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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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Guangmei D, Weishan H, Wenya L, Fasheng W, Jibing C. Evolution of radiation-induced dermatitis treatment. Clin Transl Oncol 2024:10.1007/s12094-024-03460-1. [PMID: 38594379 DOI: 10.1007/s12094-024-03460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/09/2024] [Indexed: 04/11/2024]
Abstract
Radiation-induced skin damage (RID) is the most prevalent, significant side effect of radiotherapy (RT). Nearly 95% of patients experience moderate to severe skin reactions after receiving radiation therapy. However, criteria for acute radiation dermatitis (ARD) treatment remain unavailable. Topical agents with anti-inflammatory properties may protect the skin and facilitate tissue regeneration in patients with RID. Many of these topical agents function through nuclear factor kappa B pathway regulation. They either reduce the levels of inflammatory factors or elicit anti-inflammatory properties of their own, thus preventing oxidative stress and inflammatory responses and thus enabling RID prevention and management. Herein, we explore the 25 topical agents investigated for RID prevention and management thus far and evaluate their mechanisms of action. These agents include 11 natural agents, 3 miscellaneous agents, 9 topical nonsteroidal agents, and 2 topical corticosteroids.
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Affiliation(s)
- Deng Guangmei
- Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - He Weishan
- Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Liu Wenya
- Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Wu Fasheng
- Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi, China.
| | - Chen Jibing
- Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi, China.
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Chang HC, Huang WY, Chen PH, Huang TW, Gautama MSN. Effectiveness of glutamine for the treatment of radiodermatitis in cancer patients: a meta-analysis of randomized controlled trials. Support Care Cancer 2024; 32:201. [PMID: 38427125 DOI: 10.1007/s00520-024-08411-8] [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: 10/08/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND After receiving radiation therapy, 60%-95% of patients with cancer develop radiodermatitis, which causes pain, wound infection, and poor quality of life. Glutamine is a popular nutritional supplement for patients with cancer. Several studies examined the usefulness of glutamine for reducing radiodermatitis. However, there is still no consolidated evidence for clinical use. METHODS We searched PubMed, Embase, Cochrane Library, CINAHL PLUS, and the China Knowledge Resource Integrated Database for the relevant literature published up to March 2023, without language restrictions. Two reviewers screened, filtered, and appraised these articles independently, and their data were pooled using a random-effects model. RESULTS Five randomized controlled trials (RCTs) with 218 participants were analyzed. The incidence of radiodermatitis in the glutamine group (89/110) was significantly lower than in the placebo group (99/108; risk ratio [RR], 0.90; 95% CI, 0.81-1.00; p = 0.05; I2 = 7%). The incidence of moderate to severe radiodermatitis was significantly lower in the glutamine group than in the placebo group (RR, 0.49; 95% CI, 0.32-0.76; p = 0.001; I2 = 52%). Moreover, subgroup analysis demonstrated heterogeneity (I2 = 52%) for moderate to severe radiodermatitis, the risk of which might be significantly reduced by a glutamine dose of 20-30 g/day (RR, 0.60; 95% CI, 0.41-0.87; I2 = 0%). CONCLUSION The meta-analysis indicate that glutamine might lead to a lower incidence of radiodermatitis, and that a glutamine dose of 20-30 g/day might decrease the incidence of moderate to severe dermatitis. Thus, the serious impact of radiodermatitis on treatment follow-up makes the clinical use of glutamine even more important. PROSPERO number: CRD42021254394.
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Affiliation(s)
- Hsu-Chieh Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Tri-Service General Hospital Beitou Branch, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Wei Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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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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Robijns J, Van Bever L, Hermans S, Claes M, Lodewijckx J, Lenaerts M, Tuts L, Vandaele E, Vinken E, Noé L, Verboven K, Maes A, Van de Velde AS, Bulens P, Bulens P, Van den Bergh L, Mebis J. A novel, multi-active emollient for the prevention of acute radiation dermatitis in breast cancer patients: a randomized clinical trial. Support Care Cancer 2023; 31:625. [PMID: 37819539 DOI: 10.1007/s00520-023-08096-5] [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: 08/29/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To investigate the efficacy of a novel, multi-active emollient in preventing and managing acute radiation dermatitis (ARD) in breast cancer patients undergoing moderate hypofractionated (HF) radiotherapy (RT) compared to standard of care. METHODSA A monocentric, open-label, randomized clinical trial (RCT) with breast cancer patients receiving moderate HF (dose: 40.05-55.86 Gy, fractions: 15-21) was conducted between January 2022 and May 2023. The experimental group received the novel emollient, while the control group received the standard skin care. Patients applied the skin care products twice daily during the complete RT course. The primary outcome was the severity of ARD at the final RT session measured by the modified Radiation Therapy Oncology Group (RTOG) criteria. Secondary outcomes included patient symptoms, quality of life (QoL), and treatment satisfaction. RESULTS A total of 100 patients with 50 patients per group were enrolled. In the control group, 50% of the patients developed RTOG grade 1 ARD and 48% grade 2 or higher, while in the experimental group, the severity of ARD was significantly lower with 82% grade 1 and 16% grade 2 ARD (P = .013, χ2-test). The frequency and severity of xerosis were significantly lower in the experimental compared to the control group (Ps ≤ .036, Mann Whiney U test). The impact of ARD on the QoL was low, and treatment satisfaction was high in both groups, with no significant difference. CONCLUSION This RCT shows that the novel, multi-active emollient significantly reduced the ARD RTOG grade. Research in a more diverse patient population is warranted. TRIAL REGISTRATION ClinicalTrials.gov: NCT04929808 (11/06/2021).
