Turkiye Klinikleri Journal of Dermatology

.: REVIEW
Radyodermatit Tedavisi: Geleneksel Derleme
Radiodermatitis Treatment: Traditional Review
Özlem KRALa,b, Sibel İLBASMIŞ TAMERa , Ülker GÜLc , Figen TIRNAKSIZa
aGazi Üniversitesi Eczacılık Fakültesi, Farmasötik Teknoloji ABD, Ankara, Türkiye
bAğrı İbrahim Çeçen Üniversitesi Eczacılık Fakültesi, Farmasötik Teknoloji ABD, Ağrı, Türkiye
cSağlık Bilimleri Üniversitesi Gülhane Tıp Fakültesi, Deri ve Zührevi Hastalıklar ABD, Ankara, Türkiye
Turkiye Klinikleri J Dermatol. 2023;33(1):30-9
doi: 10.5336/dermato.2022-94401
Article Language: TR
Full Text
ÖZET
 Radyodermatit (RD); eritem, ödem, dermatit, deskuamasyon, nekroz gibi ciddi deri reaksiyonları şeklinde kendini gösteren, radyasyonun yaygın bir yan etkisidir. Radyasyon uygulanmasının ardından yaklaşık 90 gün içinde ortaya çıkan akut RD ve daha uzun süre sonra ortaya çıkabilen kronik RD olarak 2 farklı şekilde görülebilir. Semptomların hafifletilmesi, klinisyenlerin RD gelişimi riskini doğru bir şekilde değerlendirme ve deri hasarının boyutunu tahmin etmedeki tecrübesine dayanmaktadır. RD tanısı temel olarak klinik bulgulara dayanır ve bu amaçla çok sayıda tanısal araç mevcuttur. RD belirtilerinin derecelendirilmesi için farklı skorlama sistemleri kullanılmaktadır. RD, radyoterapi (RT) uygulanan kanser hastalarının yaklaşık %95'inde görülmektedir. Radyasyon uygulaması ile oluşan nemli deskuamasyon, nekroz ve ülserasyon gibi deri reaksiyonları, hastaların RT'ye uyumunu önemli ölçüde azaltır ve tedavi protokollerinin kesintiye uğramasına neden olur. Bu nedenle, RD'nin önlenmesi ve tedavisi için çok sayıda çalışma yapılmıştır. Tedavi sırasında RD belirtileri gösteren derinin temizliğinin sabun ve su ile yapılması önerilmektedir. Tedavi seçenekleri arasında kortikosteroid ve gümüş sülfadiazin kullanımı yaygın olmakla beraber ilaç olarak değerlendirilmeyen topikal ürünler de bulunmaktadır. Merhem, yama, aerosol, emülsiyon, emüljel, hidrojel ve pat RD'yi tedavi etmek amacıyla üzerinde çalışılan veya ticari olarak var olan topikal dozaj şekilleridir. Bu derlemede, RD ile ilgili genel bilgiler verilmiş, olası tedavi seçenekleri derlenmiş; bu konuda farklı dozaj şekillerinin çalışıldığı makaleler ve patentler incelenmiştir.

Anahtar Kelimeler: Radyodermatit; dozaj formları; yara iyileşmesi
ABSTRACT
 Radiodermatitis (RD) is a common side effect of radiation, seen as serious skin reactions such as erythema, edema, dermatitis, desquamation, necrosis. It can be seen in 2 different ways as acute RD that occurs approximately 90 days after the application of radiation and chronic RD that can occur after a longer period of time. Relief of symptoms is based on clinician's experience in accurately assessing the risk of developing RD and estimating the extent of skin damage. The diagnosis of RD is mainly based on clinical findings and many diagnostic tools are available for this purpose. Different scoring systems are used for grading RD symptoms. RD occurs in approximately 95% of cancer patients undergoing radiotherapy (RT). Skin reactions such as moist desquamation, necrosis and ulceration caused by radiation application significantly reduce the compliance of patients to RT and cause interruption of treatment protocols. Therefore, many studies have been conducted for the prevention and treatment of RD. It is recommended to clean the skin that shows signs of RD during treatment with soap and water. Although the use of corticosteroids and silver sulfadiazine is common among the treatment options, there are also topical products that are not considered as drugs. Ointment, patch, aerosol, emulsion, emulgel, hydrogel, and paste are topical dosage forms studied or commercially available to treat RD. In this review, general information about RD was given and possible treatment options were compiled; In this regard, articles and patents on different dosage forms were examined.

