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Javdan B, Pattison LM, Rangu SA, Tejeda E, McLellan BN. The validity of over-the-counter skin, hair, and nail recommendations for adult patients with cancer: A systematic review. Support Care Cancer 2024; 32:577. [PMID: 39112734 PMCID: PMC11306727 DOI: 10.1007/s00520-024-08735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/11/2024] [Indexed: 08/10/2024]
Abstract
IMPORTANCE Patients undergoing cancer treatment experience a multitude of skin, hair, and nail adverse events, prompting them to use non-evidence-based and often restrictive over-the-counter (OTC) recommendations to alleviate their symptoms. Comprehensively assessing evidence-based OTC modalities is crucial to enable cancer patients to comfortably resume their lives post-treatment and integrate clinically sound practices into their self-care routines. OBJECTIVE Perform a systematic review and assessment of evidence-based OTC skin, hair, and nail care recommendations for adult patients undergoing cancer treatment. EVIDENCE REVIEW PubMed, Cochrane, Embase, and Medline databases were searched in March 2023 to identify English articles addressing OTC skin, hair, and nail care recommendations for adult patients before, during, and after cancer chemotherapy or radiation therapy (RT). Quality was assessed with Oxford Centre for Evidence Based Medicine criteria. FINDINGS 2192 unique articles were screened, of which 77 met inclusion criteria consisting of 54 randomized controlled trials (RCT), 8 non-randomized controlled cohorts, 1 non-randomized controlled clinical trial, 3 controlled prospective cohorts, 4 prospective cohorts, 2 controlled clinical trials, 1 prospective comparative study, 2 case reports, and 2 case series discussing 9322 patients. An additional article outside of our database search was included for a total of 78 articles. OTC skin care treatments with the best quality of evidence included moisturizing creams. Our review revealed a paucity of evidence-based hair and nail care practices. CONCLUSIONS AND RELEVANCE This systematic review serves to highlight the efficacy of diverse OTC skin, hair, and nail care recommendations for adult cancer patients while encouraging further clinical trials to establish evidence-based management guidelines.
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Affiliation(s)
- Bahar Javdan
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Lindsay M Pattison
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sneha A Rangu
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emely Tejeda
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Beth N McLellan
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.
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Kuszaj O, Day M, Wronski M, Corbin K, Herst P, Hill R, Rades D, Wong C, Karam I, Gallant F, Lee SF, Tse SSW, Chow E, Wong H. Mepitel film for the prevention of radiation dermatitis: A comprehensive review of its efficacy, side effects, physics measurements, patient- and clinician-reported outcomes. Asia Pac J Oncol Nurs 2024; 11:100530. [PMID: 39051046 PMCID: PMC11268185 DOI: 10.1016/j.apjon.2024.100530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/29/2024] [Indexed: 07/27/2024] Open
Abstract
Objective This review aimed to summarize the benefits, side effects, physics measurements, and patient- and clinician-reported outcomes of Mepitel film (MF) in preventing radiation dermatitis (RD) for cancer patients. Methods The online database PubMed was searched from inception to April 15, 2024 with the search terms "Mepitel film" or "Mepitel." Articles of any study design evaluating MF for the prevention of RD were included. Non-human studies were excluded. Results The database search identified 119 articles and 13 of them were included in this review. Across these studies, MF was found to be beneficial in reducing RD and improved patient- and clinician-reported outcomes in breast and head and neck cancers. Side effects of MF included itchiness, acne, allergic reaction, tightness, discomfort, and poor film adherence, but patient dropouts were uncommon. MF did not cause a bolus effect or increased skin dose in physics measurements. Conclusions MF is a safe and effective intervention for preventing acute RD. It should be recommended in breast cancer patients where the data is more robust. Further research is needed to evaluate MF's efficacy on patients with different skin tones, its cost-effectiveness, and identifying patients who most benefit from MF relative to other effective interventions.
