Prophylaxis of Radiation-Induced Dermatitis in Patients With Breast Cancer Using Herbal Creams: A Prospective Randomized Controlled Trial

Abstract

Radiation-induced toxicity is a major limiting factor for prescribing radiation dose in cancer radiotherapy. Skin reaction to radiation is one of the primary concerns, which could affect quality of life of the patients both physically and mentally. Reviews of the literature show limited number of effective reagents for its prophylaxis. In this study, we attempted to determine whether prophylactic treatment of the 3 different herbal creams containing Centella asiatica, Cucumis sativus, and Thunbergia laurifolia extracts as well as a commercial moisturizing cream could reduce acute skin reaction in breast cancer patients undergoing radiotherapy. A total of 153 breast cancer patients undergoing radiotherapy were randomly assigned into 5 different groups with one group receiving no treatment. The patients were instructed to apply their designated creams once daily from their first radiotherapy session until 1-month post-irradiation. Their skins were graded by a radiation oncologist on a weekly basis until 1-month post-irradiation to identify any skin reactions. The results showed that the administration of the herbal creams or the moisturizing cream could neither reduce the severity nor delay the onset of dermatitis compared with the no treatment group. However, despite the limited benefits from the prophylaxis, the Cucumis sativus cream was shown to help with the skin recovery post-irradiation. These results suggested that breast cancer patients undergoing radiotherapy should be advised to apply moisturizing cream to the area of irradiated skin.

Plant and Herbal Extracts as Ingredients of Topical Agents in the Prevention and Treatment Radiodermatitis: A Systematic Literature Review

“…In this literature review we quoted the results of 34 studies (between 1996 and 2021), three of which concern preparations containing more than one herbal extract (paste with a mixture of Aloe vera L., Turmeric curcuma longa, Azadirachta indica and Ocimum sanctum [74,75], ointment Jaungo containing Angelica gigas, Lithospermum radix [78,79]). In addition, in two presented studies, two or more preparations were analyzed in parallel: specifically, preparations containing Achillea millefolium or Glycyrrhiza glabra [59], or the preparations containing respectively Centella asiatica, Cucumis sativus or Thunbergia laurifolia [88]. In the study by Franco et al [94] the carrier of Hypericum perforatum extract was neem oil with curative properties.…”

“…In most discussed clinical studies, the assessment was done by a team of experts or the members of the study group. To do this, the assessment tools were: the scale (guidelines) RTOG/EORTC [59,66,67,71,74,75,78,[81][82][83][84][85][86][88][89][90]94,[96][97][98][99], Acute Radiation Morbidity Scoring Criteria [73], Common Toxicity Criteria [63,64], modified 10-point Catterall scale [65], Common Terminology Criteria for Adverse Events [92] or National Cancer Institute Common Terminology for Adverse Events [96]. Photographs of skin were taken in studies [11,63,72,81,89,90].…”

“…Possible changes in treatment were linked to allergy or to development of dermatitis of second degree or higher, which required the introduction of corticosteroids, antibiotics or analgesics. In the case of moist desquamation, individual works [71,88] stopped the application of the preparation in the area of occurrence. Only the studies carried out by the team Franco et al [94] included the application of two forms of preparations depending on the type of radiodermatitis observed.…”

“…In the works quoted, multiple forms of preparations were compared simultaneously during the study; for example, cream and oil or powder [65,71,98,99], creams with water infusion [88], gels with creams [11,[62][63][64]72,89,90,100], gels with soap [67], gels with ointments [60], gels with oils [94]. We know currently that the skin barrier layer should not only be moisturized but also rebuilt, which cannot be done with preparations such as soap.…”

Alterações Dermatológicas Durante Tratamento Oncológico de Mulheres com Câncer de Mama: Estudo em Prontuários Clínicos

“…Neste primeiro momento, espera-se que mais de 80% dessas reações iniciais sejam moderadas ou graves, frequentemente descritas na clínica como uma combinação de eritema e dor, embora possam se manifestar de forma bolhosa ou ulcerada 31 . A ocorrência aguda e severa de alterações dermatológicas induzidas pela radiação pode contraindicar a continuidade do tratamento com radiação e piorar o prognóstico de mulheres com câncer, além de prejudicar a autoestima e a qualidade de vida 32 .…”