Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidelines for the prevention and management of acute radiation dermatitis: international Delphi consensus-based recommendations

Effect of an herbal gel for the prevention of radiation dermatitis-related symptoms: an open-label randomized clinical trial

PURPOSE OF THE STUDY

Radiation-induced dermatitis (RID) is the most frequent side effect of radiotherapy; however, no effective treatments are currently available. This study investigated the efficacy and safety of an herbal gel for preventing RID and associated symptoms in patients with cancer.

MATERIALS AND METHODS

Cancer patients were randomly assigned 1:1 in an open-label randomized clinical trial. Patients in the prophylactic group received preventative herbal gel treatment (one day before radiotherapy). Patients in the interventional group received herbal gel treatment (upon the development of grade 2 RID). Outcome measures were scored according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer. Patient-reported skin symptoms (Skindex-16), quality of life (QLQ-C30), and adverse effects (CTCAE V4.0) were investigated.

RESULTS

Among 71 participants, the prophylactic group showed significant relief with a medium effect size for itching, hurting, and burning or stinging (p < .05, effect size >0.5) compared to the interventional group. No statistically significant difference in the incidence of RID was found (51% in the prophylactic group vs. 53% in the interventional group, p = .91). The prophylactic application of the gel did not affect patient quality of life. No adverse reactions associated with the gel were observed.

CONCLUSIONS

Preventative herbal gel treatment can alleviate the radiation dermatitis-related symptoms with good safety, which indicates that gel could be an option for integration in patient care to improve RT in patients with breast, lung, and head and neck cancers.

Modified Delphi Consensus on Interventions for Acute Radiation Dermatitis in Breast Cancer: A Canadian Expert Perspective

PURPOSE

Acute radiation dermatitis (ARD) is a prevalent adverse effect of radiotherapy in patients with breast cancer, and there is a lack of high-quality data regarding its prevention and management. This study employs a systematic and iterative process to compile the perspectives of Canadian radiation oncology, nursing, and dermatology experts, aiming to establish consensus-based recommendations for the prevention and management of ARD in breast cancer patients.

METHODS AND MATERIALS

A modified Delphi consensus was conducted with the participation of 19 experts from across Canada. The process involved a systematic review of existing literature on the prevention and treatment of ARD in breast cancer, from January 1946 to September 2023. After review of the literature, participants first provided their opinions on the strength and quality of the evidence for the identified interventions. A second round assessed the degree to which the interventions would be recommended in either low- and/or high-risk settings. Two more rounds consolidated consensus.

RESULTS

After the four rounds, consensus for recommendation was reached for 3 prevention interventions in both low- and high-risk patients: prevention care education, moisturizing, and washing. For high-risk settings, 2 additional prevention interventions reached consensus: Mepitel Film and mometasone furoate. With regards to the management of ARD, there was consensus for recommendation of Mepilex Lite, betamethasone valerate, mometasone furoate, saline soaks/cold compresses and barrier creams.

CONCLUSIONS

This pan-Canadian modified Delphi consensus provides expert-reviewed and evidence-based recommendations for interventions to prevent and manage acute radiation dermatitis in patients with breast cancer. The endorsed interventions offer valuable guidance for clinicians and their patients, highlighting areas where consensus among experts has been achieved.

Association of Multi-Kingdom Skin Microbiota With Radiation Dermatitis in Patients With Breast Cancer After Reconstructive Surgery: A Prospective, Longitudinal Study

BACKGROUND

The clinical significance of multi-kingdom skin microbiota in acute radiation dermatitis (ARD) is not well understood. We hypothesized that skin microbiota is associated with ARD in patients with breast cancer (BC) undergoing radiation therapy (RT) after reconstructive surgery.

METHODS AND MATERIALS

A total of 412 skin microbiota samples from 103 patients, taken before and after RT, from both the treated and contralateral healthy sides, were analyzed using bacterial 16S ribosomal RNA (rRNA) V3-V4 region and fungal rRNA internal transcribed spacer (ITS) sequencing. ARD was graded using the Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG). Patients were divided into 2 groups: no or mild ARD subgroup (N_MD, RTOG grade 0-1) and significant ARD subgroup (SD, RTOG grade ≥ 2).

RESULTS

Significant differences in skin microbiota were observed between the N_MD and SD subgroups, with Staphylococcus, Cutibacterium, and Malassezia genera enriched in SD and Ralstonia and Methyloversatilis enriched in N_MD. Network analysis revealed that interkingdom and intrakingdom ecological interactions were more notable and stable in N_MD than SD over the course of RT. Importantly, 2 dermotypes with robust patterns of microbial networks were identified, with the "D-dermotype" (highly diversified and dominated by Devosiaceae) composing entirely of N_MD. Dermatitis-prediction classifiers were constructed. Classifiers I and III, which included bacterial variables with or without fungal variables, performed significantly better than classifier II, which relied solely on fungal variables. Bacteria-based classifier I yielded the best area under the curve in the test set of 94.64% (95% confidence interval, 83.58%-100%).

CONCLUSIONS

This prospective longitudinal study indicated an association between multi-kingdom skin microbiota and the development of significant ARD in patients with BC undergoing RT after reconstructive surgery, implying the possible application of skin microbiota in the prediction of ARD and microbial therapy in the management of ARD.

Mepitel® film versus standard care for the prevention of skin toxicity in breast cancer patients treated with adjuvant radiotherapy: A randomized controlled trial

Background & purpose

Radiotherapy plays a key role in breast cancer treatment however, radiation-induced dermatitis can impact on treatment delivery and patient quality of life.The primary outcome was to compare Mepitel® Film versus standard treatment in preventing radiotherapy skin toxicity onset.

Methods

A multicentre randomised controlled phase III study compared standard treatment (aqueous-urea cream - Excipial U hydrolotion applied at the beginning of radiotherapy and antiseptic cream - Flammazine or Ialugen Plus applied at the onset of moist desquamation) versus Mepitel® Film in patients with breast cancer undergoing post-operative radiotherapy. The primary outcome was the proportion of moist desquamation (RTOG score ≥ 2) in the experimental and control groups.