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Affiliation(s)
- Olivia Kuszaj
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marley Day
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Matt Wronski
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Patries Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | - Rosemary Hill
- Lions Gate Hospital, North Vancouver, British Columbia, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Cindy Wong
- Union Oncology Centre, Kowloon, Hong Kong S.A.R., China
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Francois Gallant
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Shirley SW. Tse
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon Central Cluster, Hospital Authority, Hong Kong S.A.R, China
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R, China
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Guan Y, Liu S, Li A, Cheng W. Comparison of the efficacy among different interventions for radiodermatitis: A Bayesian network meta‑analysis of randomized controlled trials. PLoS One 2024; 19:e0298209. [PMID: 38598529 PMCID: PMC11006171 DOI: 10.1371/journal.pone.0298209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Radiation dermatitis (RD) is a prevalent and difficult-to-manage consequence of radiation therapy (RT). A variety of interventions have been proven effective in preventing and treating RD. However, the optimal approach remains unclear. This network meta-analysis (NMA) conducted a comparison and ranking of the effectiveness and patient-reported outcomes (PROs) of the interventions currently utilized in RD. METHODS PubMed, Web of Science, Embase, and Cochrane Library were searched to identify pertinent randomized controlled trials (RCTs) focused on the prevention and treatment of RD. The primary outcome measures included the incidence of grade≥2 RD (i.e., percentage of moist desquamation) and RD score. The secondary outcome measures encompassed patients' subjective assessment scores of pains, itching and burning sensations. RESULTS Our meta-analysis encompassed 42 studies and 4884 participants. Regarding the primary outcomes, photobiomodulation treatment (PBMT) ranked first in surface under curve cumulative ranking area (SUCRA:0.92) for reducing the incidence of grade≥2 RD. It demonstrated a significant difference when compared to Trolamine (OR 0.18,95%CrI 0.09-0.33) and Xonrid® (OR 0.28,95%CrI 0.12-0.66). Mepitelfilm (SUCRA: 0.98) achieved the highest rank in reducing the RD score, demonstrating superiority over StrataXRT® (MD -0.89, 95% CrI -1.49, -0.29). Henna (SUCRA: 0.89) demonstrated the highest effectiveness in providing pain relief, with a significant difference compared to Hydrofilm (MD -0.44, 95% CrI -0.84, -0.04) and Mepitelfilm (MD -0.55, 95% CrI -0.91, -0.19). Hydrofilm (SUCRA: 0.84) exhibited the fewest itching sensations, demonstrating superiority over Mepitelfilm (MD -0.50, 95% CrI -0.84, -0.17). No statistically significant difference was observed among various interventions in the assessment of burning sensations. CONCLUSION PBMT and Mepitelfilm demonstrated better efficacy in reducing the incidence of grade≥2 RD and RD score, respectively. In terms of PROs, Henna and Hydrofilm had fewer complaints in pain and itching sensations, respectively. However, studies with larger sample size on different interventions are warranted in the future. TRIAL REGISTRATION PROSPERO registration number CRD42023428598.
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Affiliation(s)
- Ying Guan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China
| | - Shuai Liu
- Department of Radiotherapy Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Anchuan Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, P. R. China
| | - Wanqin Cheng
- Department of Radiation Oncology, Shunde Hospital, Southern Medical University, Shunde, P. R. China
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Kraemer J, Momm F. Decrease of radiation-induced skin reactions in breast cancer patients by preventive application of film dressings-a systematic review. Strahlenther Onkol 2024; 200:109-122. [PMID: 37755486 DOI: 10.1007/s00066-023-02151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE Radiation-induced skin reactions remain one of the most frequent side effects of adjuvant radiotherapy for breast cancer, which is the most common global malignancy. In individual cases, we observed a decrease in radiation dermatitis under film dressings used for skin marking purposes. Therefore, we decided to revise the available evidence regarding the prophylactic use of film dressings to reduce radiation dermatitis in breast cancer patients. METHODS On 20 March 2023, we conducted a systematic review of literature for randomized controlled trials published in the English, German, French, or Spanish language, available in the PubMed database. RESULTS Of 82 publications, 9 full texts were assessed and 6 randomized controlled trials were included in the final synthesis. Two trials analyzed the application of polyurethane film (Hydrofilm, Paul Hartmann AG, Heidenheim, Germany), the other four of silicone-based polyurethane film (Mepitel film, Molnlycke Health Care Limited, Milton Keynes, United Kingdom). The evaluation scales Common Terminology Criteria for Adverse Events (CTCAE), Radiation Therapy Oncology Group (RTOG), and the Radiation-Induced Skin Reaction Assessment Scale (RISRAS) were used for assessment. All six trials, with a total of 788 patients yielding data for analysis, demonstrate a significant decrease in radiation-induced skin reactions by use of the film (mainly p < 0.001). CONCLUSION Our analysis demonstrates a significant decrease in radiation-induced skin reactions by prophylactically applied film dressings in breast cancer patients. Consequent preventive use of film dressings might systematically reduce acute radiation-induced skin reactions in these patients.
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Affiliation(s)
- Judith Kraemer
- Department of Radiation Oncology, Ortenau Klinikum Offenburg-Kehl, Academic Teaching Hospital of the Albert Ludwig University of Freiburg, Weingartenstraße 70, 77654, Offenburg, Germany.
