Page 33 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

Additionally, their indications, guidelines for use and effectiveness, along with cost

considerations are discussed.

A review of evidence by Kumar, Juresic, Barton, and Shafiq (2010) suggests that

recommendations on general wound care management such as moist dressing may not be

appropriate based on a trial by Macmillan et al. (2007). The randomized controlled trial (n=

357) evaluated the effect of a hydrogel (Intrasite®) versus a dry dressing (Tricotex®) in the

management of radiation induced moist desquamation. Of the 100 patients who developed moist

desquamation, the study concluded that hydrogel dressings do not expedite healing. The

principal finding was that the study found no evidence to support the routine use of hydrogel

dressings in patients with moist desquamation after radiotherapy. According to Kumar et al.

(2010), “It should be noted that skin toxicity unlike a burn wound, occurs due to damage done

repeatedly and not via an instantaneous injury, and therefore it may not be appropriate to directly

relate burn wound management guidelines to radiotherapy skin reactions” (p. 276). The authors

conducted a pattern of care survey in New Zealand on recommendations given to patients to

manage skin toxicity that demonstrated variability in skin care practices based on protocols

derived from both literature and anecdotal evidence.

Dosimetric measurement. Each patient undergoing radiotherapy requires careful

treatment planning. Clinical evaluation, therapeutic plan, imaging, simulation, and isodose

planning are all part of the treatment planning process (Khan, 2007, p.3). Medical dosimetry is

the calculation of absorbed dose and optimization of dose delivery in radiation therapy that is

often performed by a medical dosimetrist. In order to plan the delivery of radiation therapy, the

radiation produced by the sources is usually characterized and dose profiles are measured by

medical physicists. Khan wrote, “The radiation oncologist, who has the ultimate responsibility