Incidence, Risk Factors, and Management of Radiotherapy-Related Skin Toxicity in Rectoanal Cancer Patients: a...

Area of Science:

• Oncology
• Radiation Oncology
• Dermatology

Background:

• Radiotherapy is a cornerstone treatment for rectoanal cancer.
• High radiation doses and complex pelvic anatomy increase the risk of radiodermatitis.
• No prior meta-analysis specifically addressed radiodermatitis in this patient cohort.

Purpose of the Study:

• To conduct a comprehensive meta-analysis on the incidence and risk factors of radiodermatitis in rectoanal cancer patients.
• To identify effective interventions and optimal radiation strategies for managing skin toxicity.
• To establish a dose-effect relationship for radiation dose and severe dermatitis risk.

Main Methods:

• Systematic literature search across major databases (PubMed, Embase, Cochrane, Web of Science) up to September 2025.
• Inclusion of 50 studies with 4,892 participants.
• Application of pooled meta-analysis, network meta-analysis, and dose-effect meta-analysis.

Main Results:

• Overall radiodermatitis incidence was 58.7%, with severe cases (Grade ≥3) at 12.3% and moist desquamation at 34.5%.
• Significant risk factors identified include tumor distance ≤5 cm from the anal verge, absence of a stoma, total dose >50 Gy, concurrent chemotherapy, HIV infection, 3D-CRT compared to IMRT, and tumor skin invasion.
• Effective interventions include spray-type skin protectants (SUCRA 92.3%), volumetric modulated arc therapy (VMAT), recombinant human epidermal growth factor, and amifostine.
• A dose inflection point at 50 Gy was observed, with a 29% increased risk of severe dermatitis per additional 5 Gy.

Conclusions:

• Skin toxicity is a prevalent complication in rectoanal cancer radiotherapy, influenced by tumor characteristics, treatment parameters, and patient factors.
• Optimized radiotherapy techniques, such as VMAT, alongside supportive measures like spray-type skin protectants, are crucial for effective management.
• Precision management strategies can significantly improve patient outcomes by mitigating skin toxicity.