Table 3.
Preradiotherapy assessment: |
Screen patient for radiation hypersensitivity syndromes |
Assess for use of medications (eg, chemotherapy) with potential to cause dermatitis |
Examine patient for baseline RTOG/CTCAE dermatitis score |
Patient recommendations during treatment: |
Protect skin from sun exposure |
Minimize skin trauma from excessive movement, exposure to extreme temperatures, or adhesives |
Gently wash skin with mild soap and water |
Apply deodorant/antiperspirant as needed |
Radiation treatment planning: |
Three-dimensional dosimetric planning with use of field-in-field or IMRT techniques |
Improve dose homogeneity to minimize “hot spot” regions |
Consider prone positioning for large-breasted women |
Consider hypofractionated treatment if otherwise indicated |
Practices for radiation dermatitis prevention and treatment: |
Skin emollients (not immediately before RT) |
Topical steroids (eg, mometasone, betamethasone) for prevention |
Consider nonsteroidal agents (eg, silver sulfadiazine, calendula ointment, barrier films) |
Consider protective dressings for areas of moist desquamation |
Monitor for and treat secondary infections if necessary |
Provide reassurance, monitor symptoms for resolution |
Abbreviations: RTOG/CTCAE, Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer; IMRT, intensity-modulated radiation therapy; RT, radiotherapy.