Abstract
To determine the effect of various cleaning methods for skin with acute radiation dermatitis (RD) in patients treated for nasopharyngeal carcinoma (NPC). A total of 168 NPC inpatients were randomized, while 152 patients completed the whole trial and the data were analyzed. Patients were randomly divided into the non-washing group (Group 1), washing with water alone group (Group 2), and washing with water and soap group (Group 3). All three groups received intensity-modulated radiation therapy (IMRT) with other treatments. Follow-up from recruitment or the initial radiotherapy dose to 1month after the final radiotherapy dose. CONSORT checklist was applied as the reporting guidelines for this study. The study evaluated a range of endpoints, including incidence, timing, severity of acute RD, and quality of life (QOL). There were no allergic reactions or aggravating in both washing groups during the whole treatment. The incidence of acute RD was 100% in all three groups, while the incidence of severe RD (grades 2-3) differed among groups (Group 1 vs. Group 2 vs. Group 3: 51% vs. 23.5% vs. 18%; P = 0.001), washing moderately reduced severity compared with patients without washing. Washing also delayed the onset time of acute RD; the incidence of acute RD was significantly lower than non-washing during the first 20 fractions (P < 0.001). What is more, washing reduced the incidence of moist desquamation (25.5% vs. 5.9% vs. 6%; P = 0.003) and helped relieve itching (6.49 ± 2.09 vs. 4.90 ± 1.90 vs. 4.00 ± 1.58; P < 0.001). There were no significant differences among groups with respect to pain or burning sensation. Washing improved QOL on physical (64.37 ± 4.08 vs. 67.41 ± 4.05 vs. 71.30 ± 4.87; P < 0.001), emotional (61.47 ± 4.75 vs. 65.75 ± 3.46 vs. 70.80 ± 3.27; P < 0.001), and social functional dimensions (62.64 ± 3.57 vs. 64.87 ± 3.88 vs. 68.04 ± 4.89; P < 0.001) at the end of radiotherapy, and the outcome was similar at 1month after radiotherapy (P < 0.05). Washing with water and soap was the most effective way to reduce itching and improving QOL among the three groups (P < 0.05). Washing irradiated skin reduces the occurrence and severity of acute radiation dermatitis. ChiCTR2000038231, date of registration 09.18.2020.
Highlights
Nasopharyngeal carcinoma (NPC) in China accounts for 38.29% and 40.14% of the worldwide morbidity and mortality of NPC, respectively
The incidence of acute radiation dermatitis (RD) was 100% in all three groups, while the degree of severity differed among groups
Washing moderately reduced severity compared with patients without washing; washing delayed the onset time of acute RD, reduced the incidence of moist desquamation and pruritus
Summary
Nasopharyngeal carcinoma (NPC) in China accounts for 38.29% and 40.14% of the worldwide morbidity and mortality of NPC, respectively. The associated morbidity and mortality are higher than the world average (1.2/10 million, 0.7/10 million), ranking 18th and 23rd in terms of incidence and mortality, respectively [1]. The proportions of dry and moist desquamation were higher in patients receiving treatment to the head and neck than other diseases [3]. 90–95% of NPC patients suffer from acute radiation dermatitis. Moist desquamation resulting from radical radiotherapy treatment was reported in more than 60% of patients [4]. The causes of the high incidence of RD of the neck skin include thinner skin, active sweat and sebaceous glands, more wrinkles, and frequent rubbing
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