Abstract
Radiation-induced skin injury represents the most frequent side effect in breast cancer patients undergoing whole-breast irradiation (WBI). Numerous clinical studies on systemic and topical treatments for radiation dermatitis have failed to provide sustainable treatment strategies. While protective skin products such as dressings are undoubtedly the standard of care in wound care management, their utilization as preventive treatment in radiotherapy has been somewhat neglected in recent years. In this prospective, intra-patient randomized observational study, Hydrofilm polyurethane films were prophylactically applied to either the medial or lateral breast-half of 74 patients with breast cancer undergoing hypofractionated whole-breast irradiation following breast-preserving surgery. Maximum radiation dermatitis severity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.03 toxicity scores, photospectrometric erythema and pigmentation measurements and patient-assessed modified Radiation-Induced Skin Reaction Assessment Scale (RISRAS) scale. Phantom studies revealed a clinically negligible dose build-up of less than 0.1% with Hydrofilm. Compared to the control compartments physician-assessed radiation dermatitis severity was reduced in the hydrofilm compartments (mean 0.54 vs. 1.34; p = < 0.001). Objective photospectrometric skin measurements showed decreased erythema (p = 0.0001) and hyperpigmentation (p = 0.002) underneath Hydrofilm. Hydrofilm also completely prevented moist desquamation, and significantly reduced patients’ treatment-related symptoms of itching, burning, pain, and limitations of day-to-day-activities. Significant beneficial effects were observed in terms of radiation dermatitis severity, erythema, hyperpigmentation as well as subjective treatment-related symptom experiences, while adverse reactions were rare and minor. Therefore, a prophylactic application of Hydrofilm polyurethane films can be suggested in hypofractionated WBI.
Highlights
Whole-breast irradiation (WBI) represents the standard of care after breast-conserving surgery for breast cancer as it significantly improves oncologic outcomes following lumpectomy [1].Conventional fractionation regimens in WBI are typically performed over a period of 5–6 weeks with fractions of 1.8–2 Gy per day
We recently investigated the prophylactic application of polyurethane films (Hydrofilm) in an initial feasibility study and observed a reduction of both incidence and severity of radiation dermatitis during normofractionated WBI [23]
Protection from friction and maceration by dressings is the standard of care in damaged skin areas, this approach has not been widely appreciated in radiation-induced skin injury [21,23,30]
Summary
Whole-breast irradiation (WBI) represents the standard of care after breast-conserving surgery for breast cancer as it significantly improves oncologic outcomes following lumpectomy [1].Conventional fractionation regimens in WBI are typically performed over a period of 5–6 weeks with fractions (fx) of 1.8–2 Gy per day. Randomized trials have shown equivalent rates of overall survival and local control with hypofractionated WBI, which uses slightly higher doses per fx, delivered over a shorter treatment period (usually 2.5–3.33 Gy/fx) [2] This more rapid completion of therapy reduces overall health care expenditures, so hypofractionated WBI has become the preferred adjuvant treatment in WBI [3,4,5,6,7]. Even though there is rising evidence that hypofractionated WBI results in slightly lower acute skin toxicity, the most frequent acute complication of hypofractionated WBI still remains the radiation dermatitis with swelling, erythema, desquamation, burning, and pain of the irradiated integument [8,9] These reactions occur during the course of radiotherapy and can last for weeks post treatment [10]
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