放射線治療之皮膚炎預防及照護指引

Clinical Practice Guideline on Radiation Dermatitis in Cancer Patients

10.3966/168395442015121503006

張黎露(Li-Lu Chang)；周繡玲(Hsiu-Ling Chou)；邱文姿(Wen-Tzu Chiu)；謝嘉芬(Chia-Fen Hsieh)；李佳諭(Chia-Yu Lee)；洪敏瑛(Ming-Ying Hong)；江孟冠(Meng-Guang Chiang)；謝忱希(Chen-Hsi Hsieh)；蔡玉真(Stella Yu-Chen Tsai)

癌症 ； 放射線治療 ； 放射線皮膚炎 ； 指引 ； cancer ； radiotherapy ； radiodermatitis ； radiation dermatitis ； guideline

腫瘤護理雜誌

15卷增訂刊（2015 / 12 / 01）

81 - 98

繁體中文

放射線治療皮膚炎（radiation dermatitis）是癌症病人接受放射線治療後常見的副作用之一。嚴重之放射線皮膚炎會迫使放射治療中斷，降低腫瘤治療的反應率與局部控制率，進而可能導致癌症復發，且會造成嚴重感染導致死亡。本指引發展的目的是從腫瘤護理人員的專業觀點，提供癌症病人接受放射線治療時，皮膚炎之預防及有效的照護方式。搜尋近十年國內外照護指引及文獻，藉由實證基礎之評核、系統性文獻查證與評讀等嚴謹的過程，加以歸納整合，並經過國內專家的共識，根據護理人員熟悉的護理過程方式書寫內容，清楚列出對於照護內容的建議等級，並解釋各項建議的內容，成為一份容易閱讀和查詢的照護指引，並提高臨床的實用性。本指引概念構圖分為：1)評估；2)確認問題；3)處置與照護，包括皮膚的預防照護、皮膚炎處置照護之準則；4)持續照護。期望藉此能培養腫瘤護理人員敏銳的觀察病人在放射治療前、中、後期之全程的皮膚照護，並能提供整體性的評估、確認病人皮膚的問題，進而提供具實證的照護處置及後續護理措施，促進病人之生活品質與提升護理人員的照護品質。

Radiation dermatitis is a common side effect when cancer patients receiving radiation therapy. Complications caused by severe radiation dermatitis can lead to treatment interruption. Prevention and management of radiation dermatitis is important to ensure patient's quality of life and treatment outcome. This guideline is developed based on comprehensive systematic review of literature, appraisal of evidences and summary of recommendations for practice by expert committee. This guideline is written as a format of four-step nursing process: 1) Assessment; 2) Identification of problem; 3) Intervention: prevention and care; 4) Evaluation: evaluation and management of complications. This guideline is intended to assist the oncology nurses in their clinical decision-making for providing optimal quality of individualized patient care.

