Wells Mary, Macmillan Maureen, Raab Gillian, MacBride Sheila, Bell Nancy, MacKinnon Karen, MacDougall Hugh, Samuel Leslie, Munro Alastair
School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK.
Radiother Oncol. 2004 Nov;73(2):153-62. doi: 10.1016/j.radonc.2004.07.032.
Evidence on which to base decisions about the management of radiation skin reactions is lacking. The purpose of this study was to investigate whether sucralfate or aqueous cream reduced acute skin toxicity during radiotherapy to the head and neck, breast or anorectal area (phase A), and to evaluate the effect of hydrogels and dry dressings on moist desquamation (phase B). This paper presents the results of phase A.
Three hundred and fifty seven patients were randomised to apply aqueous cream, sucralfate cream or no cream to the irradiated area from day one of radical radiotherapy treatment. All patients were instructed to wash using unperfumed soap. Acute skin toxicity was measured using a modified radiation therapy oncology group (RTOG) score, reflectance spectrophotometry, patient diary card and dermatology life quality index (DLQI). A cost minimisation approach was used to compare the costs of each skin care approach.
No consistent differences were found in the severity of skin reactions or levels of discomfort suffered by patients in each of the randomised groups. Patients with a higher body mass index, who smoked, received concomitant chemotherapy, boost or bolus during treatment were more likely to develop skin reactions.
There is no evidence to support the prophylactic application of either of the creams tested for the prevention of radiation skin reactions. Our results show that it is possible to predict which patients are at greatest risk of skin reactions. We suggest that known risk factors should be incorporated into future study protocols.
缺乏关于放射皮肤反应管理决策的依据。本研究的目的是调查硫糖铝或水性乳膏是否能降低头颈部、乳腺或肛管直肠区域放疗期间的急性皮肤毒性（A阶段），并评估水凝胶和干性敷料对湿性脱屑的影响（B阶段）。本文呈现A阶段的结果。
357例患者从根治性放射治疗的第一天起被随机分配，在照射区域涂抹水性乳膏、硫糖铝乳膏或不涂抹乳膏。所有患者均被指导使用无香料肥皂清洗。使用改良的放射肿瘤学组（RTOG）评分、反射分光光度法、患者日记卡和皮肤病生活质量指数（DLQI）来测量急性皮肤毒性。采用成本最小化方法比较每种皮肤护理方法的成本。
各随机分组患者的皮肤反应严重程度或不适程度未发现一致差异。体重指数较高、吸烟、在治疗期间接受同步化疗、追加照射或大剂量照射的患者更易发生皮肤反应。
没有证据支持对所测试的任何一种乳膏进行预防性应用以预防放射皮肤反应。我们的结果表明，有可能预测哪些患者发生皮肤反应的风险最大。我们建议将已知的风险因素纳入未来的研究方案中。
