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BACKGROUND AND PURPOSE: Head and neck cancer patients frequently develop radiation dermatitis (RD) during radiotherapy. We compared liposomal gel with and without chamomile extract for the prevention and management of RD in head and neck cancer patients undergoing radiotherapy. MATERIALS AND METHODS: Sixty participants undergoing radiotherapy for the first time for head and neck cancer were recruited in a double-blind randomized clinical trial. Primary outcomes were the occurrence of dry desquamation and the cumulative dose of ionizing radiation at the first occurrence of dry desquamation. Secondary outcomes were the occurrence of erythema, moist desquamation, global RD, and participant self-reported symptoms. RESULTS: Dry desquamation occurred in 76.9 % (95 % CI: 57.9, 89.0) of participants in the chamomile liposomal gel group and in 88.9 % (95 % CI: 71.9, 96.1) in the liposomal gel group (p = 0.43). The median cumulative dose of ionizing radiation when dry desquamation occurred was 48.0 Gy in the chamomile liposomal gel group and 40.0 Gy in the liposomal gel group. Fewer symptoms were reported in the chamomile liposomal gel group. CONCLUSION: No statistically significant differences in outcomes were found between the two groups, though the chamomile liposomal gel group presented with lower grades of RD than the liposomal gel group. In addition, when compared to the literature on other topical interventions to manage RD, our results show that chamomile liposomal gel has potential for better management and prevention of RD in this population, which should be further tested. This study provides crucial information to design future studies. Clinical Trials Registration (REBEC): RBR-92cts3.

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Objetivo: Analisar as evidências sobre o efeito dos agentes tópicos empregados para a prevenção da radiodermatite em pacientes com câncer. Método: Revisão sistemática de estudos clínicos randomizados duplos-cegos construída conforme recomendações do Joanna Briggs Institute e busca nas bases de dados MEDLINE/PubMed, CINAHL, LILACS, Web of Science, Embase, Scopus, além da literatura cinzenta. Utilizaram-se a ferramenta de avaliação crítica do JBI para ensaios clínicos randomizados para avaliar a possibilidade de viés, o Grading of Recommendations, Assessment, Development and Evaluation para a qualidade das evidências e o Gradepro® para recomendá-las. Resultados: Selecionaram-se 13 estudos que avaliaram diferentes agentes tópicos para prevenir a radiodermatite, a saber: corticosteroides, de ação antioxidante e fitoterápicos. A qualidade metodológica de cada estudo foi apropriada, mas a qualidade da evidência gerada pela reunião deles foi baixa, independentemente do tipo de agente tópico empregado, sugerindo que a confiança no seu efeito é limitada e tornando a força de recomendação fraca. Conclusão: Alguns agentes tópicos mostraram-se promissores para a prevenção de radiodermatite, mas as evidências aqui reunidas sobre a eficácia deles não permitem indicar seu uso para a prevenção de radiodermatite em pacientes com câncer. (AU)

Objective: To analyze the evidence on the effect of topical agents to prevent radiodermatitis in cancer patients. Methods: Systematic review of double-blind randomized clinical studies built according to JBI recommendations and search in the databases MEDLINE/PubMed, CINAHL, LILACS, Web of Science, Embase and Scopus, in addition to the Gray Literature. The JBI critical assessment tool for randomized clinical trials was used to assess the possibility of bias, GRADE for the quality of evidence, and Gradepro® to recommend them. Results: Thirteen studies were selected that evaluated different topical agents to prevent radiodermatitis, namely: corticosteroids, with antioxidant action and herbal medicines. The methodological quality of each study was appropriate. Still, the quality of evidence generated by pooling them was low, regardless of the type of topical agent employed, suggesting that confidence in its effect is limited and weakening the strength of the recommendation. Conclusions: Some topical agents have shown promise for the prevention of radiodermatitis, but the evidence gathered here about their effectiveness does not indicate their use for the prevention of radiodermatitis in cancer patients. (AU)