1. Archambeau, JO,Pezner, R,Wasserman, T(1995).Pathophysiology of irradiated skin and breast.Int J Radiat Oncol Biol Phys,31(5),1171-1185.
2. BC Cancer A gency. Symptom Management Guidelines: Radiation dermatitis. http://www.bccancer.bc.ca/Legal.htm. Accessed July 29, 2015.
3. Bentzen, SM,Overgaard, J(1994).Patient-to-patient variability in the expression of radiation-induced normal tissue injury.Semin Radiat Oncol,4(2),68-80.
4. Ben-Yosef, H(1996).Radiation recall dermatitis.Lancet,348(9037),1321.
5. Blackmar, A.(1997).Radiation-induced skin alterations.Medsurg Nurs.,6(3),172-175.
6. Bolderston, A,Lloyd, NS,Wong, RK(2006).The prevention and management of acute skin reactions related to radiation therapy: A systematic review and practice guideline.Support Care Cancer,14(8),802-817.
7. Bristow, RG,Benchimol, S,Hill, RP(1996).The p53 gene as a modifier of intrinsic radiosensitivity: Implications for radiotherapy.Radiother Oncol,40(3),197-223.
8. Chan, RJ,Larsen, E,Chan, P(2012).Re-examining the evidence in radiation dermatitis management literature: An overview and a critical appraisal of systematic reviews.Int J Radiat Oncol Biol Phys.,84(3),e357-e362.
9. Chan, RJ,Webster, J,Chung, B(2014).Prevention and treatment of acute radiation-induced skin reactions: A systematic review and meta-analysis of randomized controlled trials.BMC Cancer,14,53.
10. Chen, MF,Chen, WC,Lai, CH(2010).Predictive factors of radiation-induced skin toxicity in breast cancer patients.BMC Cancer,10,508.
11. Feight, D,Baney, T,Bruce, S(2011).Putting evidence into practice: Evidence-based intervations for radiation dermatitis.Clin J Oncol Nurs,15(5),481-492.
12. Fisher, J,Scott, C,Stevens, R(2000).Randomized phase III study comparing best supportive care to biafine as a prophylactic agent for radiationinduced skin toxicity for women undergoing breast irradiation: Radiation Therapy Oncology Group (RTOG) 97-13.Int J Radiat Oncol Biol Phys Dec,48(5),1307-1310.
13. Gerlach, MA(2005).Wound care issues in the patient with cancer.Nurs Clin North Am.,40(2),295-323.
14. Guirado, D,Ruiz de Almodóvar, JM(2003).Prediction of normal tissue response and individualization of doses in radiotherapy.Phys Med Biol,48(19),3213-3223.
15. Harper, JL,Franklin, LE,Jenrette, JM(2004).Skin toxicity during breast irradiation: Pathophysiology and management.South Med J.,97(10),989-993.
16. Hill, A,Hanson, M,Bogle, MA(2004).Severe radiation dermatitis is related to Staphylococcus aureus.Am J Clin Oncol,27(4),361-363.
17. Hymes, SR,Strom, EA,Fife, C.(2006).Radiation dermatitis: Clinical presentation, pathophysiology, and treatment.J Am Acad Dermatol,54(1),28-46.
18. Iwakawa, M,Noda, S,Yamada, S(2006).Analysis of non-genetic risk factors for adverse skin reactions to radiotherapy among 284 breast cancer patients.Breast Cancer,13(3),300-307.
19. Iwamoto, RR,Haas, ML(2012).Gosselin T. Manual for radiation oncology nursing practice and education.Pittsburgh, PA:Oncology Nursing Society.
20. Kraus-Tiefenbacher, U,Sfintizky, A(2012).Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS).Radiat Oncol,7,217.
21. Macmillan, MS,Wells, M,MacBride, S(2007).Randomized comparison of dry dressings versus hydrogel in management of radiation-induced moist desquamation.Int J Radiat Oncol Biol Phys.,68(3),864-872.
22. McQuestion, M(2011).Evidence-based skin care management in radiation therapy: Clinical update.Semin Oncol Nurs,27(2),e1-e17.
23. Mendelsohn, FA,Divino, CM,Reis, ED(2002).Wound care after radiation therapy.Adv Skin Wound Care,15(5),216-224.
24. Nitzan, M,Weshler, Z,Gimmon, Z(1996).Irradiation induced blood flow changes in the breast during radiotherapy: A pilot study.J Basic Clin Physiol Pharmacol,7(1),71-82.
25. O’Rourke, ME(1987).O’Rourke MEEnhanced cutaneous effects in combined modality therapy.Oncol Nurs Forum,14(6),31-35.
26. Oncology Nursing Society. Radiodermatitis. https://www.ons.org/practice-resources/pep/radiodermatitis. Accessed July 29, 2015.
