The Multinational Association of Supportive Care in Cancer (MASCC) Acute Radiation Dermatitis Scoring Tool: Results of an International Delphi Consensus Study.

Abstract

This study aimed to develop a standardized, comprehensive grading system for acute radiation dermatitis (ARD) to improve consistency and accuracy in severity assessment in clinical and research settings. Existing ARD scales vary widely in structure and criteria, limiting comparability across trials. To address these inconsistencies, the Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology Study Group conducted a modified Delphi consensus study to create a tool integrating both clinician and patient perspectives, supporting objective evaluation of symptom severity and therapeutic efficacy. A MASCC-led systematic review published in May 2025 identified limitations in existing ARD assessment tools. Based on these findings, a modified Delphi process was conducted using electronic surveys with 31 international experts from 15 countries and 5 disciplines, supplemented by interviews with 3 patient advocates. Forty statements on conceptualization, categorization, and integration of clinician- and patient-reported outcomes were developed from the review. Panelists rated each statement on a five-point Likert scale, with consensus defined as ≥75% agreement. Statements failing to reach consensus were revised and re-evaluated in subsequent rounds. Consensus was achieved for 33 of 40 statements, resulting in a three-step ARD severity scoring tool approved by 29 (93.5%) panel members. Step 1 assesses eight patient-reported outcomes with an optional free-text field. Step 2 evaluates overall patient-reported symptom burden. Step 3 allows healthcare professionals to assign a final grade by integrating clinician assessment with patient-reported data. Moist desquamation is stratified into Grades 3A and 3B based on ≥25% versus <25% skin involvement and/or skin fold involvement. This is the first Delphi consensus study to develop an ARD grading tool incorporating both patient and clinician perspectives. Future validation studies will assess reliability, cross-population applicability, and inter-rater consistency among clinicians, researchers, and patients.