质子碳离子治疗腺样囊性癌的近期疗效及不良反应

目的 观察束流调强粒子放射治疗头颈部腺样囊性癌的不良反应和近期疗效。方法 2015年5月至2016年3月,8例初治的病理证实的头颈部腺样囊性癌患者,5例患者为局部晚期（T_3-4期）,3例患者为R1切除,5例患者为活检术后或R2切除。7例患者采用束流调强质子放射治疗（IMPT）联合束流调强碳离子放射治疗（IMCT）,IMPT放射临床靶区体积（CTV）56 GyE/28次后,采用IMCT给予局部加量治疗15 GyE/5次。1例患者接受了单纯的IMPT治疗。结果 根据新版实体瘤疗效评价标准（RECIST）评估标准,本组5例具有明确肿瘤病灶的患者,在放疗结束时和结束后1个月,3例肿瘤部分缓解（PR）,2例疾病稳定（SD）;4例放疗结束后3个月随访时,有2例达到完全缓解（CR）,1例PR,1例SD。至2016年3月所有患者均无肿瘤进展和死亡。放疗期间,2例发生了3级口腔黏膜反应,随访3个月无重度皮肤反应发生。结论 束流调强粒子放射治疗头颈部腺样囊性癌安全、有效,但后期不良反应和远期疗效尚需更长时间的观察。     

26例脑膜瘤的质子放射治疗初步临床结果

目的 考察质子射线放射治疗世界卫生组织（WHO）Ⅰ/Ⅱ级脑膜瘤的初步疗效及不良反应。方法 回顾性分析2015年5月至2018年10月上海市质子重离子医院治疗脑膜瘤患者26例,其中18例为颅底脑膜瘤。患者的中位年龄为42岁（范围15~79岁）。病理诊断为WHOⅠ级脑膜瘤的患者8例,病理诊断为WHO Ⅱ级的脑膜瘤患者9例,影像学诊断患者9例。7例患者为术后放疗（Simpson Ⅰ~Ⅲ级切除2例,Simpson Ⅳ~Ⅴ级切除5例）,10例患者为术后复发后放疗。结果 中位随访时间为22.2个月,所有患者均完成了既定的质子射线放射治疗,中位等效剂量为54 GyE（范围50.4~60 GyE）, 单次剂量为1.8~2.0 GyE。治疗后70%患者症状部分缓解,2年无进展生存率（PFS）和总生存率（OS）均为100%。治疗期间急性放射反应轻微,仅出现1级脱发（n=22）和黏膜反应（n=2）,无2级及以上急性反应,目前尚未观察到晚期不良反应。结论 质子治疗颅内及颅底脑膜瘤安全有效,长期疗效及不良反应需进一步随访。     

鼻咽癌放疗后继发性皮肤晚期放射损伤

目的 通过分析皮肤早期放射反应对皮肤晚期放射反应的影响,探讨皮肤的继发性晚期放射损伤。方法 对门诊随访的放疗后生存5年以上的335例鼻咽癌患者进行调查研究,其中放疗时中位年龄41岁(12～67岁),240例伴颈部淋巴结转移。鼻咽原发灶首程放疗中位剂量为70Gy(55～86Gy),以面颈野为主野放疗71例,以耳前野为主野放疗264例。颈部根治性放疗中位剂量为64Gy(46～72Gy),预防照射中位剂量为55Gy(21～67Gy)。48例合并化疗。根据1995年SOMA标准评价皮肤晚期放射反应。结果 随访间隔中位时间为14年(5～38年)。63例无皮肤晚期反应,1、2、3、4级皮肤晚期反应发生率分别为43.9%(147例)、20.9%(70例)、13.7%(46例)、2.7%(9例)。44例放疗中出现湿性脱皮反应,其中1、2、3、4级皮肤晚期反应发生率分别为41%(18例)、23%(10例)、30%(13例)和5%(2例);无湿性脱皮患者的相应发生率分别为44.3%(129例)、20.6%(60例)、11.3%(33例)和2.4%(7例),两者差异有统计学意义(χ²=17.42,P=0.002)。分层分析结果显示初诊时是否伴颈部淋巴结转移、放疗野及颈部淋巴结放疗剂量均对皮肤晚期反应发生有关,而性别、年龄及是否联合使用化疗与皮肤晚期反应的发生无关。 结论 严重的皮肤早期放射反应可能增加皮肤晚期放射反应,可能存在继发性皮肤晚期放射损伤。     

