Roy, I., Fortin, A., & Larochelle, M. (2001). The impact of skin washing with water and soap during breast irradiation: A randomized study. Radiotherapy and Oncology, 58, 333–339.

To evaluate the impact of washing breast skin with soap and water during radiation therapy on the intensity of acute skin toxicity

Patients were randomized prior to receiving radiation into two groups. In group 1, skin within the treatment field was not allowed to be washed. In group 2, skin within the treatment field could be washed with Dove^® or Ivory^® soap and water. Patients were not to apply any other materials unless prescribed by a physician. Topical treatment was prescribed for 87% of non-wash patients and 80% of wash patients for a mean duration of 18.2 and 17.6 days, respectively. The topical agents prescribed were topical corticosteroids, eosin, Burow’s solution, and Biafine^®. Patients were requested not to tell physicians if they were washing the irradiated area or not. Skin toxicity was independently scored by the author and radiation oncologist.

• The study sample was comprised of 99 patients with breast cancer who received treatment in group 1 (n = 49) or and group 2 (n = 50).
• Mean patient age was 56 years in group 1, with a range of 33.2–78 years, and 58.4 years in group 2, with a range of 27.6–84.2 years.
• Sixty-nine percent of group 1 and 72% of group 2 were postmenopausal.
• Total prescribed dose was more than 40 Gy.

The study took place at an institution in Quebec, Canada.

The study used a randomized, blinded, controlled trial design.

• Acute skin toxicity was recorded according to the Radiation Therapy Oncology Group (RTOG) scale before radiation therapy, weekly during radiation therapy, and one month after end of radiation therapy.
• Subjective assessment for pain, itching, and burning was scored by visual analog scales at the same time intervals.
• Other data included type of washing, frequency of washing, radiation technique, necessity for second simulation, and interruptions of treatment.
• Analysis was performed on an intent-to-treat basis, and no patients were excluded.

In group 1, 57% had grade 2 or higher skin toxicity. In group 2, 36% had grade 2 or higher skin toxicity (p = 0.04). Mean time to maximal toxicity score achieved was not different between the groups. Maximal erythema score was not significantly different between the two groups. Incidence of moist desquamation was significantly higher in group 1 (p = 0.03). Dry desquamation (one month after treatment) was experienced by 74% of patients in group 1 compared with 56% of patients in group 2. The difference was not significant. Variables in univariate model significantly associated with acute skin toxicity included group 1, chemotherapy as part of treatment regimen, concomitant chemotherapy, presence of hot spots on dosimetry, and increased patient weight.

Allowing patients to wash irradiated skin did not result in any increased skin toxicity.

• Patients were treated with a combination of cobalt and megavoltage equipment.
• Fifteen percent of group washed during the study.
• Soap used was not consistent, as advised in group 2.
• Not clear how use of topical agents may have also affected results.