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Erschienen in: Supportive Care in Cancer 4/2013

01.04.2013 | Original Article

Topical agent therapy for prevention and treatment of radiodermatitis: a meta-analysis

verfasst von: Yuejiao Zhang, Shoude Zhang, Xiaoling Shao

Erschienen in: Supportive Care in Cancer | Ausgabe 4/2013

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Abstract

Background

Radiodermatitis (RD) is a common side effect during radiotherapy. Various topical agents have been tried to be applied on RD. However, the efficiency of topical agents applied on radiotherapy is still uncertain.

Objective

This study aims to assess the efficiency of the topical agents in the prevention and treatment of RD.

Methods

The Cochrane Central Register of Controlled Trials, Pubmed, and Medline were searched for relevant reports. Quantitative analysis was carried out to evaluate the efficiency of topical agents in the prevention and treatment of RD.

Results

Twenty reports involving 3,098 patients were included: 2,406 patients for prophylactic trials and 692 for treatment trials, respectively. For prophylactic trials, primary meta-analysis indicated that using topical agents could not reduce the incidence of grade 2 and higher RD (P = 0.128, RR = 0.90, 95 % CI = 0.78–1.03) with a high heterogeneity (P = 0.000, I 2 = 71.5 %). In subgroup analyses, heterogeneity disappeared by excluding reports with low Jadad score (≤3) (P = 0.292, I 2 = 15.2 %), and still no significant difference was found between the topical agent group and control group (P = 0.625, RR = 0.98, 95 % CI = 0.89–1.07). In addition, for treatment trials, topical agents failed to increase the incidence of wound healing (P = 0.784, RR = 1.01, 95 % CI = 0.92–1.12) with a high heterogeneity (P = 0.067, I 2 = 51.5 %).