前列腺癌术后中等分割放射治疗I期临床研究

目的 评价前列腺癌术后中等分割照射的急性不良反应。方法 选取2017年2月至8月,本院20例前列腺癌术后患者入组。中等分割处方剂量为盆腔45 Gy/25次,1.8 Gy/次;前列腺床62.75 Gy/25次,2.51 Gy/次。不良反应的评价采用北美放射肿瘤协作组（RTOG）急性不良反应评价标准和常见不良事件评价标准（CTCAE）4.0。结果 中位随访时间7.5个月。1例（5%）患者出现了2级急性胃肠反应;2例（10%）患者出现了2级急性泌尿反应。2例（10%）患者放射治疗期间出现了2级尿失禁,放疗后1个月恢复至0级或1级。结论 与既往常规分割照射文献相比,前列腺癌术后中等分割照射模式（2.51 Gy/次×25次）没有明显增加患者急性胃肠、泌尿系统不良反应。近期随访结果显示,没有增加患者尿失禁风险。     

鼻咽癌调强放疗与常规放疗患者生存质量的初步观察

目的 比较鼻咽癌患者调强放疗与常规放疗的急慢性反应和生存质量。方法 系统分析2008年8月至2010年9月在宁波市李惠利医院行常规放疗及调强放射治疗(IMRT)的初治鼻咽癌患者91例,分为IMRT组(35例)和常规放疗组(56例)。常规放疗采用面颈联合野+颈切线野及耳前野+颈部电子线野,靶区剂量2.0 Gy/次,35次,共70 Gy;调强放疗设定9个共面野,靶区剂量2.12 Gy/次,33次,共69.96 Gy。比较IMRT和常规放疗患者的急性不良反应如口干、吞咽疼痛、吞咽困难、皮肤和黏膜反应等;晚期放射损伤如吞咽困难、张口困难、甲状腺功能低下、视力及听力下降、皮肤损伤、皮下组织纤维化、脊髓炎、脑损伤等方面。结果 与常规组相比,IMRT组的急性不良反应有不同程度的减轻,口干、吞咽疼痛、吞咽困难、皮肤反应和黏膜反应等的发生率较低(χ²=85.73、 56.03、 26.58、69.28和55.99,P<0.05);晚期损伤中口干、吞咽困难、味觉改变、张口困难、皮肤损伤等方面显著减轻(χ²=37.95、7.48、9.49、9.49和11.87, P<0.05),而听力下降程度、视力损伤、脑损伤等的发生率差异无统计学意义,可能与随访时间较短有关。结论 相对于常规放疗,IMRT技术能够减轻急性不良反应,并减少晚期损伤发生率,改善患者的生存质量。     

