Topical Management of Acute Radiation Dermatitis in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Abstract

(OR: 0.29; p<0.0001) and reducing the mean RD score p<0.00001 Radiation induces damage to the skin, activating inflammatory pathways and causing cytokines overproduction (1, 2). Radiation dermatitis is a common acute side-effect that occurs within hours to weeks after the start of radiotherapy (3, 4) and affects more than 87% of patients (2, 5). Radiation dermatitis can limit the therapeutic dose delivered to patients and can, sometimes, lead to a break in treatment, thus potentially compromising local control and survival outcome (1, 6). It can also have a considerable impact on patients' quality of life (7,8). Despite significant development in radiotherapy techniques, efficacious interventions in the prevention of acute skin reactions is still lacking and current evidence is unable to provide adequate guidelines for the management of this sideeffect (9, 10). Studies have examined numerous topical agents such as Aloe Vera, aqueous cream, Calendula, petrolatum and sulcrafate cream as a means to reducing the dehydrating effects of radiation dermatitis (6,11,12). However, the results in terms of managing radiation dermatitis and treatment related pain have not been clinically significant (13,14). Corticosteroids have anti-inflammatory properties and are known to down-regulate cytokine gene expression, making them ideal for managing radiation dermatitis (15-17). A systematic review by Bolderston et al. concluded that there is limited evidence to support or oppose the use of topical agents for the management of acute radiation dermatitis (18).Skin care advice given to breast cancer patients varies among institutions (19). No gold-standard for the appropriate management of this side-effect exists and in most cases the decision of care is left at the discretion of the health care professional rather than clinical evidence (20,21). Clinical advice is often given based on anecdotal evidence (22).The present systematic review and meta-analysis was conducted to assess the potential efficacy of corticosteroids in the management of RD and its impact on pain and quality of life in female breast cancer patients. However, the anticipated adverse effect associated with steroids is not evaluated and is beyond the scope of this review. We restricted our review to one site only due to radiotherapy dose variations used in different sites. Materials and MethodsSearch strategy for identification of studies. The electronic literature search was conducted up to and including March 2017. The search terms used were corticosteroid, radiation dermatitis, breast cancer, management, and prevention. The reference lists of potentially eligible studies were subsequently hand searched to identify 5343

Reducing Radiation Dermatitis Using a Film-forming Silicone Gel During Breast Radiotherapy: A Pilot Randomized-controlled Trial

“…To our knowledge, this is the first randomized trial demonstrating the superiority of a film-forming silicone gel in reducing in vivo 34: 413-422 (2020) RD during breast RT based on objectively measured physiological skin parameters. Despite decades of investigations, no clear evidence of the superiority of any single topical agent in the prevention of RD has emerged (10,(17)(18)(19)(20)(21)(22)24). Although steroids have been proven to be potent topical agents in reducing RD (31,32), the use of steroids requires a doctor's prescription and is not free of criticism.…”

Efficacy of heparinoid moisturizer as a prophylactic agent for radiation dermatitis following radiotherapy after breast-conserving surgery: a randomized controlled trial

“…Currently, a variety of interventions are used for topical therapy of ARD, however, randomized controlled trials (RCTs) have not yet consistently indicated the superiority of any single agent ( 15 ). In a pooled analysis and systematic review, the prophylactic application of topical corticosteroid in breast cancer patients undergoing radiotherapy appears to significantly reduce the incidence of ARD, specifically moist desquamation, compared with other treatments ( 16 , 17 ). However, the use of topical steroids may result in thinning of the SC, which leads to the transepidermal water loss (TEWL) and skin irritation ( 18 ).…”

Aplicação tópica de creme contendo nanopartículas com vitamina E para prevenção de radiodermatite em mulheres com câncer de mama: estudo piloto randomizado

“…Apesar de alguns estudos randomizados terem sido ou estarem sendo conduzidos para avaliar as estratégias de prevenção e de tratamento de radiodermatites, muitas intervenções, comumente utilizadas na prática clínica, são baseadas na tradição ou na opinião dos profissionais e em experiências institucionais, além de não serem pesquisadas exaustivamente (Feight et al, 2011;Fernandez-Castro, Martin-Gil, 2015;Glover, Harmer, 2014;Kole, Kole, Moran, 2017;Kodiyan, Amber, 2015;Singh et al, 2016). Na literatura específica sobre o tema, pode-se constatar a falta de evidências acerca das recomendações sobre intervenções ou produtos (de uso oral ou tópico), alguns dos quais reportados por enfermeiros e médicos (Chan, Larsen, Chan, 2012;Chan et al, 2014;Feight et al, 2011;Fernandez-Castro, Martin-Gil, 2015;Glover, Harmer, 2014;Haruna, Lipsett, Marignol, 2017;Kodiyan, Amber, 2015;Kole, Kole, Moran, 2017;McQuestion, 2011;Meghrajani et al, 2013;Salvo et al, 2010;Singh et al, 2016;Waghmare, 2013).…”

“…Dentre os produtos tópicos identificados na literatura, incluem-se loções, cremes, pomadas e coberturas especiais (Bolderston et al, 2006;Chan, Larsen, Chan, 2012;Haruna, Lipsett, Marignol, 2017;McQuestion, 2011;Meghrajani et al, 2013;Salvo et al, 2010). Além desses, estratégias como a fotobiomodulação com laserterapia de baixa intensidade (Censabella et al, 2016;Costa et al, 2014;Robijns et al, 2018;Seité, Bensadoun, Mazer, 2017) e o uso tópico de vasoconstritores adrenérgicos (Cleary et al, 2017;Fahl, 2016) também têm sido reportadas.…”

“…A indicação de um produto hidratante tópico é comumente realizada na prática clínica, apesar de não existir, até o momento, consenso na literatura acerca da eficácia e da melhor recomendação (Andrade et al, 2012;Chan, Larsen, Chan, 2012;Chan et al, 2014;Haruna, Lipsett, Marignol, 2017;Kole, Kole, Moran, 2017;Leventhal, Young, 2017;Meghrajani et al, 2013;Ryan, 2012;Seité, Bensadoun, Mazer, 2017;Waghmare, 2013;Zhang, Zhang, Shao, 2013). Alguns estudos apontam a eficácia da calêndula (Andrade et al, 2012;Bolderston et al, 2006;Pommier et al, 2004) e dos corticosteróides tópicos (Andrade et al, 2012;Haruna, Lipsett, Marignol, 2017;Meghrajani et al, 2013;Salvo et al, 2010;Shukla et al, 2006) para a prevenção de radiodermatites, porém constituem evidências ainda limitadas. A revisão integrativa conduzida por Andrade et al (2012) Singh et al (2016).…”