Delphi consensus-based recommendations of tools and outcomes for the assessment of radiation dermatitis severity

Introduction: Acute radiation dermatitis (ARD) is a common side effect experienced during radiation therapy (RT) for cancer. Published clinical trials for ARD use a myriad of assessment tools and outcomes to measure ARD severity, which limits the comparability of clinical trial results. Our study utilized a modified Delphi consensus survey to gather expert opinions on commonly used tools for ARD severity. Materials and methods: Thirty experts were invited to participate in a two-round Delphi consensus survey. Of these, 80 % (24/30) completed the first round; and 92 % (22/24) completed the second round. The Delphi process was conducted using the REDCap platform to systematically collect expert opinions on 32 assessment tools and 11 key outcomes pertinent to the severity of ARD. Assessment tools and outcomes that achieved a consensus of ≥ 70 % among the experts were subsequently recommended. Results: Expert recommendations included four tools (RTOG, CTCAE, RISRAS, and Skindex-16) and eight relevant outcomes (moist desquamation, pain, QoL, erythema, dry desquamation, pruritus/itching, necrosis/ulceration, and burning) for ARD severity assessment. Due to limited evidence, no biophysical parameters reached consensus. Further, experts suggested modifications to existing tools to improve measurement of ARD severity across all skin types. Conclusion: Our study was the first step in standardizing ARD severity assessment with expert consensus recommendation for four tools and eight relevant outcomes. However, modifications to existing tools are necessary to promote validation and accuracy across all skin types. Future efforts should create a new comprehensive ARD severity assessment tool to address deficiencies in existing tools.