Acute radiation dermatitis (ARD) – characterized by redness, pain, itching, or flaking of the skin – affects up to 95% of people undergoing radiation therapy for cancer. Severe cases can cause significant swelling and painful skin ulcers that significantly impair quality of life, but little is known about why this condition occurs, and there are many strategies for preventing severe ARD. Standardized treatments are not widely adapted.
Researchers at the Montefiore Einstein Cancer Center (MECC) have found that many cases of ARD involve common skin bacteria, and that simple, low-cost treatments can prevent severe cases . Their findings were reported in two of his papers published today. JAMA OncologyEach year, 10 million people undergo radiation therapy to reduce the size of their tumors.
In the past, ARD was thought to be caused simply by radiation burning of the skin, so there wasn’t much that could be done to prevent it. A readily available treatment that we have developed and undergone clinical trials has the potential to save hundreds of thousands of people in the United States each year from severe ARD and its excruciating side effects. “
Beth N. McLellan, MD Director, Supportive Oncodermatology at Montefiore Einstein Cancer Center, Director of Dermatology at Montefiore Health System and Albert Einstein College of Medicine, and senior author of two studies
Staphylococcus aureus (SA) Bacteria, often abbreviated as “Staphylococcus”, usually live harmlessly on the skin, such as in the nose and underarms. However, cuts that break the skin can lead to infections. Radiation can cause infection by weakening the skin structure at the treatment site and allowing SA to break through the outer layers of the skin. Courses of radiation therapy regularly require weeks of routine treatment and increase the risk of developing skin infections.
Because SA has been implicated in common skin disorders that lead to skin breakdown, such as eczema, Dr. McLellan and her colleagues reasoned that the bacterium may also be involved in ARD.in one of JAMA Oncology In the study, MECC researchers enrolled 76 patients undergoing radiation therapy for cancer. Bacterial cultures were taken from the patient’s three different sites before and after radiation therapy: from the inside of the nose, from the skin in the irradiated area, and from the skin on the non-radiated side.
Before treatment, approximately 20% of patients were SA-positive but had no active infections. After treatment, his 48% of patients who developed severe ARD tested positive for the presence of her SA, compared with only 17% of patients who developed the mildest condition. Many patients with cutaneous SA also test positive for nasal SA, suggesting that nasal SA may infect the skin.
“This study clearly shows that SA plays a major role in ARD,” said Dr. McLellan. “The good news is that there are many tools available to combat this bacterium. A second study tested a combination of topical antibiotics that people found effective and easy to use.”
Prevention of severe ARD
A second study enrolled 77 patients undergoing radiation therapy, all but 2 of whom had breast cancer. Participants were randomized to receive standard care at the MECC (usual hygiene and moisturizing treatments such as her Aquaphor) or an experimental antimicrobial regimen. In this treatment, he used the body cleanser chlorhexidine and mupirocin 2% nasal ointment twice a day and every other week for 5 days during radiation therapy.
More than half of patients treated with antimicrobial regimens developed mild to moderate ARD, but no patients developed wet desquamation (the most severe type of ARD that causes the skin to break down and develop erosions). no patients experienced side effects. from treatment. In contrast, severe ARD affected his 23% of participants who received standard care.
“Our regimen is simple, inexpensive, and easy, so we believe it should be used in everyone undergoing radiation therapy, without having to test individuals for SA first,” McLellan said. the doctor said. “I think this will completely change the protocol for people undergoing radiation therapy for breast cancer.”
Dr. McClellan also said: People with darker skin are more likely to develop severe ARD. “
Montefiore Einstein Cancer Center
Cost, Y. others(2023). Bacterial eradication for prevention of radiation dermatitis. JAMA Oncologydoi.org/10.1001/jamaoncol.2023.0444.