Page 92 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

Question #1: Existing evidence regarding radiating through dressings. The current

literature reviewed served as a backdrop against which current practice findings were compared.

The literature review included peer-reviewed published articles, books and grey literature and

revealed that limited evidence regarding the benefits and or potential harms of radiating through

dressings during radiotherapy is available. Existing evidence suggests that it may be safe to

radiate through thin dressings such as Mepitel® (Adamietz et al., 1995; Butson, Cheung, Yu, &

Metcalfe, 2002; Naylor & Mallett, 2001; Thilmann et al., 1996) and Mepilex® Lite in relation to

the potential radiation induced skin reactions and relatively less boost effect (Diggelmann et.al.,

2010; Mac Nally & Woodings, 2012). It is noteworthy that only Adamietz et al. and

Diggelmann et al. have published clinical trials. Two studies (laboratory-based, not with human

subjects) reported that while any of the wound dressings can be left on the skin during electron

irradiation, with photons the dose increase depends on the thickness of the dressing (Mac Nally

& Woodings; Thilmann et al.).The same study (Thilmann et al.) reported that in the case of

ulcerating tumors or fungating wounds, all non-adhesive wound dressings whose clinical

aptitude for the treatment of ulcerating tumors have been proven, can be used regardless of their

dosimetric characteristics. In all cases, the thickness of the dressing must be taken into account

when calculating the actual applied dose of radiation (Hollinworth & Mann, 2010; Thilmann et

al.).

Although the available literature speaks to dressing type and procedure, few studies have

addressed removal of dressings for radiation therapy, the area of focus I address in the thesis.

When the quality of the overall evidence is graded on a three-point scale whether good, fair and

poor, the literature review reveals that evidence is poor; assessed as level three because

“evidence is insufficient to assess the effects on health outcomes because of limited number or