Objetivo: Analizar la evidencia sobre el efecto de los agentes tópicos utilizados para la prevención de la radiodermatitis en pacientes con cáncer. Método: Revisión sistemática de estudios clínicos aleatorizados, doble ciego, elaborados según las recomendaciones del JBI y buscados en MEDLINE/PubMed, CINAHL, LILACS, Web of Science, Embase y Scopus, además de literatura gris. Se utilizó la herramienta de evaluación crítica JBI para ensayos clínicos aleatorios para evaluar la posibilidad de sesgo, GRADE para la calidad de la evidencia y Gradepro® para recomendarla. Resultados: Se seleccionaron trece estudios que evaluaron diferentes agentes tópicos para prevenir la radiodermatitis, a saber: corticosteroides, con acción antioxidante y fitoterapia. La calidad metodológica de cada estudio fue apropiada, pero la calidad de la evidencia generada al combinarlos fue baja, independientemente del tipo de agente tópico empleado, lo que sugiere que la confianza en su efecto es limitada y debilita la fuerza de la recomendación. Conclusión: Algunos agentes tópicos se han mostrado prometedores para la prevención de la radiodermatitis, pero la evidencia aquí reunida sobre su eficacia no nos permite indicar su uso para la prevención de la radiodermatitis en pacientes con cáncer. (AU)

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Radiation-induced skin damage (RID) is the most prevalent, significant side effect of radiotherapy (RT). Nearly 95% of patients experience moderate to severe skin reactions after receiving radiation therapy. However, criteria for acute radiation dermatitis (ARD) treatment remain unavailable. Topical agents with anti-inflammatory properties may protect the skin and facilitate tissue regeneration in patients with RID. Many of these topical agents function through nuclear factor kappa B pathway regulation. They either reduce the levels of inflammatory factors or elicit anti-inflammatory properties of their own, thus preventing oxidative stress and inflammatory responses and thus enabling RID prevention and management. Herein, we explore the 25 topical agents investigated for RID prevention and management thus far and evaluate their mechanisms of action. These agents include 11 natural agents, 3 miscellaneous agents, 9 topical nonsteroidal agents, and 2 topical corticosteroids.

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PURPOSE: To identify potential Single Nucleotide Polymorphisms (SNPs) of susceptibility for the development of acute radiation dermatitis in head and neck cancer patients, and also to verify the association between SNPs and the severity of RD. METHODS: This systematic review was reported according to the PRISMA guideline. The proportion meta-analysis was performed to identify the prevalence of genetic markers by geographical region and radiation dermatitis severity. The meta-analysis was performed to verify the association between genetic markers and RD severity. The certainty of the evidence was assessed by GRADE. RESULTS: Thirteen studies were included. The most prevalent SNPs were XRCC3 (rs861639) (36%), TGFß1 (rs1800469) (35%), and RAD51 (rs1801321) (34%). There are prevalence studies in Europe and Asia, with a similar prevalence for all SNPs (29-40%). The prevalence was higher in patients who developed radiation dermatitis ≤2 for any subtype of genes (75-76%). No SNP showed a statistically significant association with very low certainty of evidence. CONCLUSION: The most prevalent SNPs may be predictors of acute RD. The analysis of SNP before starting radiation therapy may be a promising method to predict the risk of developing radiation dermatitis and allow radiosensitive patients to have a customized treatment. This current review provides new research directions.

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OBJECTIVE: To evaluate the skin characteristics and quality of life of patients with breast cancer undergoing radiotherapy. METHOD: Cross-sectional study conducted with 60 women. The classification scales of skin changes resulting from exposure to ionizing radiation (RTOG) and the validated versions in Portuguese of those that classified skin types (Fitzpatrick), symptoms (RISRAS) and quality of life (DLQI) were applied. in the period between December 2021 and October 2022. For data analysis, Fisher's Exact Test, Chi-Square and Asymptotic General Independence Test were used. RESULTS: 100% of patients had skin irritation. As the treatment progressed and the radiodermatitis appeared or worsened, there was a tendency for the intensity of signs and symptoms to increase, such as: sensitivity, discomfort or pain, itching, burning and heat, dry and wet desquamation, which may have impacted the quality of life and reflected in other aspects, such as: shopping activities or outings (p=0.0020), social activities or leisure activities (p=0.0420). CONCLUSION: Radiodermatitis is a common condition that affects women with breast cancer undergoing radiotherapy, skin characteristics and quality of life of patients affected during this treatment.

