Comparison of Acute Radiation Dermatitis Secondary to Proton Beam Therapy Between Corticosteroids Transdermal Delivery Plus Film Dressing and Film Dressing Alone

Abstract

Acute radiation dermatitis (ARD) is one of the most common adverse events of proton beam therapy (PBT). Corticosteroid transdermal delivery (CTD) and film dressing (FD) have been recognized as effective treatments for ARD, however, ARD differs substantially between individuals, which makes it harder to provide the most appropriate treatment for patients. The purpose of this study was to examine the prophylactic effect of CTD plus FD on PBT-induced ARD as compared with FD alone in every patient. We conducted an institutional prospective study to manage separately on the right and left irradiated skin to a patient, namely placing an AIRWALL as FD after applying betamethasone valerate lotion as CTD on the right and putting an AIRWALL on the left. Fifty patients with prostate cancer were enrolled to the study from November 2017 to March 2018 and were irradiated a total dose of 70 Gy equivalent with 28 fractions using bilateral horizontal beams. It was not until the AIRWALL peeled off the skin spontaneously and completely that a new one was placed. Both sides of photographs were taken every weekday to evaluate ARD during the period of PBT. The patients’ median age was 68 (range, 47–81 years). Grade 0/1 ARD was seen in 28/22 patients on the right and 30/20 patients on the left, respectively. There was no significant difference between the both sides. The number of replacements of ARIWALL in a patient during PBT was 7.7 ± 4.8 (mean ± SD) on the right and 2.4 ± 1.4 on the left, respectively. A significant difference was seen between the two (p<0.0001). As far as patients with less 6 times replacement of AIRWALL in PBT, Grade 0/1 ARD was seen in 18/4 patients on the right and 14/8 patients on the left, respectively. Film dressing combined with corticosteroid transdermal delivery did not reduce the severity of ARD secondary to PBT for patients with prostate cancer compared with film dressing alone. Fewer replacement of film dressing in a patient may be a key to a synergistic effect of CTD and FD for reducing ARD.