Radiation-induced Skin Toxicity in Breast Cancer Patients: A Systematic Review of Randomized Trials

Radiation dermatitis is a common side effect of radiotherapy. Radiation dermatitis has been investigated for decades, and many approaches have been proposed to limit its incidence and severity. The purpose of the present systematic review was to summarize the approaches and findings of studies testing various methods for management of radiation dermatitis in breast cancer patients. Medline, Cochrane, and Embase were searched for studies pertaining to radiation-induced skin toxicity in breast cancer patients. The search results were limited to randomized trials of external beam radiotherapy conducted in humans and reported in the English language. The primary outcome was the incidence or severity of radiation dermatitis. Descriptive statistical analyses were performed. A total of 96 studies were included in the present review. These evaluated the effect of different radiotherapy techniques, topical treatments, supplements, skin care regimens, and treatments on radiation dermatitis. Few topical agents and oral supplements demonstrated their effectiveness across the randomized trials; however, various radiotherapy techniques, such as intensity-modulated radiotherapy, hypofractionated radiotherapy, accelerated partial breast irradiation, simultaneous integrated boost, and prone positioning consistently demonstrated decreased rates of radiation dermatitis, despite the limited number of studies in which they were evaluated.