| | - Felix Momm
- Department of Radiation Oncology, Ortenau Klinikum Offenburg-Kehl, Academic Teaching Hospital of the Albert Ludwig University of Freiburg, Weingartenstraße 70, 77654, Offenburg, Germany
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Gojsevic M, Kennedy S, Rajeswaran T, Herst P, Safavi AH, Corbin K, Hill R, Tran W, Carothers K, Gallant F, Trombetta M, Arscott WT, Shariati S, Lam J, Akkila S, Behroozian T, Zhang E, Karam I, Chow E. Patient-reported experience with the use of Mepitel Film for prevention of acute radiation dermatitis in breast cancer. Support Care Cancer 2024; 32:89. [PMID: 38190084 DOI: 10.1007/s00520-023-08302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND PURPOSE Mepitel Film (MF) has been demonstrated to reduce the severity of radiation dermatitis (RD) in patients receiving breast cancer radiotherapy (RT). The objective of this study was to characterize patient-reported experience with MF use, including its impact on daily activities and wellbeing. MATERIALS AND METHODS This single-institution study analyzed anonymized responses to a questionnaire completed by patients who used MF for the prevention of RD during breast cancer RT. RESULTS Of the 254 patients contacted, 192 patients completed the survey. Most patients disagreed or strongly disagreed that MF limited their ability to perform their daily activities, including household chores (88%, n = 169/191), their ability to work (83%, n = 157/189), or their ability to sleep (85%, n = 163/191). Furthermore, patients agreed or strongly agreed MF was comfortable on their skin (67%, n = 126/189) and protected their skin from rubbing against clothing (86%, n = 161/188). Some patients agreed or strongly agreed that MF affected their ability to shower (31%, n = 50/162), wear bras (28%, n = 51/185), and impacted their level of pruritus (35%, n = 67/189). However, most patients agreed or strongly agreed that their overall experience with MF was positive (92%, n = 173/189) and would recommend MF to a friend undergoing breast cancer RT (88%, n = 166/188). CONCLUSION MF use is associated with positive patient-reported experience during breast RT with minimal impact on daily activities.
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Affiliation(s)
- Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Samantha Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Patries Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | - Amir H Safavi
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Kimberly Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Rosemary Hill
- Lions Gate Hospital, North Vancouver, British Columbia, Canada
| | - William Tran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Katherine Carothers
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - François Gallant
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Trombetta
- Division of Radiation Oncology, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, PA, USA
| | - William T Arscott
- Division of Radiation Oncology, West Cancer Center, Compass Oncology, Tigard, OR, USA
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jacqueline Lam
- Health Sciences North, Sudbury, ON, Canada
- Sault Area Hospital, Sault Ste. Marie, ON, Canada
| | - Shereen Akkila
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Elwyn Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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6
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Perréard M, Heutte N, Clarisse B, Humbert M, Leconte A, Géry B, Boisserie T, Dadoun N, Martin L, Blanchard D, Babin E, Bastit V. Head and neck cancer patients under radiotherapy undergoing skin application of hydrogel dressing or hyaluronic acid: results from a prospective, randomized study. Support Care Cancer 2023; 32:7. [PMID: 38055076 DOI: 10.1007/s00520-023-08216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Acute radiodermatitis (ARD) is a frequent side effect of radiotherapy, a therapeutic option for head and neck squamous cell carcinoma (HNSCC). It is responsible for pain, quality of life (QoL) impairment, and increased risk of treatment discontinuation, which may compromise the prognosis for patients. Local therapies to prevent or alleviate ARD have been proposed without providing any high level of evidence to establish recommendations. METHODS We implemented a prospective multicenter randomized study on patients with HNSCC treated with definitive radiotherapy to assess the impact on ear, nose, and throat (ENT) pain of the application of a hydrogel-based skin dressing (HydroTac®) compared with the application of hyaluronic acid (Ialuset®) during radiotherapy. RESULTS Out of 130 enrolled patients, 48 patients per group were assessable for the main endpoint. No difference between groups was found: a worsening of ENT pain of 3 points or more on a visual analog scale from the initiation to 1 month after the end of the radiotherapy was observed for 8 patients (16.7%) who received HydroTac® compared to 13 patients (27%) who received Ialuset® (p = 0.342). The proportion of patients who experienced ARD and grades of ARD (CTCAE v4.0 criteria) were similar between groups. Patient compliance with radiodermatitis treatment was poor, with 56.1% of patients in the HydroTac® group having their treatment temporarily stopped. CONCLUSION The application of a hydrogel dressing to prevent ARD during radiotherapy for HNSCC patients has failed to demonstrate a benefit. These results may be limited by the difficulties of applying the dressing.
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Affiliation(s)
- Marion Perréard
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France.
- INSERM, U 1086 "Cancer Et Prévention", Avenue de La Côte de Nacre, Caen, France.