Results

During the study (2016-2020), 161 patients were randomized, 154 (95.7 %) were evaluable. Skin toxicity Radiation Therapy Oncology Group (RTOG) score ≥ 2 was observed in 9.5 % and 13.9 % of experimental and control groups respectively (Relative Risk = 0.68, 95 %CI 0.28-1.66; p = 0.393). RTOG scores > 0 were 90.5 % and 94.9 % in experimental and control groups respectively (Relative Risk = 0.95, 95 %CI 0.87-1.04; p = 0.294).Multivariable analysis, controlled for age, diabetes, BMI and smoking exposure, showed a risk reduction of RTOG > 0 of 38 % (HR = 0.62 95 %CI 0.49-0.96, p = 0.028), and a risk reduction of RTOG > 1 of 33 % (HR = 0.67 95 %CI 0.26-1.76, p = 0.420) in the experimental group.The median time to recovery from RTOG grade > 0 toxicity was 17 and 32 days for experimental and control groups, respectively (p = 0.027). At multivariable analysis, time to recovery was 38 % faster in the experimental group (HR = 1.38 95 %CI (0.99-1.93) p = 0.059).

Conclusions

Although the study did not demonstrate a statistically significant reduction in RTOG > 2 skin toxicity, there was evidence of a reduction in the rate of skin toxicity and an improvement in time to recovery. The device was well tolerated by patients.

New trends in supportive care of head and neck cancers

PURPOSE OF REVIEW

Supportive care plays a vital role in the management of head and neck cancer (HNC) patients, as the disease often affects a frail and older population that is treated with multiple strategies and is associated with severe symptoms. We will focus on mucositis, dermatitis, dysphagia, pain, cachexia, and infections, as they are among the most common and challenging symptoms encountered.

RECENT FINDINGS

Efforts have focused on multiomics approaches to decipher the complex biological pathways that drive symptom onset and treatment-related toxicities, with the aim of developing novel therapeutic strategies. A notable example is ponsegromab, a monoclonal antibody designed to target cancer cachexia. Other promising areas of research, such as machine-learning models and the role of oral and gut microbiota on cachexia and mucositis, are actively being explored; however, their impact to date remains limited.

SUMMARY

In recent years, new knowledge has emerged regarding the underlying causes and predictive models for the supportive care of HNC patients. Unfortunately, this expanding body of knowledge primarily adds to complexity without translating into practical applications or substantial improvements for patients. Future efforts should prioritize the standardization of therapeutic algorithms, and the generation of robust evidence based on existing preclinical models.

Efficacy and safety of hyperbaric oxygen therapy for radiation-induced dermatitis in patients with breast cancer: a randomized pilot study

PURPOSE

Radiation-induced dermatitis (RID) is a common adverse effect of adjuvant radiotherapy in patients with breast cancer, often leading to discomfort and reduced quality of life. Hyperbaric oxygen therapy (HBOT) has been proposed as a potential intervention to mitigate RID, but its efficacy remains uncertain. This pilot study aimed to assess the feasibility, safety, and preliminary efficacy of HBOT in reducing RID severity.

METHODS

This single-institution, randomized, controlled pilot study included 30 patients undergoing adjuvant radiotherapy for breast cancer. Participants were assigned to either HBOT (100% oxygen at 1.5 atmospheres absolute, 30 min per session, three times per week, for 7 weeks) or standard care. The primary outcome was to determine whether HBOT reduces the incidence of grade 2 or higher RID, based on Radiation Therapy Oncology Group criteria. Secondary outcomes included the Skindex-29, Catterall Skin Scoring Profile, Numeric Rating Scale (NRS), and EORTC QLQ Core Questionnaire-C30 scores.

RESULTS

Twenty-five patients completed the study. The incidence of grade 2 or higher RID was 73.3% in both the HBOT and control groups, with no significant difference (p = 0.700). No statistically significant differences were observed in primary or secondary endpoints. Trends toward lower skin-related discomfort and improved patient-reported outcomes in the HBOT group were noted but did not reach statistical significance. HBOT was well tolerated, with no serious adverse events reported.

CONCLUSION

This pilot study did not demonstrate a significant reduction in RID severity with HBOT. However, the therapy was safe and well tolerated, with potential benefits in patient comfort and quality of life. Larger trials with optimized HBOT protocols are needed to clarify its role in RID management. Trial Registration Number and the date of registration: NCT06158347 (28/11/2023) and KCT0009847 (15/10/2024).

Research trends and hot spots in the prevention and management of radiation dermatitis: a bibliometric analysis based on CiteSpace

OBJECTIVE

This study sought to examine the current state and explore the key areas and emerging trends in radiation dermatitis prevention and management through bibliometric analysis, with the goal of providing valuable insights for future research endeavors.

METHODS

This study analyzed all publications on radiation dermatitis prevention and management from the Web of Science (WOS) core database up to 2024. The CiteSpace software was utilized to visualize authors, countries/regions, publishing institutions, keywords, co-cited documents, hot spots, and research frontiers.

RESULTS

A total of 459 articles (1995-2024) were identified, with the overall number of publications demonstrating an increasing trend. The United States (125) produced the highest number of publications, followed by China (73) and Canada (45). Key research topics encompass breast cancer, head and neck cancer, acute radiation dermatitis, and radiation recall dermatitis. Double-blind clinical trials constitute the primary research methodology. The main research areas in this field focus on the role of radiotherapy dose fractionation modalities, atmospheric pressure cold plasma, hyperbaric oxygen therapy (HBOT), aloe vera, biomodulation therapy, and biological dressings in the prevention and management of radiation dermatitis.

CONCLUSION

This comprehensive bibliometric analysis reveals that risk prediction, assessment tools, and the efficacy of radiodermatitis are prominent research topics in the field. These areas are currently experiencing rapid growth and warrant further attention from researchers.

Bibliometric analysis and visualization of research trends in radiation dermatitis in the past twenty years

OBJECTIVES

This study aims to explore the most influential countries/regions, institutions, journals, authors, keywords, and trends in the study of the mechanism and treatments of radiation dermatitis (RD) from 2003 to 2023 using bibliometric analysis.

METHODS

The literature associated with RD was retrieved from the Web of Science Core Collection, only articles and reviews in English were included. Individual articles were reviewed to identify the authorship, published journal, journal impact factor, institution and country of origin, and year of publication.

RESULTS

A total of 6,453 authors from 1,605 institutions in 64 countries/regions published 1,062 RD-related literature. The United States was the most productive country. The Unicancer in France was the institution that published the majority of articles on RD. Edward Chow was the most productive author and Supportive Care in Cancer contributed the most articles. Advanced head and neck cancer is the most common cause of RD. The mechanism research mainly focused on nitric oxide, oxidative stress, and apoptosis in recent years, and Mepitel film, Mepilex Lite, and PBMT were the main preventive and therapeutic measures for RD.