碳离子放射治疗肌层浸润性膀胱癌Ⅰ/Ⅱ期临床研究的初步疗效观察

目的 评估Ⅰ/Ⅱ期临床研究中碳离子放疗(CIRT)治疗肌层浸润性膀胱癌的可行性和安全性。方法 研究对象为2020年3月至2022年1月就诊甘肃省武威肿瘤医院的9例肌层浸润性膀胱癌患者(不伴远处转移),临床分期为T_2~3。治疗包括3分次,由12 Gy增加到24 Gy的局部照射和11分次44 Gy的全膀胱照射。碳离子照射剂量均为相对生物学有效性(RBE)为3.0时的剂量。膀胱肿瘤总剂量为56~68 Gy,分14次。主要观察终点包括肿瘤的治疗相关不良反应和剂量限制毒性(DLT)、局部控制率(LC)。次要终点为无进展生存期(PFS)。结果 9例患者完成了试验研究中各剂量段CIRT,剂量递增至68 Gy。未发生DLT和≥3级的急性放疗不良反应和生存期内的晚期放疗不良反应。肿瘤剂量达到68 Gy时,出现2例2级急性泌尿生殖道反应,1例急性下消化道症状;62 Gy以上剂量组观察到3例1级晚期放射性膀胱反应,表现为尿频和镜下血尿。所有病例治疗结束时血尿均消失,排尿不畅缓解,尿红细胞值显著下降。治疗后3个月、6个月局部控制率分别为100%和88.9%,客观缓解率均为88.9%。1例患者在治疗后6个月出现局部复发,采用挽救性手术治疗。结论 碳离子放射治疗肌层浸润性膀胱癌初步疗效观察,未见剂量限制性毒性,安全可行,近期疗效显著,症状缓解明显,患者耐受性好。     

儿童髓母细胞瘤术后全脑全脊髓放疗的血液学不良反应及近期疗效观察

目的 分析儿童髓母细胞瘤术后行全脑全脊髓放疗的疗效及影响预后的因素,并分析放疗期间血液学不良反应对预后的影响。方法 回顾性分析髓母细胞瘤术后行全脑全脊髓放疗的儿童87例。血液学不良反应按美国肿瘤放射治疗协作组(RTOG)早期放射反应标准评分进行评价。分析性别、年龄、肿瘤部位、手术与放疗的时间间隔、放疗间断时间以及全脑全脊髓和后颅窝的照射顺序对生存率的影响。结果 本组患者1、2、3年的总生存率(OS)分别为95.0%,92.4%和84.9%,无进展生存率(PFS)分别为93.7%,89.8%和80.8%。90.8%的患者出现2~3级的白细胞下降。70.1%的患者出现1~2级的血小板下降。1.1%的患者出现3级的血小板下降。16.1%的患者出现1~2级的血红蛋白下降,未出现3~4级的血红蛋白下降。Kaplan-Meier生存分析显示,血小板分级在0~1级和2~4级的3年PFS分别为84.1%和49.2%,差异有统计学意义(χ²=3.936, P<0.05)。血红蛋白分级在0级和1~4级的3年PFS分别为86.6%和29.1%,差异有统计学意义(χ²=10.269, P<0.05);3年OS分别为91.6%和58.2%,差异有统计学意义(χ²=9.336, P<0.05)。中断放疗时间<3 d和≥3 d的两组患者3年PFS分别为84.6%和68.6%,差异有统计学意义(χ²=4.413, P<0.05)。结论 儿童髓母细胞瘤术后行全脑全脊髓放疗期间的血液学不良反应以及由此导致的放疗中断均对预后有一定的影响。     

鼻咽癌同期放化疗中急性皮肤黏膜反应的临床观察及其相关因素分析

目的 探讨鼻咽癌患者同期放化疗中急性皮肤及黏膜反应的影响因素,对主要相关因素进行分析。方法 对85例接受同期放化疗的鼻咽癌患者进行研究,观察并记录BMI、每周放疗剂量、口腔黏膜及颈部皮肤反应情况、血常规等15项临床指标及实验室指标,并进行单因素分析和多因素分析,筛选决定性影响因素。结果 与急性放射性口腔黏膜反应发生密切相关的危险因素,有吸烟史（OR=3.467,P<0.05）和原发灶GTV单次量>2.15Gy（OR=3.393,P<0.05）;与急性放射性皮肤反应发生密切相关的危险因素,有糖尿病史（OR=87.859,P<0.05）,放疗前1周血红蛋白值>130g/L（OR=21.404,P<0.05）。结论 对于同期放化疗的鼻咽癌患者,吸烟史和原发灶GTV单次量为急性放射性口腔黏膜反应的独立影响因素,糖尿病史和放疗前1周的血红蛋白值为急性放射性皮肤反应的独立影响因素。     