| | - Natacha Heutte
- Department of Clinical Research, Center François Baclesse, Avenue du Général Harris, Caen, France
- CETAPS EA3832, Rouen University, Rouen, France
| | - Bénédicte Clarisse
- Department of Clinical Research, Center François Baclesse, Avenue du Général Harris, Caen, France
| | - Maxime Humbert
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
- INSERM, U 1086 "Cancer Et Prévention", Avenue de La Côte de Nacre, Caen, France
| | - Alexandra Leconte
- Department of Clinical Research, Center François Baclesse, Avenue du Général Harris, Caen, France
| | - Bernard Géry
- Department of Radiotherapy, Center François Baclesse, Avenue du Général Harris, Caen, France
| | - Thomas Boisserie
- Centre d'Oncologie Et de Radiothérapie CORT37, Chambray-Lès-Tours, France
| | | | | | | | - Emmanuel Babin
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
- INSERM, U 1086 "Cancer Et Prévention", Avenue de La Côte de Nacre, Caen, France
| | - Vianney Bastit
- Department of Otolaryngology-Head and Neck Surgery, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
- INSERM, U 1086 "Cancer Et Prévention", Avenue de La Côte de Nacre, Caen, France
- Department of Head and Neck Surgery, Center François Baclesse, Avenue du Général Harris, Caen, France
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Gojsevic M, Akkila S, Kennedy SKF, Herst P, Ogita M, Ye JC, Shariati S, Rajeswaran T, Behroozian T, Lee SF, Chan RJ, Chow E. StrataXRT for the prevention and treatment of radiation dermatitis: a critical review. Support Care Cancer 2023; 31:713. [PMID: 37987843 DOI: 10.1007/s00520-023-08190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The primary objective is to systematically review primary studies, such as randomized control trials (RCTs), feasibility, exploratory, and case studies; and the secondary objective is to evaluate all secondary articles, such as reviews, guidelines, and editorials, relevant to the use of StrataXRT for the prevention and/or management of radiation dermatitis (RD) in cancer patients. METHODS A literature search was conducted up to February 26, 2023, for articles investigating the use of StrataXRT for the prevention and treatment of RD, in the following databases: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. The keywords "StrataXRT", "dermatitis", "radiotherapy", and "radiation" were used to identify relevant articles. RESULTS Twenty-seven articles from 2018 to 2022 were identified to fulfill the inclusion criteria of this review, of which nine are primary studies and 18 are secondary papers. Significant heterogeneity was observed in the current literature studying the effects of StrataXRT, making it difficult to make cross-trial comparisons. There is a suggestion of the efficacy of StrataXRT in the prevention and treatment of RD. CONCLUSION The findings of this review recommend further adequately powered RCTs with robust methodology including patient and clinician assessments to determine the efficacy of StrataXRT in preventing and treating RD. This is essential to improve the quality of life of patients and identify which groups of patients would benefit most from StrataXRT.
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Affiliation(s)
- Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shereen Akkila
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patries Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | - Mami Ogita
- Department of Radiology, the University of Tokyo Hospital, Tokyo, Japan
| | - Jason C Ye
- Department of Radiation Oncology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Raymond J Chan
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
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Dejonckheere CS, Dejonckheere E, Layer JP, Layer K, Sarria GR, Koch D, Abramian A, Kaiser C, Lindner K, Bachmann A, Anzböck T, Röhner F, Schmeel FC, Schmeel LC. Barrier films for the prevention of acute radiation dermatitis in breast cancer: A systematic review and meta-analysis of randomised controlled trials. Breast 2023; 71:31-41. [PMID: 37473629 PMCID: PMC10404536 DOI: 10.1016/j.breast.2023.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE Radiation dermatitis (RD) is the most common side effect of adjuvant whole-breast or chest wall irradiation, majorly impacting quality of life in numerous patients. The use of barrier films (polyurethane dressings such as Hydrofilm® and Mepitel® film remaining on the skin for the duration of the radiation treatment) has been investigated as a prophylactic measure in several prospective trials. Here, we critically appraise the available evidence behind preventive barrier film application in the context of breast cancer treatment. METHODS International literature was reviewed and high-quality randomised controlled trials (RCTs) were included in this meta-analysis. RESULTS The results of 5 RCTs (663 patients; >90% Caucasian) were analysed. Overall, barrier films lead to improved clinician- and patient-reported outcomes: fewer grade ≥2 RD (11% vs. 42%; OR = 0.16; p < 0.001) and moist desquamation (2% vs. 16%; OR = 0.12; p = 0.006), as well as less patient-reported pain (standardised mean difference [SMD] -0.51; p < 0.001), itching (SMD -0.52; p = 0.001), burning (SMD -0.41; p = 0.011), and limitations in daily activities (SMD -0.20; p = 0.007). Furthermore, barrier films have a high acceptance rate among patients, as well as a favourable cost-benefit ratio. Possible side effects due to its application are mild and mostly self-limiting. Overall, there was a lack of information on the radiation treatment techniques used. CONCLUSION The evidence presented in this meta-analysis suggests that barrier films are an excellent tool in the prevention of RD among Caucasian patients receiving whole-breast or chest wall irradiation. Its use should therefore be considered routinely in these patients.
