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Invited Commentary
December 2018

Avoiding Topical Agents Before Daily Radiotherapy: Debunking Dogma

Author Affiliations
  • 1Department of Radiation Medicine, Oregon Health & Science University, Portland
  • 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
JAMA Oncol. 2018;4(12):1748-1750. doi:10.1001/jamaoncol.2018.4291

The clinical science of radiotherapy (RT) has evolved considerably since the early use of low-energy (150- to 300-kV) orthovoltage x-rays, which deposit much of their energy at the skin surface. Indeed, the skin “erythema dose” was the primary means of standardizing radiation doses given the limited tangible criteria for documenting radiation effects at the time.1 Contemporary RT uses high-energy photons that deposit their maximum dose several centimeters below the skin surface. Nevertheless, in 90% to 95% of cases, moderate to high doses of this megavoltage radiation can lead to acute radiation dermatitis, which begins as erythema during the first 2 weeks of treatment before progressing to dry desquamation, and, in some cases, on to moist desquamation.2 Management of these reactions varies; preventive and interventional strategies have included frequent washing with mild soap and using topical dressings and corticosteroidal and noncorticosteroidal topical agents.

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