Keywords: Radiodermatitis; dosage forms; wound healing
REFERENCES:
  1. Mendelsohn FA, Divino CM, Reis ED, Kerstein MD. Wound care after radiation therapy. Adv Skin Wound Care. 2002;15(5):216-24. [Crossref]  [PubMed] 
  2. Singh M, Alavi A, Wong R, Akita S. Radiodermatitis: a review of our current understanding. Am J Clin Dermatol. 2016;17(3):277-92. [Crossref]  [PubMed] 
  3. McQuestion M. Evidence-based skin care management in radiation therapy. Semin Oncol Nurs. 2006;22(3):163-73. [Crossref]  [PubMed] 
  4. D'Orazio J, Jarrett S, Amaro-Ortiz A, Scott T. UV radiation and the skin. Int J Mol Sci. 2013;14(6):12222-48. [Crossref]  [PubMed]  [PMC] 
  5. Wang Y, Tu W, Tang Y, Zhang S. Prevention and treatment for radiation-induced skin injury during radiotherapy. Radiat Med Prot. 2020;1(2):60-8. [Crossref] 
  6. Ryan JL. Ionizing radiation: the good, the bad, and the ugly. J Invest Dermatol. 2012;132(3 Pt 2):985-93. [Crossref]  [PubMed]  [PMC] 
  7. Berthelet E, Truong PT, Musso K, Grant V, Kwan W, Moravan V, et al. Preliminary reliability and validity testing of a new Skin Toxicity Assessment Tool (STAT) in breast cancer patients undergoing radiotherapy. Am J Clin Oncol. 2004;27(6):626-31. [Crossref]  [PubMed] 
  8. Holler V, Buard V, Gaugler MH, Guipaud O, Baudelin C, Sache A, et al. Pravastatin limits radiation-induced vascular dysfunction in the skin. J Invest Dermatol. 2009;129(5):1280-91. [Crossref]  [PubMed] 
  9. Müller K, Meineke V. Radiation-induced alterations in cytokine production by skin cells. Exp Hematol. 2007;35(4 Suppl 1):96-104. [Crossref]  [PubMed] 
  10. Grimm J, LaCouture T, Croce R, Yeo I, Zhu Y, Xue J. Dose tolerance limits and dose volume histogram evaluation for stereotactic body radiotherapy. J Appl Clin Med Phys. 2011;12(2):3368. [Crossref]  [PubMed]  [PMC] 
  11. Lee J, Kim J. Physical agents and occupational disease compensation: noise, vibration, radiation, and other physical agents. J Korean Med Sci. 2014;29 Suppl(Suppl):S72-7. [Crossref]  [PubMed]  [PMC] 
  12. Wang FR, Fang QQ, Tang WM, Xu XS, Mahapatra T, Mahapatra S, et al. Nested case-control study of occupational radiation exposure and breast and esophagus cancer risk among medical diagnostic X ray workers in Jiangsu of China. Asian Pac J Cancer Prev. 2015;16(11):4699-704. [Crossref]  [PubMed] 
  13. Steinert M, Weiss M, Gottlöber P, Belyi D, Gergel O, Bebeshko V, et al. Delayed effects of accidental cutaneous radiation exposure: fifteen years of follow-up after the Chernobyl accident. J Am Acad Dermatol. 2003;49(3):417-23. [Crossref]  [PubMed] 
  14. Haruna F, Lipsett A, Marignol L. Topical Management of acute radiation dermatitis in breast cancer patients: a systematic review and meta-analysis. Anticancer Res. 2017;37(10):5343-53. [Crossref]  [PubMed] 
  15. Baines CR, McGuiness W, O'Rourke GA. An integrative review of skin assessment tools used to evaluate skin injury related to external beam radiation therapy. J Clin Nurs. 2017;26(7-8):1137-44. [Crossref]  [PubMed] 
  16. Robijns J, Lodewijckx J, Mebis J. Photobiomodulation therapy for acute radiodermatitis. Curr Opin Oncol. 2019;31(4):291-8. [Crossref]  [PubMed] 
  17. Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol. 2006;54(1):28-46. [Crossref]  [PubMed] 
  18. Rosenthal A, Israilevich R, Moy R. Management of acute radiation dermatitis: a review of the literature and proposal for treatment algorithm. J Am Acad Dermatol. 2019;81(2):558-67. [Crossref]  [PubMed] 