新型冠状病毒肺炎疫情期间浙江省某综合性三甲医院肿瘤放射治疗方案的实施

目的 探讨放疗科在新型冠状病毒肺炎（COVID-19）疫情期间实施放射诊疗活动的临床实践。方法 在疫情期间,严格实行消毒,加强体温监测,组织全体医护人员进行相关知识的培训,保障放射治疗诊治活动安全有序的开展。对疫情期间接受放射治疗患者的放疗目的,放疗等待时间以及医患满意度进行统计分析。结果 截至2020年2月11日,疫情期间浙江省人民医院放疗科共有60例患者接受放射治疗。与2019年同期（春节后）进行比较,放疗总体人数减少（占83.3%）,其中姑息性放射治疗患者人数下降明显（5.0% vs. 20.8%）;而根治性放疗/放化疗和术前及术后放疗/放化疗人数无明显降低,不同年份进行比较,差异存在统计学意义（χ²=6.967,P<0.05）。新住院患者在疫情期间等候放疗的中位时间为2 d,与2019年相比,无明显延长（P>0.05）。医患对当前防控疫情措施总体满意。结论 采用多种防控手段相结合,并在充分考虑医疗安全以及患者获益情况下,能够在疫情期间开展放射诊疗活动。     

甘氨双唑钠对恶性肿瘤放射增敏的临床研究

目的 评价甘氨双唑钠(sodium glycididazole, CMNa)在恶性肿瘤的放射增敏作用及安全性。方法 对符合CMNa Ⅳ期临床研究的80例诊断明确的实体瘤患者采用三维适形放疗(three dimensional conformal radiotherapy, 3D-CRT)或常规放疗,2 Gy/次,5次/周,中位照射剂量60Gy,同期应用CMNa 800 mg/m²,每周3次;观察肿瘤近期疗效和毒性作用。结果 宫颈癌的近期疗效最好,有效率91.7%,其后依次是鼻咽癌85.7%、食管癌66.7%、肺癌54.5%、肝胆癌40%,全部有效率(CR+PR)62.6%,疾病控制率(CR+PR+SD)达到100%;黏膜、皮肤的不良反应最常见,但多为1～2级轻度反应,分别为51.3%和46.3%;血液毒性白细胞下降最明显,但与治疗前相比差异无统计学意义(χ²=3.329,P=0.061),对肝肾功能、心电图变化均无明显影响。结论 放疗结合CMNa治疗恶性肿瘤有满意的近期疗效,无明显毒性反应。     

Adverse reactions of ALA-PDT for the treatment of cutaneous diseases: A retrospective study

Background5-Aminolaevulinic acid photodynamic therapy (ALA-PDT) is an effective therapy for cutaneous diseases, such as precancers, superficial non melanoma skin cancers and certain inflammatory or viral conditions. However, the absence of a complete picture of adverse reactions limits the promotion of ALA-PDT.ObjectiveTo systemically investigate the detailed evidence of adverse reactions relating to ALA-PDT for skin diseases.MethodsA retrospective study performed at the Shanghai Skin Disease Hospital.ResultsIn the retrospective study, 439 patients were included. Incidences of adverse reactions, including in-treatment pain (98.8%), erythema (92.4%), edema (35.0%), exudation (23.0%), hyperpigmentation (27.3%) were clarified. Edema was more common in female patients (P<0.05). Patients with HPV-related skin diseases were more likely to suffer erythema, edema or exudation (P<0.05). Hyperpigmentation was more likely to occur in skin appendage disorders (P<0.05). Fever (2.4%) and hypopigmentation (1.9%) are two neglected adverse reactions analyzed in detail. Fever is more prevalent in female patients. Hypopigmentation occurred predominantly in elderly with skin cancer or precancerosis lesions.ConclusionThe results outline detailed information about the adverse reactions, including systemic reactions following ALA-PDT, assisting dermatologists in predicting and managing adverse reactions for greater efficacy and higher patient satisfaction.     

