irradiation: a randomized study. Radiother Oncol 2001; 58 (3): 333–339.Google Scholar
14.Aistars, J. The validity of skin care protocols followed by women with breast cancer receiving external radiation. Clin J Oncol Nurs 2006; 10 (4): 487–492.Google Scholar
15.Bolderston, A, Lloyd, N S, Wong, R K, Holden, L, Robb-Blenderman, L. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer 2006; 14 (8): 802–817.Google Scholar
16.Bieck, T, Phillips, S. Appraising the evidence for avoiding lotions or topical agents prior to radiation therapy. Clin J Oncol Nurs 2010; 14 (1): 103–105.Google Scholar
17.Burch, S E, Parker, S A, Vann, A M, Arazie, J C. Measurement of 6-MV X-ray surface dose when topical agents are applied prior to external beam irradiation. Int J Radiat Oncol Biol Phys 1997; 38 (2): 447–451.Google Scholar
18.Lavery, B A. Skin care during radiotherapy: a survey of UK practice. Clin Oncol (R Coll Radiol) 1995; 7 (3): 184–187.Google Scholar
19.Vermeire, E, Hearnshaw, H, Van Royen, P, Denekens, J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther 2001; 26 (5): 331–342.CrossRefGoogle ScholarPubMed
20.Hadley, S W, Kelly, R, Lam, K. Effects of immobilization mask material on surface dose. J Appl Clin Med Phys 2005; 6 (1): 1–7.Google Scholar
21.Velec, M, Waldron, J N, O'Sullivan, Bet al. Cone-beam CT assessment of interfraction and intrafraction setup error of two head-and-neck cancer thermoplastic masks. Int J Radiat Oncol Biol Phys 2010; 76 (3): 949–955.Google Scholar
22.Takema, Y, Yorimoto, Y, Kawai, M, Imokawa, G. Age-related changes in the elastic properties and thickness of human facial skin. Br J Dermatol 1994; 131 (5): 641–648.CrossRefGoogle ScholarPubMed
23.Kawrakow, I, Rogers, D W O. The EGSnrc code system: Monte Carlo simulation of electron and photon transport. Technical Report PIRS-701. Ottawa, Canada: National Research Council of Canada, 2000. http://www.irs.inms.nrc.ca/EGSnrc/pirs701.pdfGoogle Scholar
24.Nelson, W R, Hirayama, H, Rogers, D W O. EGS4 Code System. Menlo Park, CA, USA: Stanford Linear Accelerator Center, 1985.Google Scholar
25.Rogers, D W, Faddegon, B A, Ding, G X, Ma, C M, We, J, Mackie, T R. BEAM: a Monte Carlo code to simulate radiotherapy treatment units. Med Phys 1995; 22 (5): 503–524.Google Scholar
26.Chow, J. Some medical applications of MOSFETs in radiation therapy: surface dose and electron backscatter measurements with Monte Carlo simulations. In: Noah T, Andre L M S (eds). MOSFETs: Properties, Preparations and Performance. New York: Nova Science Publishers, 2008: 217–251.Google Scholar
27.Chow, J C, Grigorov, G N. Surface dosimetry for oblique tangential photon beams: a Monte Carlo simulation study. Med Phys 2008; 35 (1): 70–76.Google Scholar
28.Chow, J C, Grigorov, G N, Barnett, R B. Study on surface dose generated in prostate intensity-modulated radiation therapy treatment. Med Dosim 2006; 31 (4): 249–258.Google Scholar
29.Rietschel, R L. A method to evaluate skin moisturizers in vivo. J Invest Dermatol 1978; 70 (3): 152–155.CrossRefGoogle ScholarPubMed
30.Chow, J C, Leung, M K. Monte Carlo simulation of MOSFET dosimeter for electron backscatter using the GEANT4 code. Med Phys 2008; 35 (6): 2383–2390.CrossRefGoogle ScholarPubMed