Radiotherapy remains an essential treatment for patients with cancer and is associated with a number of short term and long term side effects . One of these side effects includes radiation-induced skin reactions (RISR), also known as radiation dermatitis, which affects up to 90 % of cancer patients receiving radiotherapy [2–4]. Approximately, 85 % of these patients experience a moderate-to-severe skin reaction [5, 6]. The reactions are the combined result of a decrease in functional stem cells, changes in the skin’s endothelial cells, inflammation, and skin cell necrosis and death of the skin . Radiation-induced skin reactions are often characterised by oedema, erythema, changes in pigmentation, fibrosis and ulceration . Signs and symptoms may include skin dryness, itching discomfort, pain, warmth, and burning . Radiation-induced skin reactions have an impact on pain and quality of life in this patient group , and if severe, may necessitate changes to the patient’s radiation schedule . Therefore, managing skin reactions is an important priority in caring for this patient group .
The development of RISR may begin immediately, with increasing toxicity occurring at 2–3 weeks, with effects accumulating across the course of treatment, and may persist up to 4 weeks after treatment ends . Hypothesised risk factors influencing RISR reported in the literature are both intrinsic or extrinsic . The intrinsic factors are age, general health, ethnic origin, co-existing diseases, UV exposure, hormonal status  and genetic factors . The extrinsic factors include the dose, volume, and number of fractions of radiation, radio-sensitizers, concurrent chemotherapy and the site of treatment . Of these hypothesised factors, smoking status  and BMI [14, 15] are the major influencing factors supported by empirical data. A range of interventions are used for prophylaxis and management of these reactions. These interventions include (i) topical preparations (both steroidal and non-steroidal), (ii) dressings, (iii) systematic treatment such as amifostine, oral hydrolytic enzymes, pentoxifylline and zinc supplement, (iv) alternating modes of radiation delivery. The latest published systematic review including 39 trials before 2008 reported that only topical corticosteroid agents, among other interventions mentioned above, were found to significantly reduce the severity of some RISR, but not the levels of pain and itching . Further, it is not yet clear which corticosteroid is superior to other non-steroidal agents . This systematic review, together with a number of other previous reviews concluded that the uses of these interventions are not yet supported by conclusive evidence and warrant further investigations [4, 5, 10, 16, 17]. Current evidence indicates that there is a paucity of conclusive evidence which can inform health professionals on effective skin management of RISR [18, 19].
A natural oil-based emulsion, as known as Moogoo Udder Cream®, is a Queensland owned product that comprises allantoin, purified water, sweet almond oil, olive oil, rice bran oil, emulsifying wax, milk protein, aloe vera, vitamin E, glycerol caprylate, piroctone alamine and guarsilk. Anecdotal reports by patients with RISR and radiation oncologists in a number of Australian cancer centres suggest that Moogoo Udder Cream® may be effective in promoting healing, comfort, and pain relief. This product is being increasingly used in some other Australian cancer centres in for managing RISR, however there is not yet empirical evidence supporting this claim. This study aims to investigate the effects of Moogoo Udder Cream® against aqueous cream (which is current standard of care) in patients with RISR.