贝伐珠单抗治疗放射性脑损伤的疗效研究

目的 评估贝伐珠单抗单药治疗放射性脑损伤的疗效及安全性。方法 对23例确诊放射性脑损伤并接受贝伐珠单抗单药治疗的患者进行回顾性分析。贝伐珠单抗治疗方案为静脉滴注（每次5 mg/kg,每两周1次,共4次）。分别在给药前及疗程结束后2周行头颅MRI检查、LENT-SOMA量表和MoCA量表评分,并记录治疗期间的不良事件。结果 2例患者在第1个疗程时出现鼻衄,随即终止治疗。其余21例患者在完成相应疗程的贝伐珠单抗治疗后临床症状明显改善,与基线水平相比,治疗后MRI T2相水肿体积明显缩小[平均缩小（53.9±22.13）%,Z=-5.645,P<0.05]。治疗后MOCA评分较治疗前增高（t=3.166,P<0.05）,其中1例患者虽然在完成两个疗程后MRI上表现为病灶范围轻度增加,但是在4次治疗结束后病情明显改善。在所有完成4次治疗的患者中,1例患者出现皮疹,2例患者出现高血压,另有1例有轻度颅内出血,无3到5级不良反应事件。结论 贝伐珠单抗单药治疗放射性脑损伤有较好的疗效和安全性。     

An audit of radiation-induced skin reactions in the inframammary fold; does breast size impact on the severity of the reaction?

IntroductionSkin toxicity is a clinically significant side effect of external beam radiation; moist desquamation is particularly prevalent for breast patients, mainly in the axilla and inframammary fold (IMF). The aim of this audit was to assess if there is a correlation between patient breast size and the presence and extent of radiotherapy skin reaction in the IMF.MethodsBetween 22/12/2017 and 31/05/2018 forty patients undergoing standard whole breast radiotherapy using 3D planned medial and lateral tangential fields had their skin reaction recorded weekly, whilst on treatment, using the Radiotherapy Oncology Group (RTOG) scoring system. Skin reactions were also documented at three and eight weeks post radiotherapy. A measurement of the patients IMF length and bra size were also noted. Statistical analysis was carried out using IBMÒ SPSS Statistics 24.ResultsSix patients presented with grade ≥2 during week three of radiotherapy. The mean IMF length of six patients with adverse reactions 6.1 cm (±3.6 cm). As the length of the IMF increases, severity of skin reactions also increases; a positive correlation was identified between the two at both week three of radiotherapy and three weeks post radiotherapy (r = 0.401, n = 34, p = 0.05 and r = 0.671, n = 29, p = 0.00 respectively). Only one patient displayed grade 2 at eight weeks post radiotherapy (IMF length 7.5 cm).ConclusionThe findings from this study would suggest that larger breasted patients do present earlier, and with more severe radiation-induced skin reactions.Implications for practiceChanges to skin care practice could be considered for patients with larger breasts. This could be in the form of more frequent check-ups during treatment or proactive side effect management rather than reactive management.     