  19. Bourgeois JF, Gourgou S, Kramar A, Lagarde JM, Gall Y, Guillot B. Radiation-induced skin fibrosis after treatment of breast cancer: profilometric analysis. Skin Res Technol. 2003;9(1):39-42. [Crossref]  [PubMed] 
  20. Wong RK, Bensadoun RJ, Boers-Doets CB, Bryce J, Chan A, Epstein JB, et al. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer. 2013;21(10):2933-48. [Crossref]  [PubMed] 
  21. Zhang S, Wang W, Gu Q, Xue J, Cao H, Tang Y, et al. Protein and miRNA profiling of radiation-induced skin injury in rats: the protective role of peroxiredoxin-6 against ionizing radiation. Free Radic Biol Med. 2014;69:96-107. [Crossref]  [PubMed] 
  22. Hegedus F, Mathew LM, Schwartz RA. Radiation dermatitis: an overview. Int J Dermatol. 2017;56(9):909-14. [Crossref]  [PubMed] 
  23. Schmuth M, Sztankay A, Weinlich G, Linder DM, Wimmer MA, Fritsch PO, et al. Permeability barrier function of skin exposed to ionizing radiation. Arch Dermatol. 2001;137(8):1019-23. [PubMed] 
  24. Koenig TR, Wolff D, Mettler FA, Wagner LK. Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. AJR Am J Roentgenol. 2001;177(1):3-11. [Crossref]  [PubMed] 
  25. He Z, Lu C, Chren MM, Zhang Z, Li Y, Ni X, et al. Development and psychometric validation of the Chinese version of Skindex-29 and Skindex-16. Health Qual Life Outcomes. 2014;12:190. [Crossref]  [PubMed]  [PMC] 
  26. Spasić B, Jovanović M, Golu?in Z, Ivanov O, Te?anović D. Radiodermatitis-review of treatment options. Serbian J Dermatology Venereol. 2019;10(3):71-81. [Crossref] 
  27. Roy I, Fortin A, Larochelle M. The impact of skin washing with water and soap during breast irradiation: a randomized study. Radiother Oncol. 2001;58(3):333-9. [Crossref]  [PubMed] 
  28. Zhang Y, Zhang S, Shao X. Topical agent therapy for prevention and treatment of radiodermatitis: a meta-analysis. Support Care Cancer. 2013;21(4):1025-31. [Crossref]  [PubMed] 
  29. Ertekin MV, Tekin SB, Erdogan F, Karslioglu I, Gepdiremen A, Sezen O, et al. The effect of zinc sulphate in the prevention of radiation-induced dermatitis. J Radiat Res. 2004;45(4):543-8. [Crossref]  [PubMed] 
  30. Gujral MS, Patnaik PM, Kaul R, Parikh HK, Conradt C, Tamhankar CP, et al. Efficacy of hydrolytic enzymes in preventing radiation therapy-induced side effects in patients with head and neck cancers. Cancer Chemother Pharmacol. 2001;47 Suppl:S23-8. [Crossref]  [PubMed] 
  31. Magnusson M, Höglund P, Johansson K, Jönsson C, Killander F, Malmström P, et al. Pentoxifylline and vitamin E treatment for prevention of radiation-induced side-effects in women with breast cancer: a phase two, double-blind, placebo-controlled randomised clinical trial (Ptx-5). Eur J Cancer. 2009;45(14):2488-95. [Crossref]  [PubMed] 
  32. Lievens Y, Haustermans K, Van den Weyngaert D, Van den Bogaert W, Scalliet P, Hutsebaut L, et al. Does sucralfate reduce the acute side-effects in head and neck cancer treated with radiotherapy? A double-blind randomized trial. Radiother Oncol. 1998;47(2):149-53. [Crossref]  [PubMed] 
  33. Kouvaris JR, Kouloulias VE, Vlahos LJ. Amifostine: the first selective-target and broad-spectrum radioprotector. Oncologist. 2007;12(6):738-47. [Crossref]  [PubMed] 
  34. Martella S, Rietjens M, Lohsiriwat V, Lazzari R, Vavassori A, Jereczek B, et al. Acute radiation dermatitis in breast cancer: topical therapy with vitamin E acetate in lipophilic gel base. Ecancermedicalscience. 2010;4:190. [PubMed]  [PMC] 
