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BACKGROUND

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Over the past century, cancer treatment has evolved into a multimodality approach, necessitating surgery, chemotherapy, radiation therapy, and/or immunotherapy. These therapies are administered alone or in different combinations and order depending on the pathology and biology of the malignancy. Most recent Surveillance, Epidemiology, and End Results (SEER) data predict that in 2016, there will be nearly 1.66 million new cases of malignant neoplasms and more than half of those diagnosed with cancer will receive radiation therapy during the course of the disease, either as neoadjuvant, primary, or adjuvant treatment.1,2

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When considering head and neck cancer, radiation was primarily used as adjuvant treatment in the 1970s, but by the 1990s radiation was administered with and without chemotherapy as a primary treatment modality.3 In other cases, when given as neoadjuvant therapy, radiation is able to downstage several tumors, including soft tissue sarcoma and other solid visceral tumors. In addition, when offered with lumpectomy, radiation therapy offers a less radical surgical approach than mastectomy for certain breast cancers, producing similar outcomes. Though radiation treatment has led to significant improvements in survival and palliation in those afflicted with cancer, many of these individuals may live many years experiencing adverse acute or chronic symptomatic effects of tissue irradiation.

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Though the biologic effects of radiation begin soon after treatment, the pathologic and symptomatic features may be delayed weeks to years.4 Complications of radiation therapy are said to occur in 60% to 95% of those receiving treatment.5-7 Radiation-induced skin changes have been scientifically reported for over a century.8,9 The most radiosensitive parts of the human body are the integumentary, reproductive, and gastrointestinal organ systems.10 Viability of normal tissue around the target area is oftentimes compromised, as attempts are made to ensure adequate treatment and disease control. When radiation is used for head and neck cancer, the effects include those that impair wound healing and cosmesis, and other more serious consequences as carotid artery stenosis and osteoradionecrosis. The doses used to achieve effective yet tolerable levels are based primarily on retrospective and anecdotal data, and the doses administered differ based on the tissue type, patient, and associated risk factors.4 Not surprisingly, the use of intra-arterial chemotherapy with concomitant radiation further hinders microvascular reconstruction in head and neck cancer.11

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When considering just chronic wounds in general, total management costs amount to billions of health care dollars annually. Management of postradiation wounds necessitates an intricate interdisciplinary approach, involving plastic and reconstructive surgeons, nurses, dermatologists, radiation oncologists, general surgeons, and many other health care specialties.

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RISK FACTORS FOR POSTRADIATION WOUNDS

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The degree of radiation injury is correlated with the total radiation dose, proportion of body and volume of tissue irradiated, and time interval of received radiation dose.10 In fact, a dose-dependent clinical pattern is seen with radiation burns, ranging from desquamation at ...

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