CONCLUSION

Our bibliometric studies provide a thorough overview of RD and valuable insights and ideas for scholars in this discipline.

Mepitel Film Versus StrataXRT in Managing Radiation Dermatitis in an Intra-Patient Controlled Clinical Trial of 80 Postmastectomy Patients

BACKGROUND

Mepitel film decreases the severity of radiation dermatitis in breast cancer patients, but its application is resource-intensive. Many departments therefore use StrataXRT, a gel that patients apply themselves. We compared the protective effects of Mepitel film and StrataXRT on radiation dermatitis during and immediately after radiation therapy.

METHODS

This phase III multicentre randomised intra-patient-controlled clinical trial recruited breast cancer patients receiving radiation therapy following mastectomy in three New Zealand Hospitals. Lateral and medial aspects of the chest wall were randomised to either Mepitel film or StrataXRT. Overall skin reaction severity was measured using RISRAS and RTOG once a week during treatment and for 4 weeks after treatment completion. The primary outcome was moist desquamation (with a non-inferiority margin of 7.5%); secondary outcomes were overall skin reaction severity, patient tolerability, satisfaction and cost.

RESULTS

Between June 2021 and May 2024, 93 patients were recruited, and 80 patients completed the trial. The absolute difference in moist desquamation rates was 6% lower under Mepitel film (p = 0.413, 95% CI -5%, 18%). Overall skin reaction severity was significantly lower for Mepitel film (Researcher RISRAS: p = 0.022; RTOG: p = 0.011). Mepitel film was cheaper to apply but was less well tolerated, with poor skin adherence being an issue for many patients.

CONCLUSION

The study did not show non-inferiority for StrataXRT; overall skin reaction severity and costs were significantly lower under Mepitel film; however, StrataXRT was better tolerated.

TRIAL REGISTRATION

ACTRN12621000124831.

StrataXRT and Mepitel Film for Preventing Postmastectomy Acute Radiation Dermatitis in Breast Cancer: An Intrapatient Noninferiority Randomized Clinical Trial

PURPOSE

Acute radiation dermatitis (ARD) is a notable challenge for patients with breast cancer undergoing postmastectomy radiation therapy (RT). This study evaluates the efficacy, safety, and user experience of StrataXRT versus Mepitel Film for ARD prevention.

METHODS AND MATERIALS

This multicenter, noninferiority trial involved intrapatient randomization of 44 patients with histologically confirmed breast carcinoma who had undergone postmastectomy RT across 4 Australian hospitals from January 1 to December 31, 2017. Patients were randomly assigned to receive Mepitel Film and StrataXRT on alternate halves of the irradiated chest wall. Mepitel Film was applied by nurses and replaced every 1 to 2 weeks or as necessary, ensuring continuous coverage throughout RT. Conversely, patients self-applied StrataXRT daily to the opposite half, with adherence details recorded in patient diaries. The primary outcome was the mean difference in the time-weighted average (TWA) grade of ARD within designated rectangles in each half over 10 weeks from the commencement of RT.

RESULTS

Forty patients were analyzed per-protocol. Measurements using thermoluminescent dosimeters showed no significant dose differences between medial and lateral rectangles. StrataXRT was inferior to Mepitel Film in the primary outcome, with a mean difference in TWA grade of 0.19 (95% confidence interval, 0.12-0.26; P < .001). Secondary outcomes-mean difference in TWA grade in chest wall halves, worst ARD grade, and incidence of moist desquamation-showed noninferiority between treatments. Patient preferences were closely matched, with 37.5% favoring StrataXRT and 40% Mepitel Film. StrataXRT caused itching in 1 patient and Mepitel Film in 3, leading to 1 removal.

CONCLUSIONS

Although StrataXRT did not meet the noninferiority threshold in the primary outcome and is considered inferior, its ease of application and patient acceptance suggest that it may still be offered for ARD prevention in postmastectomy RT when Mepitel Film is not a practical option. Open discussion with patients and caregivers is recommended to determine the most appropriate skin protection agent, considering both efficacy and practicality.

Practical recommendations for the management of radiodermatitis: on behalf of the ESTRO RTT committee

BACKGROUND

There is a substantial body of literature addressing the prevention, acute management, and follow-up care of radiation induced dermatitis (RID). The quality and application of this evidence, however, is inconsistent and its interpretation varies widely. While several national guidelines have been developed to standardise practices locally, many of these resources are not publicly available. On behalf of the European Society for Radiotherapy and Oncology (ESTRO) Radiation Therapist (RTT) Committee, an international writing group consisting of 12 experts from radiotherapy and two patient representatives composed a recommendation document for the management of RID.

MAIN BODY

The consensus for these recommendations was generated based on available international guidelines, and supplemented with evidence-based review articles on the topic. These recommendations focus on the prevention and practical management of early stage RID by avoiding skin trauma and maintaining hygiene. Addressing pain and inflammation in higher grades is also covered. The current literature refutes some of the traditional recommendations, especially restricting washing as well as the use of deodorant or the potential dose build-up of lotions which has been included and rectified in recent guidelines. In addition, the importance of grading the severity, including a baseline assessment is presented. The benefit of clear, and non-contradictory communication within the multidisciplinary team as well as patient involvement (e.g. PROMs or similar) is highlighted. Furthermore, the importance of recognising different skin types and skin tones, and the impact on how RID changes these in their appearance is stressed.

CONCLUSION

This document provides practical, actionable recommendations for the clinical management of RID, referencing the supporting literature. These recommendations have, however, identified a lack of high-level evidence, especially for agent-specific recommendations.

Non-invasive physical plasma for preventing radiation dermatitis in breast cancer: study protocol for a phase 3 randomised double-blind placebo-controlled trial (NIPP-RD III)

BACKGROUND

Radiation dermatitis (RD) is the most common side effect of breast irradiation, yet only few potent preventative and therapeutic options are available. Following encouraging results from a phase 1 and 2 trial on the topical use of non-invasive physical plasma (NIPP), a very well-tolerated physical treatment option to promote tissue regeneration generated from ambient air, we now present the study protocol for a planned phase 3 trial.