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Affiliation(s)
| | - Egon Dejonckheere
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000, Leuven, Belgium; Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioural Sciences, 5037, Tilburg, the Netherlands
| | - Julian Philipp Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany; Institute of Experimental Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | | | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Alina Abramian
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Christina Kaiser
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Kira Lindner
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Anne Bachmann
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Teresa Anzböck
- Department of Gynaecology, Division of Gynaecological Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Fred Röhner
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany
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Lee SF, Wong HCY, Chan AW, Caini S, Shariati S, Rades D, Chan RJ, Kennedy SKF, Wolf JR, van den Hurk C, Behroozian T, Bonomo P, Ho FCH, Chow E, Herst P. Mepitel Film for the prevention of acute radiation dermatitis in head and neck cancer: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2023; 31:527. [PMID: 37594538 DOI: 10.1007/s00520-023-07988-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE This systematic review and meta-analysis evaluates the efficacy of Mepitel Film in preventing acute radiation dermatitis (RD) in patients with head and neck cancer (HNC) across randomized controlled trials (RCTs). METHODS Embase, MEDLINE, and Cochrane Central Register of Controlled Trials were searched on 5 March 2023 to identify relevant RCTs. RD assessment tools and outcomes were compared across studies. Pooled effect sizes and 95% confidence intervals (CI) were estimated based on random-effects analysis using RevMan 5.4. RESULTS Three RCTs conducted between 2018 and 2020 were included. Mepitel Film decreased RD severity when compared to Sorbolene or Biafine but not when compared to mometasone. A per-protocol analysis of two of the trials revealed that, overall, Mepitel Film significantly reduced the incidence of grade 2-3 RD (odds ratio (OR), 0.24; 95% CI, 0.09-0.65; p = 0.005) and moist desquamation (OR, 0.21; 95% CI, 0.10-0.46; p < 0.0001) and decreased average patient, researcher, and combined components of the Radiation-Induced Skin Reaction Assessment Scale (the standardized mean difference (SMD) for patient ratings, - 2.56; 95% CI, - 3.15 to - 1.96, p < 0.00001; SMD for researcher ratings, - 3.47; 95% CI, - 6.63 to - 0.31, p = 0.03; SMD for combined scores, - 3.68; 95% CI, - 6.43 to - 0.92, p = 0.009). Noted issues with Mepitel Film included itchiness and poor adherence. CONCLUSION While there were discrepancies across studies, Mepitel Film demonstrated a decrease in the incidence of grade 2-3 RD and moist desquamation. These findings emphasize the need for further examining Mepitel Film's efficacy across diverse patient groups and the importance of standardizing RD severity assessment methodologies and control arms.
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Affiliation(s)
- Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, 119228, Singapore.
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong.
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Corina van den Hurk
- Research and Development Department, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Francis C H Ho
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, 119228, Singapore
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patries Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
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10
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Shariati S, Behroozian T, Kennedy S, Caini S, Herst PM, Zhang L, Ding K, Karam I, van den Hurk C, Wolf JR, Lee SF, Wong H, Chan AW, Ogita M, Ye JC, Chan RJ, Gojsevic M, Rajeswaran T, Bonomo P, Chow E. Mepitel film for the prevention and treatment of acute radiation dermatitis in breast cancer: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2023; 31:524. [PMID: 37584828 DOI: 10.1007/s00520-023-07982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the efficacy of Mepitel film in preventing or treating acute radiation dermatitis (RD) in patients with breast cancer in randomized controlled trials (RCTs). METHODS Embase, APA PsychInfo, Journals@Ovid Full Text, Ovid MEDLINE, PubMed, and Cochrane Trials were searched until December 12, 2022, to identify RCTs on the use of Mepitel film for preventing or treating acute RD from breast cancer radiotherapy. Per-protocol analysis was used to compare outcomes, calculate pooled effect sizes, odds ratio (OR), and 95% confidence intervals (CI), and to create forest plots using random effects analysis in RevMan 5.4. RESULTS Three RCTs were included in this review. Mepitel film significantly reduced the incidence of grade 3 RD (OR 0.15 95% CI 0.06, 0.37, p<0.0001) and grade 2 or 3 RD (OR 0.16 95% CI 0.04, 0.65, p=0.01) as scored on either the CTCAE or the RTOG scale. Additionally, Mepitel film significantly reduced RISRAS mean scores assessed by patients and combined researcher and patient (standardized mean difference (SMD) -7.59, 95% CI -14.42, -0.76, p=0.03; SMD -15.36, 95% CI -30.01, -0.71 p=0.04) but not the researcher component of the assessment tool (SMD -17.55, 95% CI -36.94, 1.84, p=0.08). CONCLUSION Mepitel film reduced the incidence of acute RD and improved patient-reported outcomes with minimal side effects, the main one being itchiness. Future research should assess the feasibility of Mepitel film with respect to specific patient-reported outcomes such as health-related quality of life issues associated with its use.
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Affiliation(s)
- Saba Shariati
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Samantha Kennedy
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Patries M Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | | | - Keyue Ding
- Canadian Cancer Trials Division, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Corina van den Hurk
- Research and Development Department, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, New York, USA
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Henry Wong
- Department of Oncology, Princess Margaret Hospital, Hospital Authority, Lai Chi Kok, Hong Kong
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Mami Ogita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Jason C Ye
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Milena Gojsevic
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Thenugaa Rajeswaran
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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11
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Tayyib NA. Prophylactic Use of Mepitel® Film to Prevent Radiation-Induced Moist Desquamation in Cancer Patients. Cureus 2023; 15:e42186. [PMID: 37601988 PMCID: PMC10439668 DOI: 10.7759/cureus.42186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/22/2023] Open
Abstract
Cancer patients had limited treatment options for decades, such as surgery, chemotherapy, and radiation therapy, alone or combined. However, there have been substantial improvements in recent years with the introduction of stem cell therapy, hormone therapy, anti-angiogenic treatments, immunotherapy, dendritic cell-based targeted therapy, ablation therapy, nanoparticles, natural antioxidants, radionics, chemodynamic therapy, sonodynamic therapy, and ferroptosis-based therapy. Radiation therapy, or radiotherapy, is a cancer treatment that employs high doses of radiation to eliminate cancer cells and shrink tumors. This treatment is effective as a primary, adjuvant, or palliative therapy. It is an essential, efficient, cost-effective intervention crucial for providing proper palliative oncology care. Although cancer treatment modalities such as intensity-modulated radiotherapy have advanced, they still risk harming the skin and surrounding healthy tissue. Radiotherapy may induce clinical toxicity leading to chronic or acute radiation dermatitis, depending on the toxicity caused by the therapy. Radiation dermatitis, whether in its chronic or acute form, can cause skin shedding that may result in the formation of wounds. Such shedding can also lead to non-healing ulcers and radionecrosis. Mepitel® film helps control radiation-induced moist desquamation in cancer patients. Clinical trials on the prophylactic use of Mepitel film on radiation-induced moist desquamation did not show similarities among patients from various countries; however, the film-based method is more beneficial than other methods. This review examines the various types of dressings utilized in managing radiation-induced dermatitis to enhance wound healing effectiveness while avoiding harm to newly developing tissues. Additionally, this review compares the effectiveness of using Mepitel film for treating radiation-induced moist desquamation to other methods.
