A search of PreMEDLINE, MEDLINE, CANCERLIT, and the Cochrane Library (2004, Issue 1) was conducted to identify comparative studies published between 1980 and April 2004. Relevant articles were identified by combining terms and phrases related to skin and specific skin conditions with radiation therapy terms and combining these terms with terms specific to study design. The Medical Subject Heading (MeSH) terms "dermis," "epidermis," and "skin/re" (radiation effects) and text words and phrases "erythema," "radiation dermatitis," "radiodermatitis," "desquamation" (dry and moist), and "acute skin reaction" were combined with search terms for radiation therapy including "explode radiotherapy," "radiotherapy/ae" (adverse effects) and a text word search for "radiotherapy" or "radiation therapy." These terms were then combined with the search terms for the following publication types: practice guidelines, systematic reviews, meta-analyses, reviews, randomized controlled trials, controlled clinical trials, and comparative studies.
In addition, conference proceedings of the meetings of the American Society of Clinical Oncology (ASCO) were searched for abstract reports published between 1997 and 2003. The Canadian Medical Association Infobase (http://www.mdm.ca/cpgsnew/cpgs/index.asp) and the National Guidelines Clearinghouse (http://www.guideline.gov/) were also searched for existing evidence-based practice guidelines. Relevant articles and abstracts were selected and reviewed by two reviewers, and the reference lists from these sources were searched for additional trials, as were the reference lists from relevant review articles.
Inclusion Criteria
Articles were selected for inclusion if they met all of the following criteria:
- They were systematic reviews, meta-analyses, evidence-based practice guidelines, or comparative studies comparing skin care practices administered by any route for the prevention or treatment of acute skin reactions due to radiation therapy.
- Data were collected prospectively in at least one arm of the trial. Historical controls were permitted.
- Clinically relevant outcomes to skin reaction were reported. The trial reported degree of skin reaction (using a validated skin reaction score) as an outcome. Other outcomes of interest included pain, itchiness, burning, quality of life, and toxicities.
- The article was a fully published or abstract report.
Exclusion Criteria
The following articles were excluded from this systematic review of the evidence:
- Letters, comments, and editorials
- Articles published in a language other than English