Conclusions

Topical agents could not prevent or treat RD effectively. New type of agents should be developed to improve the efficiency based on the pathophysiology of RD.
Literatur
1.
Zurück zum Zitat Delaney G, Jacob S, Featherstone C et al (2005) The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer 104:1129–1137PubMedCrossRef Delaney G, Jacob S, Featherstone C et al (2005) The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer 104:1129–1137PubMedCrossRef
2.
Zurück zum Zitat Benomar S, Boutayeb S, Laiya I et al (2010) Treatment and prevention of acute radiation dermatitis. Cancer Radiother 14:213–216PubMedCrossRef Benomar S, Boutayeb S, Laiya I et al (2010) Treatment and prevention of acute radiation dermatitis. Cancer Radiother 14:213–216PubMedCrossRef
3.
Zurück zum Zitat Becker-Schiebe M, Mengs U, Schaefer M et al (2011) Topical use of a silymarin-based preparation to prevent radiodermatitis. Strahlenther Onkol 187:485–491PubMedCrossRef Becker-Schiebe M, Mengs U, Schaefer M et al (2011) Topical use of a silymarin-based preparation to prevent radiodermatitis. Strahlenther Onkol 187:485–491PubMedCrossRef
4.
Zurück zum Zitat Richardson J, Smith JE, McIntyre M et al (2005) Aloe vera for preventing radiation-induced skin reactions: a systematic literature review. Clin Oncol 17:478–484CrossRef Richardson J, Smith JE, McIntyre M et al (2005) Aloe vera for preventing radiation-induced skin reactions: a systematic literature review. Clin Oncol 17:478–484CrossRef
5.
Zurück zum Zitat D’Haese S, Bate T, Claes S et al (2005) Management of skin reactions during radiotherapy: a study of nursing practice. Eur J Canc Care 14:28–42CrossRef D’Haese S, Bate T, Claes S et al (2005) Management of skin reactions during radiotherapy: a study of nursing practice. Eur J Canc Care 14:28–42CrossRef
6.
Zurück zum Zitat Wickline MM (2004) Prevention and treatment of acute radiation dermatitis: a literature review. Oncol Nurs Forum 31:237–244PubMedCrossRef Wickline MM (2004) Prevention and treatment of acute radiation dermatitis: a literature review. Oncol Nurs Forum 31:237–244PubMedCrossRef
7.
Zurück zum Zitat Miller RC, Schwartz DJ, Sloan JA et al (2011) Mometasone furoate effect on acute skin toxicity in breast cancer patients receiving radiotherapy: a phase III double-blind, randomized trial from the north central cancer treatment group N06C4. Int J Radiat Oncol Biol Phys 79:1460–1466PubMedCrossRef Miller RC, Schwartz DJ, Sloan JA et al (2011) Mometasone furoate effect on acute skin toxicity in breast cancer patients receiving radiotherapy: a phase III double-blind, randomized trial from the north central cancer treatment group N06C4. Int J Radiat Oncol Biol Phys 79:1460–1466PubMedCrossRef
8.
Zurück zum Zitat Bostrom A, Lindman H, Swarthing C et al (2001) Potent corticosteroid cream (mometasone furoate) significantly reduce radiation dermatitis: results from a double-blind, randomized study. Radiot Oncol 59:257–265CrossRef Bostrom A, Lindman H, Swarthing C et al (2001) Potent corticosteroid cream (mometasone furoate) significantly reduce radiation dermatitis: results from a double-blind, randomized study. Radiot Oncol 59:257–265CrossRef
9.
Zurück zum Zitat Omidvari S, Saboori H, Mohammadianpanah M et al (2007) Topical betamethason for prevention of radiation dermatitis. Indian J Dermatol Veneraol Leprol 73:209–216CrossRef Omidvari S, Saboori H, Mohammadianpanah M et al (2007) Topical betamethason for prevention of radiation dermatitis. Indian J Dermatol Veneraol Leprol 73:209–216CrossRef
10.
Zurück zum Zitat Shukla PN, Gairola M, Mohanti BK et al (2006) Prophylactic beclomethasone spray to the skin during postoperative radiotherapy of carcinoma breast: a prospective randomized study. Indian J Canc 43:180–184CrossRef Shukla PN, Gairola M, Mohanti BK et al (2006) Prophylactic beclomethasone spray to the skin during postoperative radiotherapy of carcinoma breast: a prospective randomized study. Indian J Canc 43:180–184CrossRef
11.
Zurück zum Zitat Mak SS, Alexander M, Wai-man W et al (2000) The effects of hydrocolloid dressing and gentian violet on radiation-induced moist desquamation wound healing. Canc Nurs 23:220–229CrossRef Mak SS, Alexander M, Wai-man W et al (2000) The effects of hydrocolloid dressing and gentian violet on radiation-induced moist desquamation wound healing. Canc Nurs 23:220–229CrossRef
12.
Zurück zum Zitat Masferrer JP, Mejía MM, Fernández MV et al (2010) Prophylaxis with a cream containing urea reduces the incidence and severity of radio-induced dermatitis. Clin Transl Oncol 12:43–48CrossRef Masferrer JP, Mejía MM, Fernández MV et al (2010) Prophylaxis with a cream containing urea reduces the incidence and severity of radio-induced dermatitis. Clin Transl Oncol 12:43–48CrossRef
13.