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BACKGROUND: One of the main adverse reactions of adjuvant radiotherapy for breast cancer is radiodermatitis. OBJECTIVE: To assess the incidence of radiodermatitis in women with breast cancer, identify factors associated with its severity and determine the time at which this event occurs. METHODS: Prospective cohort study in 113 women with breast cancer who were evaluated before radiotherapy and at every fifth session until the end of treatment. Logistic regression and Cox proportional regression model were used for the assessment of risk factors; P values < 0.05 were considered significant. RESULTS: The incidence rate of radiodermatitis was 98.2% and it was demonstrated that for each additional point of the Body Mass Index (BMI), the chance of occurrence of grades II to IV radiodermatitis increases by 14% (OR=1.14 [95% CI 1.04-1.26]; p=0.004) and statin use increases the risk of more severe skin lesions by four-fold (OR=4.27 [95% CI 1.11-16.42]; p=0.035). The exclusive use of hydrogel for skin hydration was an independent factor in delaying the onset of radiodermatitis (HR=0.55 [95% CI 0.36-0.82]; p=0.004). STUDY LIMITATIONS: The main limitation of this study was its external validity. The identified factors should be considered for services and populations similar to those in this study. CONCLUSIONS: There was a high incidence of radiodermatitis and its severity was related to higher BMI, statin use; there was a protective effect of hydrogel use.

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Avaliar a eficácia do TEGUM® versus produto já utilizado na instituição na prevenção de radiodermites. Método: Estudo prospectivo, quantitativo, do tipo descritivo-exploratório em um hospital oncológico. O projeto foi aprovado pelo Comitê de Ética em Pesquisa com o CAAE: 24278319.8.0000.0099. Resultados: Dos 88 pacientes, 96,6% tinham câncer de mama. Em média os pacientes passaram por 25 aplicações de radioterapia, sendo 92% tratados em acelerador linear e 8% em cobalto. Dos 88 pacientes, tivemos 51,1% no Braço 1 (produto à base de Aloe Vera) e 48,9% no Braço 2 (Tegum®), e após levantamento a prevenção de radiodermite foi efetiva em 70,5% dos pacientes em ambos os braços. Conclusão: Concluímos que é necessária a prevenção, visando a redução das radiodermites nos pacientes submetidos a radioterapia. Além de mais estudos que possam definir melhor essa reação, melhorando a qualidade de vida durante e após o término do tratamento oncológico.(AU)

TTo evaluate the effectiveness of TEGUM® versus the product already used in the institution in preventing radiodermatitis. Method: Prospective, quantitative, descriptive-exploratory study in an oncology hospital. The project was approved by the Research Ethics Committee with CAAE: 24278319.8.0000.0099. Results: Of the 88 patients, 96.6% had breast cancer. On average, patients underwent 25 radiotherapy applications, with 92% treated with linear accelerator and 8% with cobalt. Of the 88 patients, we had 51.1% in Arm 1 (Aloe Vera-based product) and 48.9% in Arm 2 (Tegum®), and after survey the prevention of radiodermatitis was effective in 70.5% of patients in both arms. Conclusion: We conclude that prevention is necessary, aiming to reduce radiodermatitis in patients undergoing radiotherapy. In addition to more studies that can better define this reaction, improving quality of life during and after the end of cancer treatment.(AU)

Evaluar la efectividad de TEGUM® versus el producto ya utilizado en la institución para prevenir la radiodermatitis. Método: Estudio prospectivo, cuantitativo, descriptivo-exploratorio en un hospital de oncología. El proyecto fue aprobado por el Comité de Ética en Investigación con CAAE: 24278319.8.0000.0099. Resultados: De las 88 pacientes, el 96,6% presentó cáncer de mama. En promedio, los pacientes se sometieron a 25 aplicaciones de radioterapia, de las cuales el 92% fueron tratados con acelerador lineal y el 8% con cobalto. De los 88 pacientes, teníamos el 51,1 % en el grupo 1 (producto a base de aloe vera) y el 48,9 % en el grupo 2 (Tegum®), y después de la encuesta, la prevención de la radiodermatitis fue efectiva en el 70,5 % de los pacientes en ambos grupos. Conclusión: Concluimos que la prevención es necesaria, teniendo como objetivo reducir la radiodermatitis en pacientes sometidos a radioterapia. Además de más estudios que puedan definir mejor esta reacción, mejorando la calidad de vida durante y después de finalizar el tratamiento contra el cáncer.(AU)