A prospective study of adverse reactions of ALA-PDT for acne vulgaris

BackgroundAcne vulgaris is a chronic inflammatory skin disease around pilosebaceous unit. 5-Aminolaevulinic acid photodynamic therapy (ALA-PDT) is an effective therapy for severe acne vulgaris. However, the lack of detailed information of adverse reactions limits the promotion of ALA-PDT in clinic.ObjectiveTo systemically investigate the adverse reactions relating to ALA-PDT for acne vulgaris.MethodsA prospective study was performed at the Shanghai Skin Disease Hospital.ResultsIn the prospective study, 35 patients with acne vulgaris completed the trial. The adverse reactions were first divided into acute-phase adverse reactions, including erythema (94.3%), post-treatment pain (91.4%), burning skin (91.4%), dry skin (91.4%), itching (85.7%), pustule (82.9%), edema (20%) and blister (11.4%), or recovery-phase adverse reactions, which included crust (65.6%), exudation (48.6%) and hyperpigmentation (42.7%). Younger patients were more likely to have pustules (P<0.05). Male patients were represented itching more often than female patients (P<0.05). The efficacy of ALA-PDT for severe acne was positively related to the severity of acute-phase adverse reactions. The duration of pain was shortest. Crusting and hyperpigmentation lasted considerably longer.ConclusionIn the present study, we recorded the relative incidence of various adverse reactions following ALA-PDT for acne vulgaris. The severity of adverse reactions tended to decrease with increased patient age, except for itching and hyperpigmentation. Light-to-moderate adverse reactions might be the inflammatory reactions of ALA-PDT, predicting a good efficacy. A form for evaluation of adverse reactions based on the present study could assist dermatologists in predicting and managing adverse reactions for greater efficacy and higher patient satisfaction.     

Moist Skin Care Can Diminish Acute Radiation-Induced Skin Toxicity

BACKGROUND: Radiation treatment may induce acute skin reactions. There are several methods of managing them. Validity of these methods, however, is not sufficiently studied. We therefore investigated, whether moist skin care with 3% urea lotion will reduce acute radiation skin toxicity. PATIENTS AND METHODS: 88 patients with carcinomas of the head and neck undergoing radiotherapy with curative intent (mean total dose 60 Gy, range: 50-74 Gy) were evaluated weekly for acute skin reactions according to the RTOG-CTC score. In 63 patients, moist skin care with 3% urea lotion was performed. The control group consisted of 25 patients receiving conventional dry skin care. The incidence of grade I, II, and III reactions and the radiation dose at occurrence of a particular reaction were determined and statistically analyzed using the log-rank test. The dose-time relations of individual skin reactions are described. RESULTS: At some point of time during radiotherapy, all patients suffered from acute skin reactions grade I, > 90% from grade II reactions. 50% of patients receiving moist skin care experienced grade I reactions at 26 Gy as compared to 22 Gy in control patients (p = 0.03). Grade II reactions occurred at 51 Gy versus 34 Gy (p = 0.006). Further, 22% of the patients treated with moist skin care suffered from acute skin toxicity grade III as compared to 56% of the controls (p = 0.0007). CONCLUSION: Moist skin care with 3% urea lotion delays the occurrence and reduces the grade of acute skin reactions in percutaneously irradiated patients with head and neck tumors.     

CT联合模板引导放射性粒子植入治疗不可手术的早期非小细胞肺癌

目的 探讨CT联合模板引导放射性粒子植入治疗不可手术的早期非小细胞肺癌（NSCLC）的疗效和不良反应。方法 回顾性分析2010年12月到2016年10月间在天津医科大学第二医院接受CT引导下放射性粒子治疗的21例不可手术的T_1-2N₀M₀早期非小细胞肺癌患者。所有患者术前取得组织学病理,选用粒子活度18.5~29.6 MBq,处方剂量120~160 Gy,均在1次手术内完成粒子植入,术前及术后经TPS制定计划和质量验证。随访评价肿瘤局部控制率、总生存时间、无进展生存期、剂量验证满意率及不良反应。结果 中位随访时间为25.1个月（范围4.4~72.7个月）。1、2、3年的原发肿瘤局部控制率分别为100%、95.2%、95.2%。所有患者的中位总生存期为48个月,中位无进展生存期为43.4个月。1、2、3年生存率分别为100%、91.7%、72.9%。3年无进展生存率为70.2%。术后质量验证满意率为100%。与治疗相关的不良事件包括：气胸、支气管出血、胸膜出血、咳嗽、肺部纤维化及粒子移位。其中7例患者发生1级不良事件（33.3%）;4例患者发生2级不良事件（19%）。无3级或更高级别不良事件发生。结论 CT联合模板引导放射性粒子植入治疗T_1-2N₀M₀的NSCLC肿瘤局部控制率较高,治疗相关不良反应较少,可作为不可手术的早期非小细胞肺癌治疗的一种选择。     

