Human skin is radiosensitive and 95% of patients endure skin reactions when receiving radiation therapy (RT). Toxicity increases with the use of concomitant chemotherapy and high-dose radiotherapy. NCI RT toxicity scales describe skin reactions in stages, 0–4, ranging from faint erythema to skin necrosis. Astute nursing assessments and early interventions are required by RT nurses as skin reactions can cause treatment breaks, non-compliance with interventions, and effect quality of life. Applying wound management strategies can assist patients. Silicone dressings, petrolatum gauze, moisture vapor permeable, or gel sheets are available when patients develop moist desquamation. There are no clinical studies evaluating the wearing dressings during RT and bolus effect (amount of extra radiation absorbed dose{rad}).
Purpose/Objective(s)
The purpose was to assess the amount of rads the skin would receive above normal dosing if dressings were kept on while having RT. Two types of ionizing radiation (photon/electron beams) with varies energy levels were tested and compared.
Interventions
The radiation physicist was provided several common RT dressings. Measurements were taken and recorded by a parallel plate chamber identifying the amount of rads the skin would receive if dressings were left on during RT. Six different electron energies and two photon energies were taken once evaluating Mepilex, Mepitel, Cool Magic, and Vaseline gauze. RT nurses will benefit in applying this information in skin care management.
Results
All dressings, applying 6 different electron beams (6e–21e), increased skin dose only from 1–5%. While applying the more penetrating photon beams (6× and 15×), there was an increase skin bolus effect (30–58%), thus causing more skin toxicity.
Conclusions
Evidence supports patients can wear dressings if receiving electron beams, but should not wear them if receiving photon beams. It is essential that RT nurses understand dosing (type of energies) to instruct patients appropriately. Given this evidence, RT nurses can feel confident in writing and executing skin care protocols and instructing when to remove dressings for RT. For combined chemoradition, toxicities usually occur earlier, but the same principles can be applied. Also, RT nurses can advocate to commercial vendors to have this information on their package inserts.
Mountain Radiation Oncology, P.A., Asheville, NC
Author Disclosure: M.L. Haas, Medicus Nursing, MedImmune Nursing, F. Consultant/Advisory Board; J. Coletti, None.
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