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12
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Behroozian T, Goldshtein D, Ryan Wolf J, van den Hurk C, Finkelstein S, Lam H, Patel P, Kanee L, Lee SF, Chan AW, Wong HCY, Caini S, Mahal S, Kennedy S, Chow E, Bonomo P. MASCC clinical practice guidelines for the prevention and management of acute radiation dermatitis: part 1) systematic review. EClinicalMedicine 2023; 58:101886. [PMID: 37181415 PMCID: PMC10166790 DOI: 10.1016/j.eclinm.2023.101886] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 05/16/2023] Open
Abstract
Acute radiation dermatitis (ARD) commonly develops in cancer patients undergoing radiotherapy and is often characterized by erythema, desquamation, and pain. A systematic review was conducted to summarize the current evidence on interventions for the prevention and management of ARD. Databases were searched from 1946 to September 2020 to identify all original studies that evaluated an intervention for the prevention or management of ARD, with an updated search conducted in January 2023. A total of 235 original studies were included in this review, including 149 randomized controlled trials (RCTs). Most interventions could not be recommended due to a low quality of evidence, lack of supporting evidence, or conflicting findings across multiple trials. Photobiomodulation therapy, Mepitel® film, mometasone furoate, betamethasone, olive oil, and oral enzyme mixtures showed promising results across multiple RCTs. Recommendations could not be made solely based on the published evidence due to limited high-quality evidence. As such, Delphi consensus recommendations will be reported in a separate publication.
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Affiliation(s)
- Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, NY, USA
| | | | | | - Henry Lam
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Partha Patel
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Lauren Kanee
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Henry Chun Yip Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Simran Mahal
- Faculty of Health, University of Waterloo, Ontario, Canada
| | | | - Edward Chow
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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13
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Robijns J, Aquilano M, Banerjee S, Caini S, Wolf JR, van den Hurk C, Beveridge M, Lam H, Bonomo P, Chow E, Behroozian T. Barrier Films and Dressings for the Prevention of Acute Radiation Dermatitis: A Systematic Review and Meta-Analysis. Support Care Cancer 2023; 31:219. [PMID: 36929087 DOI: 10.1007/s00520-023-07671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the efficacy of barrier films and dressings in preventing acute radiation dermatitis (RD). METHODS OVID Medline, Embase, and Cochrane databases were searched from 1946 to September 2020 to identify randomized controlled trials on the use of barrier films or dressings to prevent RD. For comparable outcomes between studies, pooled effect sizes and 95% confidence intervals (CI) were calculated using the random effects analysis in RevMan 5.4. RESULTS Fourteen and 11 studies were included in the qualitative and quantitative analyses, respectively. Five types of barrier films used for RD were identified: Hydrofilm, StrataXRT®, Mepitel® Film, 3 M™ Cavilon™ No-Sting Barrier Film, and silver leaf nylon dressing. Hydrofilm and Mepitel Film significantly reduced the development of RD grade ≥ 2 in breast and head and neck cancer patients (RR 0.32, 95%CI 0.19, 0.56, p < 0.0001; RR 0.21, 95%CI 0.05, 0.89, p = 0.03, resp.). Moreover, Hydrofilm had a beneficial effect on patient-reported outcomes (PROs) (SMD -0.75, 95%CI -1.2, -0.29, p = 0.001). The meta-analyses on the other barrier films did not show any significant effect. CONCLUSION This review and meta-analysis demonstrated that Hydrofilm and Mepitel Film could effectively reduce RD severity and improve PROs. The evidence is generally weak for all the studies on barrier films and dressings due to a limited study number, high risk of bias, small sample sizes, and minimal comparable outcome measures. It's potential has been proven, but future research in this field is recommended to confirm the efficacy of these products and assess real-world feasibility.
