Topical silver sulfadiazine for the prevention of acute dermatitis during irradiation for breast cancer

Abstract

This study aimed to evaluate the effectiveness of topical silver sulfadiazine (SSD) in preventing acute radiation dermatitis in women receiving radiotherapy for breast cancer. A randomized controlled clinical trial was conducted on patients with breast cancer referred for radiotherapy after treatment with mastectomy and chemotherapy. The patients were randomized into the intervention (n = 51) and control (n = 51) groups and were instructed on general skin care during radiotherapy. The intervention group received SSD cream 1%, three times a day, 3 days a week, for 5 weeks during radiotherapy and one week thereafter. A blinded observer assessed the severity of dermatitis weekly (for 6 weeks) and graded it from 0 to 4 according to the Radiation Therapy Oncology Group criteria. The two groups were similar in baseline characteristics. Two patients in the control group discontinued the radiotherapy course because of severe skin injuries (grades 3 and 4). The intervention group encountered significantly less severe dermatitis during radiotherapy compared to the controls. The total score of skin injury was also lower in the intervention group compared with controls (5.49 ± 1.02 vs. 7.21 ± 1.76, p < 0.001). A multivariate analysis found that the use of SSD cream (p < 0.001) and flat chest wall anatomy (p = 0.008) were significantly associated with a decreased skin injury. SSD cream reduced the severity of radiation-induced skin injury compared with general skin care alone. Further studies in patients with other types of cancer and also comparing SSD cream with other topical agents are warranted.