Page 20 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

radiation therapy has been summarized in the four “Rs” i.e., Reoxygenation, Redistribution,

Repair and Repopulation (Halperin, Perez & Brady, 2008; Newton, Hickey & Marrs, 2009).

Treatment can be directed locally or regionally for various purposes. Irradiation is an

effective modality in the treatment of many patients with cancer and can be used as the primary

treatment for certain cancers such as early laryngeal lesions and prostate cancer (Moore-Higgs,

2007). Combined modality is chemotherapy administered before (neoadjuvant), after (adjuvant),

and concurrently with surgery or radiation therapy. Chemotherapy is used as a radio sensitizer in

neoadjuvant, adjuvant or concurrent treatment to enhance the effects of radiation therapy. The

choice of treatment is dependent on the therapeutic objective (i.e., neoadjuvant, adjuvant,

prophylaxis, control or palliation) (Moore-Higgs, 2007). Although chemo radiotherapy

improves local-regional tumor control and enhances disease free survival, there will likely be an

increase in certain toxicities (Vogel, 2007). It is noted that approximately 95% of people

develop skin reactions to some extent during or shortly after radiotherapy (Porock, Nikoletti, &

Kristjanson, 1999). In order to examine skin changes due to radiation, it is important to review

the anatomy, physiology and the manner in which healthy skin regenerates.

The skin and radiation therapy. The human skin is the largest organ in the body and is

responsible for several functions. The skin acts as a barrier to prevent fluid loss and is the first

line of defense against trauma, bacteria, toxins and ultraviolet radiation (Nouri, 2008; Sparks,

2007). The skin is also a sensory organ which contains nerve endings that sense touch, pressure,

heat, cold and vibration. The skin is involved in immune function, contributes to

thermoregulation and is a site of transport for oxygen, carbon dioxide, nitrogen and topically

applied medications and creams (Nouri, 2008). It is composed of three primary layers; the

epidermis, dermis and hypodermis.