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Affiliation(s)
- Jolien Robijns
- Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, Hasselt University, Hasselt, Belgium
| | - Michele Aquilano
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Suvam Banerjee
- Department of Health and Family Welfare, Government of West Bengal, Burdwan Medical College and Hospital, The West Bengal University of Health Sciences, West Bengal, India
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, NY, USA
| | | | - Mara Beveridge
- Department of Dermatology, University Hospitals, Cleveland, OH, USA
| | - Henry Lam
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Edward Chow
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
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14
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Behroozian T, Milton L, Karam I, Zhang L, Ding K, Lou J, Gallant F, Rakovitch E, Tran W, Soliman H, Leung E, Vesprini D, Szumacher E, Chen H, Donovan E, Lam J, Spadafora S, Wronski M, Lavoie C, Walde N, Lam E, Wong G, McKenzie E, Ariello K, Kennedy S, Shariati S, Carothers K, Gonzales G, Kagan Y, Chow E. Mepitel Film for the Prevention of Acute Radiation Dermatitis in Breast Cancer: A Randomized Multicenter Open-Label Phase III Trial. J Clin Oncol 2023; 41:1250-1264. [PMID: 36493331 DOI: 10.1200/jco.22.01873] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Radiation dermatitis (RD) is common in patients undergoing breast radiotherapy. Mepitel film (MF) can reduce RD, but the results from two randomized controlled trials are conflicting. We aimed to conduct a confirmatory randomized controlled trial in patients at risk of RD. METHODS Patients were randomly assigned to receive MF or standard care (2:1 ratio). Patients with large breasts after lumpectomy (bra size ≥ 36 inches or cup size ≥ C) or after mastectomy were eligible. Stratification factors included surgery type, dose fractionation, and administration of boost/bolus. The primary end point was grade (G) 2 or 3 RD using the Common Terminology Criteria for Adverse Events v5.0. Secondary end points included patient- and clinician-reported outcomes. RESULTS Between January 2020 and May 2022, 376 patients were included in the modified intention-to-treat analysis. The incidence of G2 or 3 RD was significantly lower in MF patients compared with standard care (n = 39/251, 15.5%; 95% CI, 11.3 to 20.6% v n = 57/125, 45.6%; 95% CI, 36.7 to 54.8% respectively, odds ratio (OR): 0.20, P < .0001). Benefits of MF remained significant in patients who developed G 3 RD (n = 7, 2.8%; 95% CI, 1.1 to 5.7% v n = 17, 13.6%; 95% CI, 8.1 to 20.9%, OR: 0.19) and moist desquamation (n = 20, 8.0%; 95% CI, 4.9 to 12.0% v n = 24, 19.2%; 95% CI, 12.7 to 27.1%, OR: 0.36). When evaluating the combined patient and health care provider score using Radiation-Induced Skin Reaction Assessment Scale, the MF arm had significantly lower scores (P < .0001). Individual items on the Radiation-Induced Skin Reaction Assessment Scale also favored the MF for both patient- and clinician-reported outcomes. Blistering/peeling, erythema, pigmentation, and edema were significantly reduced in the MF arm. Three patients removed the film prematurely because of rash (n = 2) and excessive pruritus (n = 1). CONCLUSION MF significantly reduces RD in patients undergoing breast radiotherapy.
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Affiliation(s)
- Tara Behroozian
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Milton
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- MacroStat Inc, Department of Biostatistics, Toronto, Ontario, Canada
| | - Keyue Ding
- Canadian Cancer Trials Division, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Julia Lou
- McMaster University, Faculty of Science, Hamilton, Ontario, Canada
| | - François Gallant
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eileen Rakovitch
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - William Tran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hany Soliman
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric Leung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danny Vesprini
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ewa Szumacher
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hanbo Chen
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elysia Donovan
- McMaster University, Faculty of Science, Hamilton, Ontario, Canada
| | - Jacqueline Lam
- Health Sciences North, Department of Radiation Oncology, Sudbury, Ontario, Canada.,Sault Area Hospital, Department of Radiation Oncology, Sault Ste. Marie, Ontario, Canada
| | - Silvana Spadafora
- Sault Area Hospital, Department of Radiation Oncology, Sault Ste. Marie, Ontario, Canada
| | - Matt Wronski
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Chris Lavoie
- Health Sciences North, Department of Radiation Oncology, Sudbury, Ontario, Canada
| | - Natalie Walde
- Sault Area Hospital, Department of Radiation Oncology, Sault Ste. Marie, Ontario, Canada
| | - Emily Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gina Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erin McKenzie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Krista Ariello
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Carothers
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Glen Gonzales
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yulya Kagan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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15
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Modern Dressings in Prevention and Therapy of Acute and Chronic Radiation Dermatitis—A Literature Review. Pharmaceutics 2022; 14:pharmaceutics14061204. [PMID: 35745777 PMCID: PMC9229675 DOI: 10.3390/pharmaceutics14061204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Radiotherapy is an integral part of modern oncology, applied to more than half of all patients diagnosed with cancer. It can be used alone or in combination with surgery or chemotherapy. However, despite the high precision of radiation delivery, irradiation may affect surrounding healthy tissues leading to the development of toxicity. The most common and clinically significant toxicity of radiotherapy is acute and chronic radiation dermatitis, which could result in desquamation, wounds, nonhealing ulcers, and radionecrosis. Moreover, preoperative radiotherapy impairs wound healing after surgery and may lead to severe wound complications. In this review, we comprehensively discuss available types of dressings used in the management of acute and chronic radiation dermatitis and address their efficacy. The most effective ways of preventing acute radiation dermatitis are film dressings, whereas foam dressings were found effective in its treatment. Data regarding dressings in chronic radiation dermatitis are scarce. This manuscript also contains authors’ consensus.
