In response to the article “The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline” (Bolderston et al. 2006)

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I commend the authors for their work to develop evidence-based clinical practice guidelines for the management of radiation skin reactions, but I would like to clarify a statement that the British Columbia Cancer Agency’s (BCCA) guidelines (Care of Radiation Skin Reactions 2000) are “based on expert opinion and consensus rather than a systematic review of the evidence.” The process to develop the BCCA guidelines was published in 2005 [1] and closely parallels the cycle to develop evidence-based clinical practice guidelines as described by Browman et al. [2]. The guidelines were developed through a process that included (1) a review of the current literature, (2) a survey of current BCCA, national, and international clinical practice, and (3) consensus development among health care professionals in radiation therapy, radiation oncology and nursing of the BCCA’s regional cancer centers. The final document “Care of Radiation Skin Reactions” cites many of the same references as Bolderson et al. [3]. A more extensive review was completed but did not provide evidence to inform clinical practice guidelines. The BCCA guidelines initially written in 2000 were revised in 2002 and again in March 2006. A BCCA working group actively monitors the literature for relevant new evidence or skin care management guidelines. For the most up-to-date version, see http://​www.​bccancer.​bc.​ca/​HPI/​CancerManagement​Guidelines/​SupportiveCare/​RadiationSkinRea​ctions/​default.​htm. …