METHODS

In this randomised double-blind placebo-controlled trial, patients with breast cancer will be randomised (1:1) to receive either 120 s of NIPP or sham treatment with an identical device daily during hypofractionated breast irradiation following breast-conserving surgery. Standard skin care with urea lotion will be applied twice daily to the whole breast by all patients. Acute skin toxicity will be assessed weekly and includes clinician- (CTCAE v5.0) and patient-reported (modified RISRAS), and objective (spectrophotometry) assessments. The trial has started enrolment in the first quarter of 2024 and is projected to recruit 140 patients over 36 months.

DISCUSSION

This randomised controlled trial will recruit a homogeneous patient collective in terms of RD risk and aims to unequivocally establish the impact of NIPP on RD by employing a robust trial design, incorporating both the patient's perspective and validated objective outcome measures. If the addition of NIPP proves useful, it might reduce both physical and psychological distress caused by RD in numerous breast cancer patients and beyond.

TRIAL REGISTRATION

German Clinical Trial Registry DRKS00032560 (January 9th 2024).

Common Oncologic Wounds

This article presents clinically focused, evidence-based summary of common wounds and alterations in tissue/skin associated with oncologic treatment, with a focus on risk factors, identification, prevention, and management of acute radiation dermatitis and chemotherapy-induced extravasation.

Xenogeneic platelet-rich plasma lotion for preventing acute radiation dermatitis in patients with breast cancer undergoing radiotherapy: An open-label, randomized controlled trial

Background

Breast cancer patients experience acute radiation dermatitis (ARD) during radiation therapy (RT). This study investigated the prophylactic effect of a newly developed xenogeneic platelet-rich plasma (PRP) lotion on ARD for breast cancer patients.

Methods

This study enrolled patients with ductal carcinoma in situ and early-stage invasive breast cancers after breast-conserving surgery. Hypofractionated whole-breast RT (42.5 Gy in 16 fractions) followed by tumour bed boost (10 Gy in 5 fractions) was used. The patients were randomly assigned to XONRID® gel (n = 48) or PRP lotion (n = 52) groups. We recorded the skin toxicity weekly during RT and at 2 weeks after RT. ARD was graded on the basis of the RTOG definition by two senior radiation oncologists, and the numerical rating scale (NRS) for pain and Dermatology Life Quality Index (DLQI) were subjectively scored by patients.

Results

Grade 3-4 ARD was noted in three (6 %) patients in the XONRID® gel group and no patients in the PRP lotion group (p < 0.001). One patient did not complete RT in the XONRID® gel group due to intolerable pain and refused to complete the weekly questionnaires and follow-ups. Compared with the XONRID® gel group, the PRP lotion group had significantly reduced and delayed progression of mean ARD (p = 0.001), lower mean NRS for pain value (p = 0.021) and lower mean DLQI (p = 0.048).

Conclusions

This randomized controlled trial is the first to use xenogeneic PRP lotion for ARD prevention. This lotion has prophylactic effects against ARD and thus improves quality of life of patients undergoing RT.

A critical review of randomized controlled trials on topical corticosteroids for the prevention of radiation dermatitis in breast cancer

INTRODUCTION

Topical steroids have shown effectiveness in preventing radiation dermatitis (RD) in breast cancer patients in randomized controlled trials (RCTs). This review provides an in-depth analysis of the study methodology of these RCTs to review whether topical steroids should be employed in routine clinical practice.

METHODS

A systematic literature search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted from database inception until May 31, 2024. RCTs comparing topical steroids with moisturizers or placebo for the prophylaxis of RD in breast cancer patients were included. The methodology of the RCTs, including how topical steroids were applied, whether crossover in the control arm was allowed, if stratification factors were employed, and the reporting of side effects was evaluated.

RESULTS

Twelve RCTs met inclusion criteria. Four different topical steroids were used, including betamethasone 0.1%, mometasone 0.1%, hydrocortisone 1%, and beclomethasone. Eleven studies (92%) showed that topical steroids were effective in reducing incidence or delaying occurrence of grade 2 or above RD with a relative risk of 0.69 (range, 0.19 to 0.98). In all RCTs, topical steroids were consistently used from the start of radiotherapy (RT) until completion to 3 weeks post-RT. Five RCTs (42%) provided patient education on topical steroid application. Six (50%) reported on subsequent management if moist desquamation occurred. Four studies (33%) stratified potential risk factors of RD during randomization. No studies reported any long-term side effects of topical steroids.

CONCLUSION

Topical steroids are effective in reducing the incidence of RD. However, heterogeneity was observed among the RCTs with regard to how and when the topical steroids were applied. The long-term safety profile of topical steroids is not well studied. In the context of modern radiotherapy planning techniques and increased use of hypofractionation radiation schedules, a repeat RCT addressing these methodological concerns may provide more guidance to clinicians.

Efficacy and safety of topical cream containing aminoacryl tRNA synthetase complex interacting 1-derived peptide in mitigating radiation dermatitis after adjuvant radiotherapy for breast cancer

PURPOSE

Acute radiation dermatitis (ARD) is a frequent side effect experienced by breast cancer patients undergoing radiotherapy. This study aimed to assess the efficacy and safety of a topical cream containing aminoacryl tRNA synthetase complex interacting 1 (AIMP1)-derived peptide (AdP) in mitigating radiation dermatitis (RD) in breast cancer patients undergoing radiotherapy.

METHODS

An 8-week single-center, prospective pilot study was conducted to compare the clinical efficacy and safety of an AdP-containing cream with a control cream lacking AdP for the mitigation of RD. Fifteen patients undergoing radiotherapy applied the test cream to the right side and the control cream to the left side of the radiation exposure site, bisected by the nipple line. RD was evaluated at baseline and at weeks 2, 4, 6, and 8, employing the 5-point grading system advocated by the Radiation Oncology Group (RTOG).

RESULTS

The average RTOG score was lower on the test side in comparison to the control side, and a less pronounced increase in melanin index was observed on the test side. However, these differences were not statistically significant. Both sides exhibited increased skin hydration and decreased transepidermal water loss. Analyzing the maximum RTOG scores throughout the study, RD of maximum grades 1 and 2 was noted in 54.5% and 45.5% of patients on the test side. On the control side, the maximum grades 1 and 2 were observed in 45.5% and 54.5% of patients respectively.

