Prophylactic barrier film may protect against post-lumpectomy radiation dermatitis
Use of a water-impermeable, friction-reducing barrier film (BF) may reduce skin toxicity (eg, radiation dermatitis, burning, and pruritus) on high-friction breast regions in women with breast cancer receiving post-lumpectomy adjuvant radiation therapy, according to a study.
Adjuvant radiotherapy to the breast often causes radiation dermatitis ranging from mild erythema to moist desquamation, said the researchers. “[T]he intact breast and surrounding areas (especially the axilla and inframammary fold) are at high-risk for friction trauma [due to movement which can abrade the top epidermal layer],” they added. “[Moreover, these areas] are subjected to higher moisture levels due to sweat and moisture retention. The increased moisture, compounded with higher friction forces, leads to reduced skin integrity.” [J R Soc Interface 2008;5:1317-1328]
The radiation-induced skin reactions can be painful and debilitating, consequently leading to radiation-dose reduction or even treatment cessation that would eventually impact quality of life, said the researchers. [Semin Oncol Nurs 2011;27:1-17]
BF creates a barrier which protects against friction trauma, allows time for repopulation of epidermal stem cells, and maintains hydration while retaining the skin’s capacity to breathe. Protecting the irradiated skin from friction trauma may delay the onset of or minimize radiation-induced skin toxicity, facilitate healing, and stabilize wound margins, they added.
Fifty-five women were randomized 1:1 to receive twice-weekly BF on the medial or lateral half of the breast from the first day of post-lumpectomy radiotherapy until treatment completion. The non-BF-treated patients received standard-of-care (SOC, ie, non-medicated cream) and served as an intra-individual comparison. [Cureus 2019;doi:10.7759/cureus.4807]
While the paired analysis revealed no significant difference between BF and SOC, exploratory unpaired analysis revealed a significant reduction in grade 2 radiation dermatitis determined using RTOG VAS*, during treatment in the lateral halves treated with BF vs SOC (0.91 vs 1.21; p=0.041).
“[T]he lateral compartment of the breast experiences increased friction from the underside of the arm and articles of clothing … BF [may have] reduced this friction, which may explain the protective effects seen during treatment … The medial compartment, which is not subjected to the same friction forces, did not receive the same benefit,” explained the researchers.
Paired analysis of patient-reported sensation scores (ie, burning, pruritus, tenderness, and pulling sensation) yielded no significant difference during and post-treatment. However, unpaired analysis of post-treatment scores for burning sensations on the lateral compartment (p=0.047) and pruritus on the medial compartment (p=0.035) were substantially lower with BF vs SOC.
Researchers underlined that patient-reported scores play a vital role in patients’ decision to continue radiotherapy hence the importance in assessing them. [Asia Pac J Clin Oncol 201;13:481-488; Jpn J Clin Oncol 2000;30:230-234]
At study end, 77 percent of patients indicated they would use BF again while 58 percent noted that it “made a meaningful impact on their skincare routine” due to the infrequent application necessary and the reduced erythema and dryness.
BF application discontinuation between the last treatment session and post-treatment appointment (when scores were obtained) might have been a limitation, noted the researchers. “BF is clinically proven to last 72 hours only, after which the film degrades. During this time, skin changes may occur … up to 3 months post-treatment. This may explain why the protective effects seen during treatment – when BF was continuously applied – did not extend post-treatment.”
Future, larger studies are thus necessary to validate the efficacy of BF, said the researchers. Further trials should also consider employing other, more reliable scoring and assessment methods**, they added.