Emerging therapies for ionizing radiation-associated skin field carcinogenesis.
BACKGROUND
Radiodermatitis in its acute and chronic presentations represents a set of specific adverse effects resulting from ionizing radiations. Skin-field cancerization is another condition associated to or independent of clinically recognizable radiodermatitis. This condition leads to the risk of later occurrence of skin malignancies.


METHODS
Review of the current and most pertinent peer-reviewed publications with the addition of personal perspectives.


CONCLUSIONS
The presence of field cancerization encompasses subclinical changes, precursors of malignant alterations, as well as single or multiple primary neoplasms and local neoplastic recurrences. These tumours commonly require repeated treatments over time and cause significant morbidity. In general, specific tumour-directed treatments using ablative or destructive techniques require regular follow-up and screening for disclosing any further neoplasm. Another strategy corresponding to field-directed treatment targets a larger area of irradiated skin to reduce the risk of developing second neoplasms and local recurrences. Imiquimod is an immune response modifier of the imidazoquinoline class. It is the archetype drug used to control skin-field carcinogenesis. Cryotherapy, topical 5-fluorouracil, diclofenac and conventional photodynamic therapy are supposed to bring effects differing by their indications, healing rates and remission rates. The possibility of inducting a radiation recall dermatitis by some of these therapeutic modalities has not been thoroughly evaluated, and at present cannot be ruled out with confidence.
Department of Dermatopathology, University Hospital of Liège, Liège, Belgium. Gerald.pierard@ulg.ac.be
Gérald E
GE
Piérard
Claudine
C
Piérard-Franchimont
Philippe
P
Paquet
Pascale
P
Quatresooz
D000818:Animals; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017679:Cryotherapy / Q000639:trends; D006801:Humans; D009381:Neoplasms, Radiation-Induced / Q000209:etiology* / Q000628:therapy*; D010778:Photochemotherapy / Q000639:trends; D011839:Radiation, Ionizing; D012878:Skin Neoplasms / Q000209:etiology* / Q000628:therapy*
D000970:Antineoplastic Agents