CONCLUSION

The AdP-containing cream did not prove to be more effective than the control cream without AdP in mitigating RD. However, the total incidence of RD in our study was notably lower than previously documented, illustrating the protective effects of both the test and control creams.

Therapeutic Potential of Hydrogen as a Radioprotective Agent for the Prevention of Radiation Dermatitis

Radiation dermatitis (RD) is a common side effect in patients receiving radiotherapy. Currently, clinical skincare approaches for acute RD vary widely among institutions and lack consensus. Hydrogen molecules, acting as radioprotective agents by selectively scavenging free radicals, have the potential to protect against RD. In this study, we demonstrate that hydrogen reduces double-strand breaks, mitochondrial depolarization, and inflammatory cytokines induced by irradiation damage in HaCaT cells. Furthermore, in vivo experiments reveal that exposing irradiated skin areas to a hydrogen gas environment alleviates RD. Assessment of skin appearance grade and histology staining revealed that direct transdermal application of hydrogen can prevent radiation-induced follicle damage, dermal thickening, and leukocyte infiltration, thereby reducing the severity of RD. In addition, hydrogen enhances the skin's antioxidant capacity, leading to a reduction in the Bcl-2-associated X protein/B-cell lymphoma 2 (Bax/Bcl-2) ratio, the number of apoptotic cells, and the expression of pro-inflammatory cytokines. Our data demonstrate that hydrogen possesses antioxidant, anti-inflammatory, and anti-apoptotic properties, and could be a preventive strategy for RD.

Photobiomodulation ameliorates ovarian aging by alleviating oxidative stress and inflammation damage and improving mitochondrial function

Ovarian aging is a serious clinical concern. Few safe and effective methods are currently available to improve ovarian functions. Photobiomodulation (PBM) is a safe and noninvasive physical therapy that can modulate a series of biological processes. Recently, several studies have noted its potential to improve the function of ovary and reproductive cells. However, the effects of PBM treatment on natural ovarian aging remain unclear. In this study, we used a naturally reproductive aging mouse model to observe the effect of PBM on ovarian function. Young and aged female ICR mice were treated with or without PBM for 2 months. PBM was performed using a semiconductor InGaAlP laser emitting at 650 nm (80 mW, 6.7 mW/cm2 for 5 or 10 min, resulting in a dose of 2 or 4 J/cm2, respectively). After treatment, the effects of PBM and its role in oxidative stress, inflammation, and mitochondrial function were investigated. We found that PBM (4 J/cm2) effectively recovered the levels of sex hormones, increased the number of primordial and growing follicles, improved angiogenesis, and decreased cell apoptosis in naturally aged mice. Moreover, PBM reduced oxidative stress, inhibited chronic ovarian inflammation, and improved mitochondrial function in aged ovaries. Similar protective effects of PBM were observed in a hydrogen peroxide-induced oxidative stress model of human granulosa cell line (KGN) in vitro. Increased cell viability, cell proliferation, hormone secretion, mitochondrial membrane potential, and adenosine triphosphate levels and decreased apoptosis and oxidative stress were detected in KGN cells after PBM treatment. Collectively, this study suggest that PBM treatment is beneficial for restoring ovarian function in naturally reproductive aging mice and has a significant protective effect against oxidative stress damage in KGN cells. The mechanisms underlying the benefits of PBM in ovarian aging include antioxidant stress, reduction of inflammation, and preservation of mitochondrial function. Therefore, this study emphasizes the potential of PBM as a therapeutic intervention to ameliorate ovarian aging.

Photobiomodulation therapy for mitigating severity of radiodermatitis in cancer patients undergoing radiotherapy: a scoping review

PURPOSE

Radiodermatitis (RD) is an adverse effect of radiation therapy. RD can negatively impact quality of life and can also hinder treatment in cancer patients. Photobiomodulation therapy (PBMT) has the potential to treat RD at the cellular level, and it is more promising compared to other therapy alternatives. This review aims to examine the effectiveness of PBMT for the treatment and management of RD in cancer patients undergoing radiation therapy.

METHODS

The methodology followed for the review was based on the framework proposed by Arksey and O'Malley, and the extensions by Levac et al. This involved a literature search in Scopus, PubMed, Embase, and Cochrane without any time limit, for original articles on the basis of the inclusion criteria, i.e., studies focusing on the effectiveness of PBMT on RD in cancer patients undergoing radiation therapy as an anticancer treatment. The review has been reported on the basis of the PRISMA-ScR checklist.

RESULTS

A total of 14 studies were reviewed, of which only 2 (14.28%) studies reported no significant effect of PBMT on RD; the remaining studies reported positive outcomes (85.71%) with no adverse effects. Among studies with positive outcomes, PBMT has been shown to be beneficial in reducing the severity of RD. Furthermore, PBMT application has been studied as a preventive measure (35.71%), treatment and management (50%), and for both the prevention and cure of RD (14.29%).

CONCLUSION

Overall, PBMT can be considered a reliable and effective treatment modality for reducing the severity of RD. However detailed studies related to the long-term effects of PBMT, its effect on pain intensity and quality of life (QoL) will aid in better assessment of the technique. More clinical trials with a broader sample size could also aid in fine-tuning the efficacy of PBMT treatment modalities.

Hydrogel Microneedle Patches Loaded with Stem Cell Mitochondria-Enriched Microvesicles Boost the Chronic Wound Healing

Rescuing or compensating mitochondrial function represents a promising therapeutic avenue for radiation-induced chronic wounds. Adult stem cell efficacies are primarily dependent on the paracrine secretion of mitochondria-containing extracellular vesicles (EVs). However, effective therapeutic strategies addressing the quantity of mitochondria and mitochondria-delivery system are lacking. Thus, in this study, we aimed to design an effective hydrogel microneedle patch (MNP) loaded with stem cell-derived mitochondria-rich EVs to gradually release and deliver mitochondria into the wound tissues and boost wound healing. We, first, used metformin to enhance mitochondrial biogenesis and thereby increasing the secretion of mitochondria-containing EVs (termed "Met-EVs") in adipose-derived stem cells. To verify the therapeutic effects of Met-EVs, we established an in vitro and an in vivo model of X-ray-induced mitochondrial dysfunction. The Met-EVs ameliorated the mitochondrial dysfunction by rescuing mitochondrial membrane potential, increasing adenosine 5'-triphosphate levels, and decreasing reactive oxygen species production by transferring active mitochondria. To sustain the release of EVs into damaged tissues, we constructed a Met-EVs@Decellularized Adipose Matrix (DAM)/Hyaluronic Acid Methacrylic Acid (HAMA)-MNP. Met-EVs@DAM/HAMA-MNP can load and gradually release Met-EVs and their contained mitochondria into wound tissues to alleviate mitochondrial dysfunction. Moreover, we found Met-EVs@DAM/HAMA-MNP can markedly promote macrophage polarization toward the M2 subtype with anti-inflammatory and regenerative functions, which can, in turn, enhance the healing process in mice with skin wounds combined radiation injuries. Collectively, we successfully fabricated a delivery system for EVs, Met-EVs@DAM/HAMA-MNP, to effectively deliver stem cell-derived mitochondria-rich EVs. The effectiveness of this system has been demonstrated, holding great potential for chronic wound treatments in clinic.