Kosmetische Ergebnisse nach brusterhaltender,radiologischer Mammakarzinomtherapie bei Patientinnen mit intramammären Seromen

IntroductionThere were 373 patients irradiated after breast conserving carcinoma treatment. A planning computed tomography revealed in 97 of these patients seromas and tissue defects exceeding 2 cm in diameter. The cosmetic results in those patients and the impact of seromas herein had to be evaluated.Patients and methodsMean age was 59 years. A quadrant resection was performed in 17,5 percent of the patients, a segmental resection in 27,8 percent and a tumour excision in 54,6 percent. Radiation therapy was applied with the linear accelerator and 6 MeV photons up to a total dose in the residual breast of 50 Gy followed by a boost dose to the former tumour bed of 10 Gy. A distinct evaluation and documentation of therapy related side effects and the resulting cosmesis was done in 51 patients.ResultsIn all the examined seroma patients there were moderate acute skin reactions grade 1 to 3. As late effects in 82,3 percent scar indurations were noticed. At the skin 51 percent showed enhanced pigmentation, 68,6 percent atrophia and only 11 percent teleangiectasia. Subcutaneous fibrosis occurred in 56,9 percent of the patients, 78,4 percent of the women had breast asymmetries. In 41,2 percent there were a lymphedema subcutaneously, in 72,5 percent impaired sensibility. The overall cosmetic result documented with a 5 point score was “very good” (score 1) in 19,6 percent and “good” (score 2) in 33,3 percent, 37,3 percent were “satisfactory” (score 3) and 9,8 percent “bad” (score 4) respectively. No “very bad” results (score 5) were seen.ConclusionsThe cosmetic results in the examined group of seroma and hematoma patients were inferior to those reported in the literature. We conclude that postoperative seroma and hematoma have an adverse effect on the resulting cosmesis and that their frequency and extent have to be reduced in future by the responsible surgeons.     

Radiation induced skin reactions during and following radiotherapy: A systematic review of interventions

IntroductionRadiation induced skin reactions (RISR) are a common adverse effect of radiotherapy that can impact on patient quality of life. The aim of this systematic review was to identify new research evidence on interventions for RISR to guide health practitioners on best practice skin care for people receiving radiotherapy.MethodsA narrative systematic review was adopted including published research since 2014. The MESH search terms used in the 2014 College of Radiographers skin care systematic review were supplemented with terms identified through a pearl growing search technique.ResultsThirty-three studies were identified and reviewed, 13(39.4%) were assessed as having a high risk of bias 6(18.2%) moderate risk of bias, and 13(39.4%) low risk of bias; one pilot study was not assessed. Twenty-one of the studies were randomised controlled trials, 2 feasibility studies, 9 non-randomised trials, and 1 a pilot study.ConclusionEvidence from well conducted studies identified prophylactic use of steroid cream for patients, at high risk of RISR, as being the most efficacious in reducing acute skin reactions. Further research is needed on photo biomodulation therapy, studied within standard dose fractionation schedules, before it is recommended for use in practice. There is insufficient evidence to support the use of barrier films or any topical emollients currently in practice to reduce RISRs. Despite the number of new studies in this area there is limited good comparative research of RISR that accounts for predictive risk and new radiotherapy techniques.Implications for practicePractitioners are encouraged to risk assess patients prior to radiotherapy to guide interventions and record and monitor patient skin toxicity regularly during treatment, comparing toxicity changes with scores recorded at baseline and support patient self-monitoring of skin reactions.