  35. Miller RC, Schwartz DJ, Sloan JA, Griffin PC, Deming RL, Anders JC, et al. Mometasone furoate effect on acute skin toxicity in breast cancer patients receiving radiotherapy: a phase III double-blind, randomized trial from the North Central Cancer Treatment Group N06C4. Int J Radiat Oncol Biol Phys. 2011;79(5):1460-6. [Crossref]  [PubMed]  [PMC] 
  36. Uysal B, Gamsız H, Dincoglan F, Demiral S, Sager O, Dirican B, et al. Comparative evaluation of topical corticosteroid and moisturizer in the prevention of radiodermatitis in breast cancer radiotherapy. Indian J Dermatol. 2020;65(4):279-83. [Crossref]  [PubMed]  [PMC] 
  37. Kianinia M, Roayaei M, Mahdavi H, Hemati S. A double-blind randomized trial on the effectiveness of mometasone 0.1% cream and hydrocortisone 1% cream on the prevention of acute radiation dermatitis in breast cancer patients following breast conserving surgery. Middle East J Cancer. 2021;12(3):406-14. [Link] 
  38. Pasalar M, Ahadi B, Mirzaei HR, Buentzel J, Ardestani MM, Kamian S, et al. Comparing the efficacy of dermolina-henna cream with mometasone cream in improving radiodermatitis amongst patients with breast cancer: a randomized active-control double-blind clinical trial. Research Square. 2021:1-14. [Crossref] 
  39. Hemati S, Asnaashari O, Sarvizadeh M, Motlagh BN, Akbari M, Tajvidi M, et al. Topical silver sulfadiazine for the prevention of acute dermatitis during irradiation for breast cancer. Support Care Cancer. 2012;20(8):1613-8. [Crossref]  [PubMed] 
  40. Niazi TM, Vuong T, Azoulay L, Marijnen C, Bujko K, Nasr E, et al. Silver clear nylon dressing is effective in preventing radiation-induced dermatitis in patients with lower gastrointestinal cancer: results from a phase III study. Int J Radiat Oncol Biol Phys. 2012;84(3):e305-10. [Crossref]  [PubMed] 
  41. Vadarli G, Angelo-Khattar M. A fibroblast-derived human growth factor preparation for the management of acute radiodermatitis: a case report. Int Med Case Rep J. 2020;13:691-6. [Crossref]  [PubMed]  [PMC] 
  42. Shariati L, Amouheidari A, Naji Esfahani H, Abed A, Haghjooy Javanmard S, Laher I, et al. Protective effects of doxepin cream on radiation dermatitis in breast cancer: a single arm double-blind randomized clinical trial. Br J Clin Pharmacol. 2020;86(9):1875-81. [Crossref]  [PubMed]  [PMC] 
  43. Pommier P, Gomez F, Sunyach MP, D'Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol. 2004;22(8):1447-53. [Crossref]  [PubMed] 
  44. Heggie S, Bryant GP, Tripcony L, Keller J, Rose P, Glendenning M, et al. A Phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue. Cancer Nurs. 2002;25(6):442-51. [Crossref]  [PubMed] 
  45. Zhao H, Zhu W, Jia L, Sun X, Chen G, Zhao X, et al. Phase I study of topical epigallocatechin-3-gallate (EGCG) in patients with breast cancer receiving adjuvant radiotherapy. Br J Radiol. 2016;89(1058):20150665. [Crossref]  [PubMed]  [PMC] 
  46. Ferreira EB, Ciol MA, Vasques CI, Bontempo Pde S, Vieira NN, Silva LF, et al. Gel of chamomile vs. urea cream to prevent acute radiation dermatitis in patients with head and neck cancer: a randomized controlled trial. J Adv Nurs. 2016;72(8):1926-34. [Crossref]  [PubMed] 
  47. Geara FB, Eid T, Zouain N, Thebian R, Andraos T, Chehab C, et al. Randomized, prospective, open-label Phase III trial comparing mebo ointment with biafine cream for the management of acute dermatitis during radiotherapy for breast cancer. Am J Clin Oncol. 2018;41(12):1257-62. [Crossref]  [PubMed] 