Barrier films or dressings for the prevention of acute radiation dermatitis in breast cancer: a systematic review and network meta-analysis

BACKGROUND

Barrier films or dressings were reported to be effective in preventing radiation dermatitis (RD) in breast cancer patients, but their comparative efficacy is unknown.

METHODS

A systematic literature search was performed on Embase, MEDLINE and Cochrane CENTRAL Registry of Clinical Trials from inception to October 20, 2023. Randomised controlled trials (RCTs) comparing barrier films or dressings to the standard of care (SOC) or other interventions were included. We estimated summary odds ratios and mean differences using network meta-analysis with random effects. This study was registered with PROSPERO (ID: CRD42023475021).

RESULTS

Fourteen RCTs met inclusion criteria. Six interventions were analysed: 3M™ Moisturizing Double Barrier Cream (MDBC), 3M™ No Sting Barrier Film (BF), Hydrofilm® (HF), Mepitel® Film (MF), Silver Leaf Nylon Dressing and StrataXRT®. HF, MF and StrataXRT® reduced the incidence of moist desquamation compared to SOC (HF: OR = 0.08; p = 0.02; MF: OR = 0.31 p < 0.01; StrataXRT®: OR = 0.22, p = 0.04). The ranking of agents from most to least effective in preventing moist desquamation according to P-scores was HF (92.5%), MF (78.5%), StrataXRT® (70.1%), BF (46.4%), Silver Leaf Nylon Dressing (24.9%), MDBC (22.9%) and SOC (14.7%). Only four RCTs on HF and MF included patient-reported outcome (PRO) assessments that allowed pooling for analysis. HF and MF were more effective in reducing pain, itchiness and burning sensation compared to SOC (p < 0.01 for all symptoms).

CONCLUSION

HF and MF were effective in preventing RD in breast cancer. Future RCTs should compare these interventions to effective cream preparations, such as topical corticosteroids.

Evidence-based summary of the prevention and management of radiation dermatitis in patients with breast cancer

Objective

Up to now there is a lack of research to summarize the relevant evidence for radiation dermatitis (RD) management in patients with breast cancer. Therefore, this study aimed to summarize the best evidence for the prevention and management of RD in patients with breast cancer.

Methods

According to the "6S" evidence pyramid model, all major databases were searched from January 2018 to February 2024: UpToDate, BMJ Best Practice, National Guideline Clearinghouse, Guidelines International Network, MedSci, Yi Maitong Guidelines, National Comprehensive Cancer Network, Oncology Nursing Society, Radiology Assistant database, Society and College of Radiographers, Australian JBI Evidence-Based Health Care Center database, Cochrane Library, PubMed, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wangfang Data, Chinese Science and Technology Journal Database, Chinese Biology Medicine, etc.

Results

A total of 22 articles which met the inclusion criteria were included in the study, comprising six guidelines, nine systematic reviews, four evidence summaries, one clinical decision, one expert consensus, and one randomized controlled trial. We summarized 35 pieces of evidence across four aspects: influence factor, evaluation and monitoring, prevention and treatment, care and health education.

Conclusions

This study provides a comprehensive summary of the best evidence for the prevention and management of RD in patients with breast cancer. It is recommended that subsequent evidence transformation should be conducted based on specific clinical circumstances to standardize the process of clinical prevention and management of RD.

Systematic review registration

This study was registered at the Fudan University Center for Evidence-Based Nursing (Registration No. ES20244311).

Evolution of radiation-induced dermatitis treatment

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.

Expected role of photodynamic therapy to relieve skin damage in nuclear or radiological emergency: Review

Nuclear and radiological accidents can occur due to poor management, in transportation, radiation therapy and nuclear wards in hospitals, leading to extreme radiation exposure and serious consequences for human health. Additionally, in many of previous radiological accidents, skin damage was observed in patients and survivors due to the high radiation exposure. However, as part of a medical countermeasures in a nuclear/radiological emergency, it is critical to plan for the treatment of radiation-induced skin damage. Hence, the new, non-invasive technology of photodynamic therapy (PDT) is projected to be more effectively used for treating skin damage caused by high-dose radiation. PDT plays an important role in treating, repairing skin damage and promoting wound healing as evidenced by research. This review, highlighted and recommended potential impacts of PDT to repair and decrease radiation-induced skin tissue damage. Moreover, we have suggested some photosensitizer (PS) agent as radio-mitigator drugs to decrease radiobiological effects.

Global hotspots and research trends of radiation-induced skin injury: a bibliometric analysis from 2004 to 2023

Background

Radiation therapy has become an important treatment for many malignant tumours after surgery and for palliative tumour care. Although modern radiotherapy technology is constantly improving, radiation damage to normal tissues is often difficult to avoid, and radiation-induced skin injury (RSI) is a common complication, manifested as skin erythema, peeling, ulceration, and even bone and deep organ damage, seriously affect the quality of life for patients. Basic research and clinical trials related to RSI have achieved certain results, while no researchers have conducted comprehensive bibliometric studies.

Objective

A comprehensive bibliometric analysis of publications on RSI published between 2004 and 2023 was conducted to identify current hotspots and future directions in this area of study.

Methods

RSI-related publications published between January 1, 2004, and December 31, 2023, were retrieved from the Web of Science Core Collection (WoSCC) database for analysis using VOSviewer and CiteSpace analytics.