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Descrever como acontece a utilização de Aloe vera como estratégia de cuidado de enfermagem para o tratamento de pessoas com radiodermatites. Metodologia: caráter retrospectivo e descritivo com a técnica da entrevista semiestruturada com as enfermeiras prescritoras de Aloe. Resultados: estruturação de conhecimentos sobre o Aloe vera como conduta de enfermagem nas radiodermatites que no Hospital Solidariedade resulta na efetiva prevenção de radiodermatites, principalmente de suas formas mais graves. Salienta-se que a babosa consegue prevenir a radiodermatite através do aumento da oxigenação da lesão e da diminuição da quantidade local de tecidos mortos. O estudo, também, proporciona uma maior compreensão sobre a função do enfermeiro na radioterapia e na reabilitação da pele. Conclusão: o Aloe vera tem um papel determinante na prevenção das radiodermatites, sendo um agente terapêutico inovador na área da enfermagem dermatológica e oncológica.(AU)

To describe how Aloe vera is used as a nursing care strategy to treat people with radiodermatitis. Methodology: retrospective and descriptive, using semi-structured interviews with nurses who prescribe Aloe vera. Results: structuring of knowledge about Aloe vera as a nursing approach to radiodermatitis at Solidarity Hospital resulted in the effective prevention of radiodermatitis, especially its more severe forms. It should be noted that aloe vera can prevent radiodermatitis by increasing oxygenation of the lesion and reducing the local amount of dead tissue. The study also provides a greater understanding of the role of nurses in radiotherapy and skin rehabilitation. Conclusion: Aloe vera plays a decisive role in the prevention of radiodermatitis and is an innovative therapeutic agent in the field of dermatology and oncology nursing.(AU)

Describir cómo se utiliza el Aloe vera como estrategia de cuidados de enfermería para tratar a personas con radiodermitis. Metodología: retrospectiva y descriptiva, mediante entrevistas semiestructuradas a enfermeros que prescriben Aloe vera. Resultados: la estructuración del conocimiento sobre el Aloe vera como abordaje de enfermería para la radiodermitis en el Hospital de la Solidaridad resultó en la prevención eficaz de la radiodermitis, especialmente de sus formas más graves. Cabe destacar que el aloe vera puede prevenir la radiodermatitis al aumentar la oxigenación de la lesión y reducir la cantidad local de tejido muerto. El estudio también permite comprender mejor el papel del personal de enfermería en la radioterapia y la rehabilitación cutánea. Conclusión: El aloe vera desempeña un papel decisivo en la prevención de la radiodermatitis y es un agente terapéutico innovador en el campo de la enfermería dermatológica y oncológica.(AU)

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PURPOSE: To evaluate the effectiveness and safety of oral supplementation as a radioprotective intervention in the management of radiation dermatitis (RD). METHODS: Systematic review and meta-analysis. Six databases and the gray literature were searched for randomized controlled clinical trials (RCTs). Meta-analysis was performed only with studies that evaluated the same intervention. Methodology of included studies was evaluated by the Cochrane risk-of-bias tool for randomized trials (RoB 2.0), and the certainty of evidence was assessed by the GRADE instrument. RESULTS: Seventeen RCTs were included in this review. These evaluated different types of oral supplementations. Findings from three meta-analyses demonstrated no significant benefits to the more severe grades of RD, as oral curcuminoids (RR, 0.59; 95% CI, 0.27 to 1.29; P = 0.19; I2 = 88%), glutamine (RR, 0.40; 95% CI, 0.15 to 1.03; P = 0.06; I2 = 78%) or Wobe-Mugos (RR, 0.57; 95% CI, 0.29 to 1.14; P = 0.11; I2 = 72%). Also, the certainty of the evidence of outcomes evaluated was moderate or low. Except for a few gastrointestinal adverse events, oral supplementation was well tolerated. CONCLUSION: Most oral supplements cannot yet be recommended to manage RD due to insufficient or conflicting evidence. However, despite no significant results, glutamine was shown to be a promising substance in terms of the potential radioprotective effect and may be well tolerated. These results suggest that more RCTs with larger samples are needed to evaluate the efficacy, safety, and tolerance of glutamine in the management of RD.

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