Laser Treatment Options

“Today, there is insufficient evidence available to form recommendations that would prevent or reduce radiodermatitis. However, several multidisciplinary groups have proposed guidelines that suggest management strategies with the objective to avoid or reduce the severity of radiodermatitis reactions,” wrote the authors of a recent review.1

Although evidence-based recommendations on the prevention or reduction of radiodermatitis are lacking, some early advances in its treatment are promising. For example, low level light therapy (LLLT) or vascular lasers can manage symptoms.

Results from preclinical and clinical research suggest LLLT could have bio-stimulating properties, thereby promoting the regeneration of tissues for quicker healing, less inflammation, and fibrosis prevention.

In the hospital-sponsored TRANSDERMIS trial in Belgium (ClinicalTrial.gov Identifier: NCT02443493), 120 patients with breast cancer who received identical RT regimens after lumpectomy were equally randomized to undergo LLLT or placebo 2 days per week, immediately after radiation therapy.2

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LLLT was delivered via a class IV MLS® M6 laser combining 2 synchronized laser diodes in the infrared range (808 to 905 nm) with a fixed energy density (4 J/cm2).2

Researchers used the Radiation Therapy Oncology Group (RTOG) and the Radiation-Induced Skin Reaction Assessment Scale (RISRAS) to score skin reactions. Patients responded to the Skindex-16 questionnaire to assess quality of life. Researchers collected measurements on the first day with an RT dose of 40 Gy and again at the end of therapy, with a total dose of 66 Gy.2

At the initial RT administration, no significant differences in distribution of RTOG grades occurred between the 2 groups. By the end of RT, however; significantly more patients in the placebo group (30%) experienced RTOG grade 2 or greater than in the LLLT group (6.7%; P =.004).2

This RISRAS score, which is objective, supported these results. Both the RISRAS score and the results from Skindex-16 indicated better quality of life in the LLLT group than the placebo group.2

These results suggest that LLLT can both prevent the development of radiodermatitis and manage the symptoms of the condition.2

Pulsed dye laser treatment can resolve telangiectasia that characterizes late-onset radiodermatitis. Therapy with pulsed dye laser has been used to treat hypertrophic scars, warts, hemangiomas, port wine stains, telangiectasias, and fibrosis.

Topical Treatment Options

In a meta-analysis of randomized clinical trials on the use of topical corticosteroids in the treatment and prevention of radiodermatitis in patients who underwent RT for breast cancer, results from 845 patients across 10 trials indicated use of topical corticosteroids led to reduced occurrence of the wet desquamation of radiodermatitis (OR, 0.29; 95% CI, 0.19-0.45; P <.0001) and lower average radiodermatitis score (standardized mean difference, –0.47; 95% CI, –0.61 to 0.33; P <.00001).4

Another topical treatment that shows promise is a norepinephrine adrenergic vasoconstrictor cream (NG12-1) applied prior to the administration of RT. A preclinical model using rats indicated a 100% prevention of radiodermatitis with this approach.5

“Current best clinical practices for the prevention and treatment of acute radiation dermatitis are limited to agents that minimize discomfort, promote healing, or prevent infection,” wrote the authors.5 “No interventions to date have been shown to be clinically effective, and none address the core problem of preventing or minimizing acute radiation damage to the skin.”