Results

A total of 1009 publications on RSI from 2004 to 2023 were included in the WoSCC database. The United States had the highest productivity with 299 papers, accounting for 29.63% of the total production, followed by China with 193 papers (19.13%) and Japan with 111 papers (11.00%). In terms of research institutions and journals, the University of Toronto and Journal of Supportive Care in Cancer published the highest number of papers. Professor Edward Chow published the most articles, while Professor Shuyu Zhang was the most cited. The top ten most-cited papers focused on the pathogenesis, prevention, and management of RSI. Keyword co-occurrence analysis and the top 25 keywords with the strongest citation bursts suggest that current research focuses on the pathogenesis, prevention, and treatment management of RSI.

Conclusion

This study conducted a systematic bibliometric analysis of RSI publications from 2004 to 2023; identified the trends in RSI publications, major research countries, major research institutions, major research journals, major research authors, and major research keywords; and revealed the future development direction and research hotspots of this field. This study provides a valuable reference for future RSI research.

Mepitel film for the prevention of radiation dermatitis: A comprehensive review of its efficacy, side effects, physics measurements, patient- and clinician-reported outcomes

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.

A topical BRAF inhibitor (LUT-014) for treatment of radiodermatitis among women with breast cancer

Background

Modern radiotherapy is associated with dermatitis (RD) in approximately one-third of patients treated for breast cancer. There is currently no standard for treating RD.

Objective

The objective of this study was to determine whether LUT014, a topical BRAF inhibitor which paradoxically activates mitogen-activated protein kinase, can safely improve RD.

Methods

A phase I/II study was designed to first follow a small cohort of women with grade 2 RD regarding toxicity and response. Then, 20 patients were randomized to compare LUT014 to "vehicle" relative to safety and response (measured with common terminology criteria for adverse events, Dermatology Life Quality Index).

Results

No substantial toxicity (eg, 0 serious adverse event) was associated with LUT014. All 8 women receiving LUT014 achieved treatment success (5-point Dermatology Life Quality Index reduction at day 14) compared to 73% (8/11) on the placebo arm (P = .591). The time to complete recovery was shorter in the treatment arm.

Limitations

The sample size was limited. Only 2 hospitals were included.

Conclusions

Topical LU014 is tolerable and may be efficacious for grade 2 RD.

Amelioration of Acute Radiation Dermatitis in Breast Cancer Patients by a Bioadhesive Barrier-Forming Gel (Episil): A Single-Center, Open, Parallel, Randomized, Phase I/II Controlled Trial

Episil is a bioadhesive barrier-forming liquid gel that can relieve mucositis caused by radiotherapy (RT) and effectively relieve pain. The purpose of this trial is to compare the efficacy and safety of Episil in improving acute radiation dermatitis (ARD) in patients with breast cancer. This study included patients who met the criteria for postoperative RT for breast cancer. The primary end point was the grade of RD during treatment. A total of 102 patients were included in this study. The patients were grouped in a 2:1 ratio using the randomized number table method: 67 patients received Episil combined with conventional skin care (the Episil group), whereas the remaining 35 patients served as the control group and received conventional skin care only (the control group). According to the grading criteria of the Radiation Therapy Oncology Group (RTOG), the skin reaction rate and severity were significantly better in the Episil group than the control group (24.62%, 72.31%, 3.08, 0, 0 vs. 0, 85.71%, 14.29%, 0, 0, 0) across grades 0 to 4 (P < 0.05). The itchiness score exhibited s significant reduction in the Episil group as compared with the control group (P < 0.05). The results of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) showed that the overall health (z = -5.855, P < 0.001) and overall quality of life (z = -6.583, P < 0.001) were better in the Episil group than the control group after RT. Overall, in patients with breast cancer receiving RT, the topical application of Episil may significantly reduce the grading of ARD, alleviate patient symptoms, and improve the patient's overall quality of life.

Decrease of radiation-induced skin reactions in breast cancer patients by preventive application of film dressings-a systematic review

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.

Non-invasive physical plasma for preventing radiation dermatitis in breast cancer: Results from an intrapatient-randomised double-blind placebo-controlled trial

Background and Purpose

To investigate the effect of topical non-invasive physical plasma (NIPP), a volatile mix generated out of ambient air, on prevention of acute radiation dermatitis (RD) during and after whole-breast irradiation (WBI).

Materials and Methods

Lateral and medial breast halves were randomised within each patient to receive either 120 s of NIPP or sham treatment daily during WBI. Standard skin care with urea lotion was applied to the whole breast. Blinded acute skin toxicity was assessed weekly for each breast half separately and included clinician- (CTCAE) and patient-reported (modified RISRAS), and objective (spectrophotometry) assessments. As an additional external control, a comparable standard of care (SoC) patient collective from a previous prospective trial was used.

Results

Sixty-four patients were included. There were no significant differences between breast halves. Post-hoc comparison with a similar SoC control collective revealed OR = 0.28 (95% CI 0.11-0.76; p = 0.014) for grade ≥ 2 RD upon WBI completion, along with less hyperpigmentation (p < 0.001), oedema (p = 0.020), dry (p < 0.001) and moist desquamation (p = 0.017), pain, itching, and burning (p < 0.001 for each). Tolerability of NIPP was excellent and side effects were not observed.

Conclusion

Even though there were no differences between intrapatient-randomised breast halves, the overall incidence and severity of acute radiation-induced skin toxicity were considerably lower when compared to a prospectively collected SoC cohort. Our data suggest the potential benefit of NIPP in RD prevention. A randomised trial with a physical control group is warranted to confirm these promising results (DRKS00026225).

Head and neck cancer patients under radiotherapy undergoing skin application of hydrogel dressing or hyaluronic acid: results from a prospective, randomized study

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.

Perceptions of healthcare professionals on the use of Mepitel Film for the prevention of acute radiation dermatitis in breast cancer

INTRODUCTION

Randomized clinical trials support Mepitel Film (MF) as a prophylactic treatment for radiation dermatitis (RD) in patients undergoing breast radiotherapy. Although several studies have canvassed the opinion of patients on using MF, no such studies have been done to investigate the perception of healthcare professionals (HCPs). The objective of this study was therefore to investigate the perceptions of HCPs on MF as a treatment option for RD.

METHODS

Anonymized responses to a web-based survey sent to HCPs at a single institution managing patients using MF during breast radiotherapy were analyzed.