Zurück zum Zitat Rizza L, D’Agostino A, Girlando A et al (2010) Evaluation of the effect of topical agents on radiation-induced skin disease by reflectance spectrophotometry. J Pharma Pharmacol 62:779–785 Rizza L, D’Agostino A, Girlando A et al (2010) Evaluation of the effect of topical agents on radiation-induced skin disease by reflectance spectrophotometry. J Pharma Pharmacol 62:779–785
14.
Zurück zum Zitat Gollins S, Gaffney C, Slade S et al (2008) RCT on gentian violet versus a hydrogel dressing for radiotherapy-induced moist skin desquamation. J Wound Care 17:268–275PubMed Gollins S, Gaffney C, Slade S et al (2008) RCT on gentian violet versus a hydrogel dressing for radiotherapy-induced moist skin desquamation. J Wound Care 17:268–275PubMed
15.
Zurück zum Zitat Hongbing M, Xiaozhi Z, Minghua B et al (2007) Clinical effect of Lianbai liquid in prevention and treatment of dermal injury caused by radiotherapy. J Tradit Chin Med 27:193–196 Hongbing M, Xiaozhi Z, Minghua B et al (2007) Clinical effect of Lianbai liquid in prevention and treatment of dermal injury caused by radiotherapy. J Tradit Chin Med 27:193–196
16.
Zurück zum Zitat Liguori V, Guillemin C, Pesce GF et al (1997) Double-blind, randomized clinical study comparing hyaluronic acid cream to placebo in patients treated with radiotherapy. Radiot Oncol 42:155–161CrossRef Liguori V, Guillemin C, Pesce GF et al (1997) Double-blind, randomized clinical study comparing hyaluronic acid cream to placebo in patients treated with radiotherapy. Radiot Oncol 42:155–161CrossRef
17.
Zurück zum Zitat Schmuth M, Wimmer MA, Hofer S et al (2002) Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study. Br J Dermatol 146:983–991PubMedCrossRef Schmuth M, Wimmer MA, Hofer S et al (2002) Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study. Br J Dermatol 146:983–991PubMedCrossRef
18.
Zurück zum Zitat Williams MS, Burk M, Loprinzi CL et al (1996) Phase III double-blind evaluation of an Aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys 36:345–349PubMedCrossRef Williams MS, Burk M, Loprinzi CL et al (1996) Phase III double-blind evaluation of an Aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys 36:345–349PubMedCrossRef
19.
Zurück zum Zitat Heggie S, Bryant GP, Tripcony L et al (2002) A phase III study on the efficacy of topical Aloe vera gel on irradiated breast tissue. Canc Nurs 25:442–451CrossRef Heggie S, Bryant GP, Tripcony L et al (2002) A phase III study on the efficacy of topical Aloe vera gel on irradiated breast tissue. Canc Nurs 25:442–451CrossRef
20.
Zurück zum Zitat Gosselin TK, Schneider SM, Plambeck MA et al (2010) A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy. Oncol Nurs Forum 37:619–626PubMedCrossRef Gosselin TK, Schneider SM, Plambeck MA et al (2010) A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy. Oncol Nurs Forum 37:619–626PubMedCrossRef
21.
Zurück zum Zitat Fisher J, Scott C, Stevens R et al (2000) Randomized phase III study comparing best supportive care to biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: radiation therapy oncology group (RTOG) 97-13. Int J Radiat Oncol Biol Phys 48:1307–1310PubMedCrossRef Fisher J, Scott C, Stevens R et al (2000) Randomized phase III study comparing best supportive care to biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: radiation therapy oncology group (RTOG) 97-13. Int J Radiat Oncol Biol Phys 48:1307–1310PubMedCrossRef
22.
Zurück zum Zitat Mak SS, Zee CY, Molassiotis A et al (2005) A comparison of wound treatments in nasopharyngeal cancer patients receiving radiation therapy. Canc Nurs 28:436–445CrossRef Mak SS, Zee CY, Molassiotis A et al (2005) A comparison of wound treatments in nasopharyngeal cancer patients receiving radiation therapy. Canc Nurs 28:436–445CrossRef
23.
Zurück zum Zitat Delaney G, Fisher R, Hook C et al (1997) Sucralfate cream in the management of moist desquamation during radiotherapy. Australas Radiol 41:270–275PubMedCrossRef Delaney G, Fisher R, Hook C et al (1997) Sucralfate cream in the management of moist desquamation during radiotherapy. Australas Radiol 41:270–275PubMedCrossRef
24.
Zurück zum Zitat Elliott EA, Wright JR, Swann S et al (2006) Phase III trial of an emulsion containing trolamine for the prevention of radiation dermatitis in patients with advanced squamous cell carcinoma of the head and neck: results of radiation therapy oncology group trial 99-13. J Clin Oncol 24:2092–2096PubMedCrossRef Elliott EA, Wright JR, Swann S et al (2006) Phase III trial of an emulsion containing trolamine for the prevention of radiation dermatitis in patients with advanced squamous cell carcinoma of the head and neck: results of radiation therapy oncology group trial 99-13. J Clin Oncol 24:2092–2096PubMedCrossRef
25.
Zurück zum Zitat Jadad AR, Moore RA et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRef Jadad AR, Moore RA et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRef
26.
Zurück zum Zitat Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRef Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRef
27.
Zurück zum Zitat Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101PubMedCrossRef Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101PubMedCrossRef
28.
Zurück zum Zitat Egger M, Davey SG (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRef Egger M, Davey SG (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRef
29.
Zurück zum Zitat Aistars J (2005) The validity of skin care protocols followed by women with breast cancer receiving external radiation. Clin J Oncol Nurs 10:487–493CrossRef Aistars J (2005) The validity of skin care protocols followed by women with breast cancer receiving external radiation. Clin J Oncol Nurs 10:487–493CrossRef
30.
Zurück zum Zitat Sitton E (1992) Early and late radiation-induced skin alterations. part I: mechanisms of skin reactions. Oncol Nurs Forum 13:11–16 Sitton E (1992) Early and late radiation-induced skin alterations. part I: mechanisms of skin reactions. Oncol Nurs Forum 13:11–16
31.
Zurück zum Zitat Hymes SR, Strom EA, Fife C (2006) Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol 54:28–46PubMedCrossRef Hymes SR, Strom EA, Fife C (2006) Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol 54:28–46PubMedCrossRef
32.
Zurück zum Zitat Dunne-Daly CF (1995) Skin and wound care in radiation oncology. Canc Nurs 18:144–162 Dunne-Daly CF (1995) Skin and wound care in radiation oncology. Canc Nurs 18:144–162
33.
Zurück zum Zitat Cronstein BN, Kimmel SC, Levin RI et al (1992) A mechanism for the antiinflammatory effects of corticosteroids: the glucocorticoid receptor regulates leukocyte adhesion to endothelial cells and expression of endothelial-leukocyte adhesion molecule 1 and intercellular adhesion molecule 1. Proc Natl Acad Sci 89:9991–9995PubMedCrossRef Cronstein BN, Kimmel SC, Levin RI et al (1992) A mechanism for the antiinflammatory effects of corticosteroids: the glucocorticoid receptor regulates leukocyte adhesion to endothelial cells and expression of endothelial-leukocyte adhesion molecule 1 and intercellular adhesion molecule 1. Proc Natl Acad Sci 89:9991–9995PubMedCrossRef
34.
Zurück zum Zitat Shaw TJ, Martin P (2009) Wound repair at a glance. J Cell Sci 122:3215–3223CrossRef Shaw TJ, Martin P (2009) Wound repair at a glance. J Cell Sci 122:3215–3223CrossRef
35.
Zurück zum Zitat Doughty D (1992) Principles of wound healing and wound management. In: Bryant BA (ed) Acute and chronic wounds: nursing management. Moshy-Year Book, St Louis, p 45 Doughty D (1992) Principles of wound healing and wound management. In: Bryant BA (ed) Acute and chronic wounds: nursing management. Moshy-Year Book, St Louis, p 45
36.
Zurück zum Zitat Hotter AN (1990) Wound healing and immunocompromise. Nurs Clin North Am 25:193–203PubMed Hotter AN (1990) Wound healing and immunocompromise. Nurs Clin North Am 25:193–203PubMed
37.
Zurück zum Zitat Olascoaga A, Vilar-Compte D, Poitevin-Chacon A et al (2008) Wound healing in radiated skin: pathophysiology and treatment options. Int Wound J 5:246–257PubMedCrossRef Olascoaga A, Vilar-Compte D, Poitevin-Chacon A et al (2008) Wound healing in radiated skin: pathophysiology and treatment options. Int Wound J 5:246–257PubMedCrossRef
38.
Zurück zum Zitat Braund R, Hook S, Medlicott NJ (2007) The role of topical growth factors in chronic wounds. Curr Drug Deliv 4:195–204PubMedCrossRef Braund R, Hook S, Medlicott NJ (2007) The role of topical growth factors in chronic wounds. Curr Drug Deliv 4:195–204PubMedCrossRef
39.
Zurück zum Zitat Robson MC, Mustoe TA, Hunt TK (1998) The future of recombinant growth factors in wound healing. Am J Surg 176:80S–82SPubMedCrossRef Robson MC, Mustoe TA, Hunt TK (1998) The future of recombinant growth factors in wound healing. Am J Surg 176:80S–82SPubMedCrossRef
40.
Zurück zum Zitat Goldman R (2004) Growth factors and chronic wound healing: past, present, and future. Adv Skin Wound Care 17:24–35PubMedCrossRef Goldman R (2004) Growth factors and chronic wound healing: past, present, and future. Adv Skin Wound Care 17:24–35PubMedCrossRef
41.
Zurück zum Zitat Steed DL (1998) Modifying the wound healing response with exogenous growth factors. Clin Plast Surg 25:397–405PubMed Steed DL (1998) Modifying the wound healing response with exogenous growth factors. Clin Plast Surg 25:397–405PubMed
Metadaten
Titel
Topical agent therapy for prevention and treatment of radiodermatitis: a meta-analysis
verfasst von
Yuejiao Zhang
Shoude Zhang
Xiaoling Shao
Publikationsdatum
01.04.2013
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 4/2013
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-012-1622-5

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