Problems of late radiation injuries of the skin and possibilities of their treatment

Abstract

Currently there is a problem of insufficient effectiveness of treatment of late radiation skin lesions. Possibilities of application of combined schemes of treatment of malignant neoplasms, including radiation therapy, show both good immediate and distant results, life expectancy of patients has increased. However, the issue of such remote local radiation lesions as radiation ulcers also remains relevant. Such lesions in the practice of clinical oncologists usually occur from 1-1,5 months and more after the end of the course of close-focus X-ray therapy for skin cancer. The peculiarity of radiation ulcers is that they heal extremely poorly even by secondary tension. In the pathogenesis of late radiation ulcers, along with disruption of microcirculation, the main role is played by the direct damaging effect of radiation on stem cells and, consequently, suppression of reparative processes. For this reason, such ulcerous defects are characterized by torpidity to drug and surgical treatment. The analysis of modern scientific and practical literature does not fully reveal the peculiarities of the pathogenesis of post-radiation skin lesions leading to the development of radiation ulcers. Researchers have set a goal to search for new modern methods of effective treatment of this pathology. The main purpose of the literature review was to theoretically substantiate the possibilities of including enzyme antioxidants and epidermal growth factor preparations into the complex of pathogenetic treatment of radiation skin ulcers. Superoxide dismutase (SOD) is an active enzyme-antioxidant, it neutralizes excessive free oxygen radicals, and also has a pronounced anti-inflammatory effect by means of oxidative post-radiation stress of skin tissues. Epidermal growth factor promotes cell growth and differentiation of stem cells (SC) involved in ulcer defect regeneration. Pathogenetically justified stepwise application of these drugs will improve the effectiveness of treatment of post-radiation skin ulcers. This paper presents the current information about the pathogenesis of late radiation skin ulcers, the mechanism of action of SOD, epidermal growth factor preparations, as well as the importance of the microenvironment and the homing effect in controlling the links of the pathogenesis of radiation ulcers and the possibility of their reparative regeneration.