RESULTS

Of the 28 HCPs contacted, 22 completed the survey, including 6 radiation oncologists (ROs), 11 radiation therapists (RTTs), and 5 nurses. Most HCPs reported MF was better at preventing severe RD than the standard of care and improved radiation-induced skin reactions (n = 20/22, 91%, and n = 19/22, 86%, respectively). MF was recommended for mastectomy patients without reconstruction (n = 15/21, 71%). The majority of HCPs believed that patients' families could be trained to apply and remove MF (n = 19/22, 86%). Many HCPs perceived that implementation of MF would be difficult in terms of maintaining patient flow and wide-scale implementation within their institution (n = 11/22, 50%, and n = 10/22, 46%, respectively). Most HCPs perceived that fewer than 50% of their patients could afford MF if priced at $100 CAD (n = 15/20, 75%).

CONCLUSION

These findings provide insights into the possibility of MF to be incorporated into standard practice of care for RD. Although most HCPs were satisfied with MF as a prophylactic treatment for RD, there are concerns about its resource-intensive operationalization and financial accessibility to patients. Future research should focus on ways to improve HCP experience with MF and to improve its implementation into clinical settings as standard of care.

Do Barrier Films Impact Long-Term Skin Toxicity following Whole-Breast Irradiation? Objective Follow-Up of Two Randomised Trials

Purpose: Hydrofilm, a polyurethane-based barrier film, can be used to prevent acute radiation dermatitis (RD) in adjuvant whole-breast irradiation (WBI) for breast cancer. This cost-effective prophylactic measure is currently being recommended to a growing number of patients, yet long-term safety data and its impact on late radiation-induced skin toxicity such as pigmentation changes and fibrosis have not been investigated. Methods: We objectively evaluated patients who were previously enrolled in either of two intrapatient-randomised (lateral versus medial breast halve) controlled trials on the use of Hydrofilm for RD prevention (DRKS00029665; registered on 19 July 2022). Results: Sixty-two patients (47.7% of the initial combined sample size) provided consent for this post-hoc examination, with a median follow-up time (range) of 58 (37-73) months. Following WBI, there was a significant increase in yellow skin tones of the entire breast when compared to baseline measurements before WBI (p < 0.001) and a significant increase of cutis, subcutis, and oedema thickness (p < 0.001, p < 0.001, and p = 0.004, respectively). At follow-up, there were no significant differences in either pigmentation changes or skin fibrosis between the Hydrofilm and standard of care breast halves. Conclusion: These data suggest that Hydrofilm can be safely used in the context of acute RD prevention, without affecting late side effects, supporting its widespread use.

A novel, multi-active emollient for the prevention of acute radiation dermatitis in breast cancer patients: a randomized clinical trial

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).

Barrier films for the prevention of acute radiation dermatitis in breast cancer: A systematic review and meta-analysis of randomised controlled trials

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.

Shedding light on the management of acute radiation dermatitis: insight from the MASCC Oncodermatology study group

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.

New Insights into Photobiomodulation of the Vaginal Microbiome-A Critical Review

The development of new technologies such as sequencing has greatly enhanced our understanding of the human microbiome. The interactions between the human microbiome and the development of several diseases have been the subject of recent research. In-depth knowledge about the vaginal microbiome (VMB) has shown that dysbiosis is closely related to the development of gynecologic and obstetric disorders. To date, the progress in treating or modulating the VMB has lagged far behind research efforts. Photobiomodulation (PBM) uses low levels of light, usually red or near-infrared, to treat a diversity of conditions. Several studies have demonstrated that PBM can control the microbiome and improve the activity of the immune system. In recent years, increasing attention has been paid to the microbiome, mostly to the gut microbiome and its connections with many diseases, such as metabolic disorders, obesity, cardiovascular disorders, autoimmunity, and neurological disorders. The applicability of PBM therapeutics to treat gut dysbiosis has been studied, with promising results. The possible cellular and molecular effects of PBM on the vaginal microbiome constitute a theoretical and promising field that is starting to take its first steps. In this review, we will discuss the potential mechanisms and effects of photobiomodulation in the VMB.

StrataXRT for the prevention of acute radiation dermatitis in breast cancer: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

To evaluate the overall efficacy of StrataXRT, a topical gel dressing, in preventing acute radiation dermatitis (RD) in breast cancer patients undergoing radiotherapy (RT).

METHODS

A systematic search was conducted on April 25, 2023 in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) assessing the effectiveness of StrataXRT in preventing acute RD in breast cancer patients undergoing adjuvant RT to the breast or chest wall with or without regional nodes were included. Pooled incidence odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model, with analysis and forest plots generated in RevMan v5.4.

RESULTS

The analysis included three RCTs with a total of 189 patients assessed using per-protocol analysis. Two RCTs compared StrataXRT to standard of care, while the third compared it with Mepitel film and was reported separately. In the former RCTs, the odds ratio (OR) for developing acute grade 3 RD favored StrataXRT at 0.05 (95% CI, 0.01-0.22; P < 0.0001). The OR for developing acute grades 2-3 RD was 0.32 (95% CI, 0.03-3.18; P = 0.33). The RCT comparing StrataXRT with Mepitel film showed insignificant ORs for grade 3 and grades 2-3 RD. One RCT reported significantly lower erythema index (P = 0.008) and melanin index (P = 0.015) in StrataXRT patients. The use of StrataXRT did not raise additional safety concerns.

CONCLUSION

StrataXRT may help prevent severe acute RD in breast cancer RT patients. Further high quality, large-scale studies are needed to confirm these findings.

Cicaderma® in radiation-related dermatitis of breast cancer: Results from the multicentric randomised phase III CICA-RT

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.

Systematic review and meta-analysis on interventions for radiation dermatitis prevention and management: an overview of the methods

Over several decades, research on the prevention and management of acute radiation dermatitis (RD) has continued to emerge, yet there remains no "gold standard" treatment for RD care. Recent guidelines on RD prevention and management were published in 2022 by the Oncodermatology Study Group of the Multinational Association of Supportive Care in Cancer (MASCC). As part of this guideline process, a collaborative effort was undertaken by international RD experts to quantitatively compare commonly studied RD skin interventions through meta-analyses and discern superiority of interventional treatments over another intervention, standard-of-care, or placebo in RD prevention and management. This paper summarizes the materials and methodology used in a set of meta-analysis studies that supplement the 2022 MASCC Clinical Practice Guidelines on RD Prevention and Management.