27. Partl, R,Richtig, E,Kapp, KS.(2012).Calling attention to radiation recall reactions: Simultaneous occurrence of a recall dermatitis after CMF application in two separate sites irradiated 10 years apart.Acta Oncol.,51(6),809-811.
28. Payne, WG,Naidu, DK,Wheeler, CK(2008).Wound healing in patients with cancer.Eplasty,8,e9.
29. Pignol, JP,Olivotto, I,Rakovitch, E(2008).A multicenter randomized trial of breast intensitymodulated radiation therapy to reduce acute radiation dermatitis.J Clin Oncol,26(13),2085-2092.
30. Porock, D,Kristjanson, L,Nikoletti, S(1998).Predicting the severity of radiation skin reactions in women with breast cancer.Oncol Nurs Forum,25(6),1019-1029.
31. Porock, D,Nikoletti, S,Cameron, F(2004).The relationship between factors that impair wound healing and the severity of acute radiation skin and mucosal toxicities in head and neck cancer.Cancer Nurs.,27(1),71-78.
32. Schnur, JB,Love, B,Scheckner, BL(2011).A systematic review of patient-rated measures of radiodermatitis in breast cancer radiotherapy.Am J Clin Oncol,34(5),529-536.
33. See, A,Wright, S,Denham, JW(1998).A pilot study of dermofilm in acute radiation-induced desquamative skin reactions.Clin Oncol (R Coll Radiol),10(3),182-185.
34. Sharp, L,Johansson, H,Hatschek, T(2013).Smoking as an independent risk factor for severe skin reactions due to adjuvant radiotherapy for breast cancer.Breast,22(5),634-638.
35. Sitton, E(1992).Early and late radiation-induced skin alterations. Part I: Mechanisms of skin changes.Oncol Nurs Forum,19(5),801-807.
36. Soter, NA,Baden, HP(1991).Pathophysiology of Dermatologic diseases.New York, NY:McGraw-Hill.
37. Tucker, SL,Turesson, I,Thames, HD(1992).Evidence for individual differences in the radiosensitivity of human skin.Eur J Cancer,28A(11),1783-1791.
38. Twardella, D,Popanda, O,Helmbold, I(2003).Personal characteristics, therapy modalities and individual DNA repair capacity as predictive factors of acute skin toxicity in an unselected cohort of breast cancer patients receiving radiotherapy.Radiother Oncol,69(2),145-153.
39. van der Laan, HP,Dolsma, WV,Maduro, JH(2007).Three-dimensional conformal simultaneously integrated boost technique for breast-conserving radiotherapy.Int J Radiat Oncol Biol Phys.,68(4),1018-1023.
40. Welsh, J,Thomas, J,Shah, D(2011).Obesity increases the risk of chest wall pain from thoracic stereotactic body radiation therapy.Int J Radiat Oncol Biol Phys,81(1),91-96.
41. Wengström, Y,Häggmark, C,Strander, H(2000).Perceived symptoms and quality of life in women with breast cancer receiving radiation therapy.Eur J Oncol Nurs.,4(2),78-88+89-90.
42. Wickline, MM(2004).Prevention and treatment of acute radiation dermatitis: A literature review.Oncol Nurs Forum,31(2),237-247.
43. Xiao, C,Hanlon, A,Zhang, Q(2013).Symptom clusters in patients with head and neck cancer receiving concurrent chemoradiotherapy.Oral Oncol,49(4),360-366.
44. Yazbeck, VY,Villaruz, L,Haley, M(2013).Management of normal tissue toxicity associated with chemoradiation (primary skin, esophagus).Cancer J.,19(3),231-237.
45. Yeo, W,Johnson, P J(2000).Radiation-recall skin disorders associated with the use of antineoplastic drugs: Pathogenesis, prevalence, and management.Am J Clin Dermatol,1(2),113-116.
46. Zhang, Y,Zhang, S,Shao, X(2013).Topical agent therapy for prevention and treatment of radiodermatitis: A meta-analysis.Support Care Cancer,21(4),1025-1031.
47. 邱文姿(2007)。臺灣大學護理研究所。
48. 衛生福利部食品藥物管理署。衛生福利部食品藥物管理署西藥、醫療器材、含藥化粧品許可證查詢 ，http://www.fda.gov.tw/MLMS/(S(dw4igo45gpflqaznfmzbcr55))/H0001.aspx. Accessed May 20, 2015.

1. 曾怡菱,林沛儀(2021)。一位齒齦癌個案接受同步化放射療之護理經驗。腫瘤護理雜誌，21(增訂刊II)，5-17。
2. 陳繪竹,陳遴鞠,胡馨方,李文馨(2018)。一位青壯年直腸癌併急性腸阻塞病人之護理經驗。志為護理-慈濟護理雜誌，17(5)，123-132。
3. 程繼鳳,張于慧,徐育寗,胡筱慧,汪子平,李淑瓊(2022)。鼻咽癌病人放射線皮膚炎自我照護改善專案。腫瘤護理雜誌，22(2)，35-48。
4. 郭淑柳,邱靖雯,李欣倫(2023)。質子治療的發展與臨床應用。新臺北護理期刊，25(2)，1-7。
5. 留英珊(2022)。照護一位罹患尤文氏肉瘤病童接受質子治療之護理經驗。腫瘤護理雜誌，22(2)，129-140。
6. 謝春金,黃怡純,林美惠,王翊芳(2023)。照顧一位女性舌癌病人之護理經驗。長庚護理，34(2)，89-99。