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16
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Management of Acute Radiodermatitis in Non-Melanoma Skin Cancer Patients Using Electrospun Nanofibrous Patches Loaded with Pinus halepensis Bark Extract. Cancers (Basel) 2021; 13:cancers13112596. [PMID: 34073193 PMCID: PMC8199239 DOI: 10.3390/cancers13112596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary The most frequent adverse effect for patients receiving radiotherapy, an effective treatment for skin cancer when surgical removal of the tumor is impossible, is acute radiodermatitis, affecting patients’ physical function and often leading to therapy termination. Creams and other topical formulations used so far for the prevention of acute radiodermatitis are applied at regular intervals but do not ensure a constant and controlled transepidermal absorption. The aqueous extract of Aleppo pine bark, previously preclinically and clinically assessed in the form of gel, was herein loaded on micro/nanofibrous patches and clinically evaluated in comparison with a commercially used reference cream on non-melanoma skin carcinoma patients undergoing radiotherapy. The experimental patch significantly contributed to prophylaxis and successful management of acute radiodermatitis, safely restoring skin and its biophysical parameters to normal levels and reducing patients’ discomfort. Topical application of pine-loaded micro/nanofibrous patches holds great potential for the development of a new generation of anti-inflammatory skin care dressings against radiodermatitis. Abstract Acute radiodermatitis is the most common side effect in non-melanoma skin cancer patients undergoing radiotherapy. Nonetheless, despite the ongoing progress of clinical trials, no effective regimen has been found yet. In this study, a non-woven patch, comprised of electrospun polymeric micro/nanofibers loaded with an aqueous extract of Pinus halepensis bark (PHBE), was fabricated and clinically tested for its efficacy to prevent radiodermatitis. The bioactivity of the PHBE patch was evaluated in comparison with a medical cream indicated for acute radiodermatitis. Twelve volunteer patients were selected and randomly assigned to two groups, applying either the PHBE patch or the reference cream daily. Evaluation of radiation-induced skin reactions was performed during the radiotherapy period and 1 month afterwards according to the Radiation Therapy Oncology Group (RTOG) grading scale, photo-documentation, patient-reported outcomes (Visual Analog Scale, questionnaire), biophysical measurements (hydration, transepidermal water loss, erythema, melanin), and image analysis. In contrast with the reference product, the PHBE patch showed significant anti-inflammatory activity and restored most skin parameters to normal levels 1 month after completion of radiation therapy. No adverse event was reported, indicating that the application of the PHBE patch can be considered as a safe medical device for prophylactic radiodermatitis treatment.
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17
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Delishaj D, D'amico R, Corvi D, De Nobili G, Alghisi A, Colangelo F, Cocchi A, Declich F, Soatti CP. Management of grade 3 acute dermatitis with moist desquamation after adjuvant chest wall radiotherapy: a case report. Radiat Oncol J 2020; 38:287-290. [PMID: 33389984 PMCID: PMC7785838 DOI: 10.3857/roj.2020.00983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 11/03/2022] Open
Abstract
We reported a successful case management of G3 skin acute dermatitis in a 32-year-old woman affected by locally advanced breast cancer underwent adjuvant chest wall irradiation. Skin acute toxicity with dry desquamation areas was treated daily with dressing medication using physiological solution, oxygen therapy and applying hyaluronic acid gauze. At the end of radiotherapy treatment, G3 skin acute dermatitis with moist desquamation was observed, so the patient continued advanced wound dressing shifted to twice weekly with physiological solution, oxygen therapy and applying hydrocolloid dressing. The patient completed radiotherapy treatment without interruption and one month after treatment acute skin toxicity was resolved with pain relief. We suggest that advanced dressing with trained nursing staff is essential in this sub-set of patients due to guaranteed continuation of radiotherapy treatment, indispensable to ensure patient cure.
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Affiliation(s)
- Durim Delishaj
- Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Romerai D'amico
- Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Daniela Corvi
- Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Giuseppe De Nobili
- Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Alessandro Alghisi
- Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Francesco Colangelo
- Department of Radiation Oncology, University of Milano Bicocca, Milan, Italy
| | - Alessandra Cocchi
- Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Fausto Declich
- Medical Physics Unit, Alessandro Manzoni Hospital, Lecco, Italy
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Rose P. Radiation-induced skin toxicity: prophylaxis or management? J Med Radiat Sci 2020; 67:168-169. [PMID: 32822520 PMCID: PMC7476184 DOI: 10.1002/jmrs.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022] Open
Abstract
This editorial aims to provide context for changing skin care interventions for radiation-induced skin toxicities over several decades.
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Affiliation(s)
- Pauline Rose
- Radiation Oncology Raymond Terrace CentrePrincess Alexandra HospitalBrisbaneQueenslandAustralia
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