Meghrajani, C.F., Co, H.C., Ang-Tiu, C.M., & Roa, F.C. (2013). Topical corticosteroid therapy for the prevention of acute radiation dermatitis: A systematic review of randomized controlled trials. Expert Review of Clinical Pharmacology, 6, 641–649. 

DOI Link

Purpose

STUDY PURPOSE: To assess the efficacy of topical corticosteroids in the prevention of acute radiation dermatitis compared with placebo, other topical medication, or no treatment

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed, Cochrane Library, Ovid, Clinicaltrials.gov, and Google Scholar
 
KEYWORDS: Radiation dermatitis, treatment, prophylaxis, and topical corticosteroid
 
INCLUSION CRITERIA: Randomized controlled trials with parallel study design on topical corticosteroids for the prevention of acute radiation dermatitis (regardless of year of publication), patients with cancer undergoing external radiotherapy for any form of malignancy, male or female, any age. Active treatment arm: topical corticosteroid applied from day one to last day of radiotherapy to prevent radiodermatitis. Comparison arm: placebo, other topical medication, or no treatment.
 
EXCLUSION CRITERIA: Articles not written in English

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 115
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: All of the articles were independently screened by two of the study authors, who also later reviewed the eligible studies. Of the 115 articles retrieved, 9 were duplicates and another 95 were excluded because they were conducted in animal models, not written in English, not relevant to this review, lab science, case reports, guidelines, or the intervention was not a topical steroid or a combination therapy was used. The data were extracted using the Review Manager (version 5.0) software application that is used for the Cochrane Database.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 6
  • SAMPLE RANGE ACROSS STUDIES: The study sample size spectrum for both arms of the studies ranged from 23–169 participants.
  • TOTAL PATIENTS INCLUDED IN REVIEW: 413
  • KEY SAMPLE CHARACTERISTICS: All studies focused on female patients with breast cancer, ages ranging from 27–89 years, receiving post-operative radiotherapy after modified radical mastectomy or breast conservation surgery with an indication for post-operative radiotherapy. Radiotherapy was administered for an average of 25–39 days at a dose of 50–60 Gy.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

The primary outcome of the systematic review was the incidence of moist desquamation or grade 3 radiation dermatitis. Only five of the six studies mentioned moist desquamation or grade 3 radiation dermatitis as an outcome. A meta-analysis was performed on the five studies mentioning moist desquamation or grade 3 skin toxicity using Review Manager. Three studies were determined to be at low risk, one at moderate risk, and two were at high risk for bias related to study design. A quantitative synthesis of mean acute radiation dermatitis scores also was done. A pooled analysis was conducted on the five studies. Four studies showed a significant reduction of radiation dermatitis in the topical steroid arm (risk ratio = 0.39; 95% confidence interval: 0.19–0.80; p = 0.01). The risk of developing moist desquamation is 2.5 times less likely with the use of topical steroids. Heterogeneity was not a threat in this study (I2 = 0%).
 
Secondary outcomes of pruritus, burning, and pain were measured in three of the five studies. Pruritus and burning were significantly less (i.e., at least < 0.05) in the steroid arm of two studies. The lessening of pruritus and burning did not reach the p < 0.05 level of significance in the third study. Pain significantly was reduced in only one study.

Conclusions

Together, the studies showed that the prophylactic application of topical corticosteroids reduced the incidence of moist desquamation and lowered the mean acute radiation dermatitis scores.

Limitations

  • Use of different steroid medications, potency, and routes of application
  • Differing skin toxicity scales used (e.g., Radiation Therapy Oncology Group, Common Terminology Criteria for Adverse Events)
  • Lack of blinding in some studies
  • Only six studies written in English were included in all levels of the analysis
  • Breast was the only site evaluated

Nursing Implications

The results of this systematic review and meta-analysis show that topical steroids may be likely to reduce the incidence of radiotherapy-induced moist desquamation of the breast. Additional well-constructed studies consistently implementing blinding and testing the same steroid formulation and route of administration are needed. Studies examining other radiation treatment sites are indicated.

Legacy ID

4115