  48. Kirova YM, Fromantin I, De Rycke Y, Fourquet A, Morvan E, Padiglione S, et al. Can we decrease the skin reaction in breast cancer patients using hyaluronic acid during radiation therapy? Results of phase III randomised trial. Radiother Oncol. 2011;100(2):205-9. [Crossref]  [PubMed] 
  49. Kouvaris JR, Kouloulias VE, Plataniotis GA, Balafouta EJ, Vlahos LJ. Dermatitis during radiation for vulvar carcinoma: prevention and treatment with granulocyte-macrophage colony-stimulating factor impregnated gauze. Wound Repair Regen. 2001;9(3):187-93. [Crossref]  [PubMed] 
  50. Kong M, Hong SE. Topical use of recombinant human epidermal growth factor (EGF)-based cream to prevent radiation dermatitis in breast cancer patients: a single-blind randomized preliminary study. Asian Pac J Cancer Prev. 2013;14(8):4859-64. [Crossref]  [PubMed] 
  51. Fernández-Castro M, Martín-Gil B. Efectividad del tratamiento tópico en pacientes con cáncer de mama que sufren radiodermatitis. Una revisión sistemática [Efectiveness of topical therapies in patients with breast cancer that experience radiodermatitis. A systematic review]. Enferm Clin. 2015;25(6):327-43. [Crossref]  [PubMed] 
  52. Lee CJ, Fang HF, Wang CY, Chou KR, Huang TW. Effect of hyaluronic acid on radiodermatitis in patients with breast cancer: a meta-analysis of randomized controlled trials. Support Care Cancer. 2022;30(5):3965-75. [Crossref]  [PubMed] 
  53. Ferreira EB, Ciol MA, de Meneses AG, Bontempo PSM, Hoffman JM, Reis PEDD. Chamomile gel versus urea cream to prevent acute radiation dermatitis in head and neck cancer patients: results from a preliminary clinical trial. Integr Cancer Ther. 2020;19:1534735420962174. [Crossref]  [PubMed]  [PMC] 
  54. Yang K, Kim SY, Park JH, Ahn WG, Jung SH, Oh D, et al. Topical application of phlorotannins from brown seaweed mitigates radiation dermatitis in a mouse model. Mar Drugs. 2020;18(8):377. [Crossref]  [PubMed]  [PMC] 
  55. Fisher J, Scott C, Stevens R, Marconi B, Champion L, Freedman GM, et al. Randomized phase III study comparing Best Supportive Care to Biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: Radiation Therapy Oncology Group (RTOG) 97-13. Int J Radiat Oncol Biol Phys. 2000;48(5):1307-10. [Crossref]  [PubMed] 
  56. Løkkevik E, Skovlund E, Reitan JB, Hannisdal E, Tanum G. Skin treatment with bepanthen cream versus no cream during radiotherapy--a randomized controlled trial. Acta Oncol. 1996;35(8):1021-6. [Crossref]  [PubMed] 
  57. Ryan Wolf J, Gewandter JS, Bautista J, Heckler CE, Strasser J, Dyk P, et al. Utility of topical agents for radiation dermatitis and pain: a randomized clinical trial. Support Care Cancer. 2020;28(7):3303-11. [Crossref]  [PubMed]  [PMC] 
  58. Johnson K, Fenton G, White RJ. Radiation dermatitis: The evaluation of a new topical therapy for the treatment and prevention of radiation-induced skin damage and moist desquamation: a multicentre UK case cohort study. J Radiother Pract. 2021;20(4):461-5. [Crossref] 
  59. Iacovelli NA, Naimo S, Bonfantini F, Cavallo A, Bossi P, Fallai C, et al. Preemptive treatment with Xonrid®, a medical device to reduce radiation induced dermatitis in head and neck cancer patients receiving curative treatment: a pilot study. Support Care Cancer. 2017;25(6):1787-95. [Crossref]  [PubMed] 