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Affiliation(s)
- Jolien Robijns
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium.
- Dept. Oncology and Dept, Jessa & Science, LCRC, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium.
| | - Leen Van Bever
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Sanne Hermans
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Marithé Claes
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Dept. Oncology and Dept, Jessa & Science, LCRC, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - Joy Lodewijckx
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Dept. Oncology and Dept, Jessa & Science, LCRC, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - Melissa Lenaerts
- Department of Surgery GROW School for Oncology & Reproduction, Maastricht University, Universiteitssingel 50, 6229ER, Maastricht, The Netherlands
| | - Laura Tuts
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
| | - Eline Vandaele
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
| | - Evelien Vinken
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Leen Noé
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Katleen Verboven
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Annelies Maes
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Anne-Sophie Van de Velde
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Paul Bulens
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Philippe Bulens
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Laura Van den Bergh
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Jeroen Mebis
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Dept. Oncology and Dept, Jessa & Science, LCRC, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Radiotherapy - Limburg Oncology Center, Jessa Hospital - Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium
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Bonomo P, Wolf JR. Shedding light on the management of acute radiation dermatitis: insight from the MASCC Oncodermatology study group. Support Care Cancer 2023; 31:568. [PMID: 37695382 DOI: 10.1007/s00520-023-08011-y] [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: 05/05/2023] [Accepted: 06/05/2023] [Indexed: 09/12/2023]
Abstract
This paper highlights a collection of eleven recently published manuscripts on the prevention and management of acute radiation dermatitis. These meta-analyses provide additional evidence for the updated clinical practice guidelines by the Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology study group for prevention and management of acute radiation dermatitis. The collection of papers elucidate the currently available evidence on acute radiation dermatitis, highlighting consolidated knowledge, effective treatments, and proposed areas for future clinical trials. Overall, a total of 51 randomized controlled trials were retrieved and included for quantitative analysis of an initial systematic review of literature from 1946 to January 2023. Discussion of the clinical impact of various therapeutic interventions include: antiperspirant and deodorant use, barrier films and dressings, natural and miscellaneous agents, photobiomodulation therapy, topical corticosteroids, topical non-steroidal agents, skin hygiene and washing, as well as StrataXRT and Mepitel film in breast cancer patients. The comprehensive nature of the meta-analyses and their related findings may help reduce the discrepancies in in treatment of acute radiation dermatitis and facilitate consistency of therapeutic interventions employed in clinical practice worldwide.
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Affiliation(s)
- Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Julie Ryan Wolf
- Departments of Dermatology & Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA.
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Racadot S, Arnaud A, Schiffler C, Metzger S, Pérol D, Kirova Y. Cicaderma® in radiation-related dermatitis of breast cancer: Results from the multicentric randomised phase III CICA-RT. Clin Transl Radiat Oncol 2023; 41:100647. [PMID: 37441546 PMCID: PMC10334129 DOI: 10.1016/j.ctro.2023.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 07/15/2023] Open
Abstract
Background and purpose To prevent the occurrence of grade ≥ 2 radiodermatitis after post-operative breast irradiation in patients with non metastatic breast cancer. Methods This prospective randomised open-label multicenter study allocated patients from 3 French institutions, ≥18 years, requiring postoperative radiotherapy for histologically proven, early-stage (non-metastatic) unilateral breast adenocarcinoma or in situ breast cancer, with R0 or R1 post-operative status, to receive hygiene rules, associated with either Cicaderma® (Arm A), or preventive treatment according to the investigator preference (mainly hyaluronic acid (ialuset®), essential oils, or water spray, or no medication (Arm B). The primary outcome was to compare the efficacy of Cicaderma® versus local standard management in preventing the occurrence of grade ≥ 2 radiodermatitis. Main secondary objectives include Cicaderma® impact on radiotherapy discontinuation and on skin toxicity (pruritus), pain, quality of life, satisfaction. Results The CICA-RT study enrolled from June 2020 to April 2021, 258 women with a median age of 61 (22-91) years in 3 institutions. Patients received either Cicaderma® (A: N = 130) or standard practice (B: N = 128). In the 123 patients who initiated radiotherapy in each arm, 95 (77%, 95%CI 68.8%-84.3%) patients did not develop grade ≥ 2 dermatitis. Sensitivity and per-protocol analyses confirmed the absence of differences between arms. Conclusion This prospective study did not meet its primary endpoint of superiority of Cicaderma® over routine practice skin care in terms of prevention of acute radioinduced dermatitis of grade 2 or higher. However, Cicaderma® showed a significant decrease in the occurrence of pruritus with less patients reporting at least once grade ≥ 2 pruritus (A: N = 38, 31%; B: N = 58, 47%; p = 0.009).ClinicalTrials.gov identifier NCT04300829.
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Affiliation(s)
| | - Antoine Arnaud
- Radiotherapy Department, Institut Sainte-Catherine, Avignon, France
| | - Camille Schiffler
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Séverine Metzger
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - David Pérol
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Youlia Kirova
- Radiotherapy Department, Institut Curie, Paris, France
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