Effects of radiotherapy on wound healing

Abstract

Background Radiotherapy is widely used to treat cancer, but it can influence the normal wound-healing process. Aim To present a narrative review of the current evidence related to the effects of radiotherapy on normal wound healing. Findings Fractionated radiotherapy treatment induces a repetitive cycle of inflammation. The acute effects of radiotherapy are mostly transient and are resolved within 4 weeks of the last dose, which correlates with the normal pathogenesis of skin regeneration. Two main theories exist with regards to the late effects of radiotherapy and the development of a chronic wound. One hypothesis is that there is a hypoxic–hypocellular–hypovascular effect. Other authors have argued that damage occurs as a result of changes to the microvasculature, in addition to the depletion of parenchymal and stromal cells. Conclusion: Recent evidence indicates that advances in treatment modalities, for example, the use of proton therapy and intensity-modulated radiotherapy, can positively influence patient outcomes in relation to tissue injury. Further advancements in our understanding of radiotherapy and its effects may lead to an improvement in the type of treatment modalities available, thereby helping prevent tissue injury altogether. Clinicians need to appreciate that healing of a radiation wound may not be realistic. Symptom-relieving treatment is of paramount importance to address the deleterious consequences of a radiotherapy related wound. Effects of radiotherapy on wound healing Clinicians also need to be cognisant of the need to maintain the patient’s self-esteem and maximise their quality of life. Key Messages This review explores the existing evidence related to the effects of radiotherapy on normal wound healing. The main observations from the studies examined indicate that ionising radiation damages cellular molecules primarily through strand breaks of deoxyribonucleic acid (DNA) or by the production of free radicals and reactive oxygen species, affecting both normal and tumour cells. Radiotherapy can impair the normal healing process in any phase of tissue repair as a result of cellular depletion, alteration in the extracellular matrix (ECM), and impairment of the microvasculature with subsequent tissue hypoxia. The acute effects of radiotherapy on the tissues range in severity from erythema to dry desquamation and hyperpigmentation. In the months or years following radiotherapy, tissue breakdown may occur leading to skin atrophy, dryness, telangiectasia, dyschromia, and dyspigmentation. INTRODUCTION Radiotherapy has been used as a treatment modality for over a century, and currently, it is used as a standalone cancer treatment or as an adjunct to surgery or chemotherapy.1 The two main types of radiotherapy are as follows: electromagnetic radiation with x-rays and gamma rays and particulate radiation using electrons, neutrons, and protons.2 Radiation is delivered through multiple modalities, with external beam being the most commonly used modality.1,3 The treatment modality depends on the anatomical location, size, and type of Correspondence: [email protected] Conflicts of interest: None Science, Practice and Education Radiotherapy is widely used to treat for cancer. This therapy aims to kill cancer cells while sparing the surrounding tissue where possible. Radiotherapy can impair the normal healing process in any phase of tissue repair. This review discusses the acute and late effects of radiotherapy and relates them to wound healing. \ue0a9