  60. Hong D, Yuan Y, Shuangchan W, Dongbo X, Ge Y. Application of glycyrrhizic acid, glycyrrhetinic acid or salt thereof as well as gel composition and preparation method for gel composition. CN; CN102614213A. 2012. [Link] 
  61. Ahn S, Sung K, Kim HJ, Choi YE, Lee YK, Kim JS, et al. Reducing radiation dermatitis using a film-forming silicone gel during breast radiotherapy: a pilot randomized-controlled trial. In Vivo. 2020;34(1):413-22. [Crossref]  [PubMed]  [PMC] 
  62. Yee C, Lam E, Gallant F, Karam I, Czarnota G, Soliman H, et al. A feasibility study of mepitel film for the prevention of breast radiation dermatitis in a Canadian Center. Pract Radiat Oncol. 2021;11(1):e36-e45. [Crossref]  [PubMed] 
  63. Röper B, Kaisig D, Auer F, Mergen E, Molls M. Thêta-Cream versus Bepanthol lotion in breast cancer patients under radiotherapy. A new prophylactic agent in skin care? Strahlenther Onkol. 2004;180(5):315-22. [Crossref]  [PubMed] 
  64. Kyritsi A, Kikionis S, Tagka A, Koliarakis N, Evangelatou A, Papagiannis P, et al. Management of acute radiodermatitis in non-melanoma skin cancer patients using electrospun nanofibrous patches loaded with Pinus halepensis bark extract. Cancers (Basel). 2021;13(11):2596. [Crossref]  [PubMed]  [PMC] 
  65. Garbuio DC, Ribeiro VDS, Hamamura AC, Faustino A, Freitas LAP, Viani G, et al. A Chitosan-coated chamomile microparticles formulation to prevent radiodermatitis in breast: a double-blinded, controlled, randomized, phase II clinical trial. Am J Clin Oncol. 2022;45(5):183-9. [Crossref]  [PubMed] 
  66. Song F, Liao Z, Li T, Kang N, Li Z, Fan S, et al. Topical use of Jiawei Simiao Yongan Gao to prevent radiodermatitis in patients with head and neck cancer: a retrospective cohort study. Medicine (Baltimore). 2020;99(48):e23318. [Crossref]  [PubMed]  [PMC] 
  67. He J, Ma, Li G, Dai Y, Chen W, Wang H, et al., Compound gel preparation for treating radiodermatitis and preparation method thereof. CN; CN107115271A, 2017. [Link] 
  68. Guglielmini G, Fontana M, Fontana A. Topical compositions for the treatment and prevention of skin diseases, in particular radiation dermatitis caused by ionising radiation. EP; EP2494973A1. 2012. [Link] 
  69. Chan RJ, Mann J, Tripcony L, Keller J, Cheuk R, Blades R, et al. Natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer: a phase 3, double-blind, randomized, controlled trial. Int J Radiat Oncol Biol Phys. 2014;90(4):756-64. [Crossref]  [PubMed] 
  70. Xiao B, Li J, Zhang X, Wu J, Liu Y, Chen B. Medical radiation protective emulsifiable paste and preparing method thereof. CN; CN106474313A. 2006. [Link] 
  71. Zu G, Wan Y. Externally used emulsifiable paste for treating radiodermatitis and preparation method of emulsifiable paste. CN; CN104666528A. 2015. [Link] 
  72. Hu X, Liao W, Wu S, Xiaobing H. Patch for treating radiodermatitis and preparing method thereof. CN; CN105596600A. 2016. [Link] 
  73. Wang L,Wang X, Ma X, Deng F. Medical protective agent and preparation method and application thereof. CN; CN107184964A. 2017. [Link] 
  74. Huanchen L, Jingkun L, Chi C. Pharmaceutical combination for curing acute radiation dermatitis. CN; CN101254203A. 2008. [Link] 
  75. Song Z, Zhao J, Chang C, Gao J. Percutaneous administration preparation for treating radiodermatitis caused by tumor radiotherapy. CN; CN107595873B. 2018. [Link] 

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3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com