Antimicrobial therapy may resolve acute radiation dermatitis in breast cancer patients undergoing radiotherapy


From ASCO Post Staff

Posted: 2023/5/8 10:39:00 AM

Last update: May 8, 2023 11:13:55 AM

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Researchers have found that acute radiation dermatitis may involve skin bacteria Staphylococcus aureus Two new studies (one randomized clinical trial and one prospective cohort study) published by Kost et al. show that a simple, low-cost treatment prevents severe disease in patients undergoing radiation therapy. indicates a possibility. JAMA OncologyThe findings may indicate a potential new standard of care in this patient population.

Background

About 10 million cancer patients receive radiation therapy each year to reduce the size of their tumors. However, up to 95% of patients undergoing this treatment may develop acute radiation dermatitis, characterized by redness, pain, itching, or flaking of the skin.

Severe cases can cause marked swelling and painful skin ulcers, which can adversely affect the patient’s quality of life. Nevertheless, little is known about why this condition occurs, and standardized treatments to prevent severe acute radiation dermatitis have not been widely applied.

“until now, [acute radiation dermatitis] It was thought to be caused simply by radiation burns to the skin, which meant there wasn’t much we could do to prevent it,” explained the lead study author. Beth N. McClellan, MDAssociate Professor of Dermatology, Faculty of Medicine, Albert Einstein College of Medicine, Director of Dermatology, and Director of Supporting Oncology at Montefiore Einstein Cancer Center.

Staphylococcus aureus Bacteria normally live harmlessly on the skin, such as in the nose and underarms, but cuts that break the skin are known to cause infections. A series of radiation treatments that require daily treatment over several weeks weakens the skin structure in the treated area, causing Staphylococcus aureus Bacteria break through the outer layer of the skin.

ever since Staphylococcus aureus Bacteria are implicated in common disorders that lead to skin breakdown such as eczema. McLellan and her colleagues reasoned that bacteria may also be involved in acute radiation dermatitis. Wet desquamation is the most serious type of acute radiation dermatitis, causing skin breakdown and sores.

First Investigation: Identifying Sources

In the first study, researchers collected bacterial cultures from 76 cancer patients before and after treatment with radiation therapy. Cultures were sampled from three different body sites on her: the inside of the nose, the skin in the radiation-exposed area, and the skin on the non-radiation-exposed side.

Approximately 20% of patients tested positive before treatment. Staphylococcus aureus Bacteria, but there was no active infection. After treatment, researchers found that 48% of patients who developed severe acute radiation dermatitis had Staphylococcus aureus bacteria, compared with only 17% of those who developed the mildest form of symptoms. Staphylococcus aureus Bacteria—Suggests that bacteria from the nose may be infecting the skin.

“This study clearly [S aureus bacteria] play a major role in [acute radiation dermatitis]emphasized Dr. McClellan. “The good news is [that] There are many tools available to combat this germ,” she added.

Second Study: Prevention of Severe Acute Radiation Dermatitis

In a second study, investigators randomly assigned 77 patients (97% (n = 75/77) had undergone radiotherapy for breast cancer) to receive mupirocin 2% nasal ointment in combination with body An experimental antibacterial regimen of cleanser chlorhexidine was administered. Twice daily for 5 days, every other week during radiotherapy, or standard hygiene and moisturizing treatments.

“of [this] A study tested a combination of topical antibiotics that appeared to be effective and simple [patients] use,” said Dr. McLellan.

More than 50% of patients who received antimicrobial regimens developed mild to moderate acute radiation dermatitis, none of whom developed wet desquamation or experienced adverse effects of treatment. In contrast, severe acute radiation dermatitis affected 23% of patients receiving standard care.

Conclusion

“Our regimen is simple, inexpensive, and easy. [all patients] Has undergone radiation therapy and does not require the individual to be tested first Staphylococcus aureusI think this would change the protocol completely [patients] I am undergoing radiation therapy for breast cancer,” commented Dr. McLellan.

“Like most of our trials [the Montefiore Einstein Cancer Center], the majority of participants were Black and Hispanic members of our community.In other words, this protocol is generalizable and effective [patients] of various races and ethnicities. This is especially important. [those] People with darker skin tones are more likely to get severe symptoms [acute radiation dermatitis]A readily available treatment that we developed and tested in clinical trials could save hundreds of thousands of lives. [patients] every year [United States] from severe [acute radiation dermatitis] And its excruciating side effects,” she concludes.

Disclosure: For full study author disclosures, visit jamanetwork.com and jamanetwork.com.

The content of this post has not been reviewed by the American Society of Clinical Oncology (ASCO®) and does not necessarily reflect the views or opinions of ASCO®.




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