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Trolamine emulsion for the prevention of radiation dermatitis in patients with squamous cell carcinoma of the head and neck

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Abstract

Purpose

This phase III trial was designed to test trolamine emulsion compared with the usual supportive care for patients with head and neck cancer undergoing radiation therapy with concurrent chemotherapy.

Patients and methods

Patients with biopsy-proven head and neck squamous cell carcinoma (HNSCC) treated with radical radiotherapy and weekly concurrent cisplatin 40 mg/m2 at the South Egypt Cancer Institute (Assiut) were randomly assigned to one of the following groups: treatment group (prophylactic trolamine emulsion every 8 h, 4 h apart from the radiotherapy session) or control group (usual supportive care). The primary outcome was the reduction of grade III or higher skin toxicity, as per RTOG Acute Radiation Toxicity Criteria.

Results

From March 2008 to June 2009, 30 patients were entered onto the trial. The average age was 54.5 years. Patients were predominately male (83%) and most continued to use tobacco products (70%). The rate of skin-reaction was 100% in both groups. A mild radiation reaction (grades I and II) occurred as follows: 80% (12/15 cases) in the treatment group and 46.6% (7/15 cases) in the control group. A grade III skin reaction developed in 20% (3/15 cases) in the treatment group and 53.3% (8/15 cases) in the controls. There was a significant difference (P < 0.01) between the two groups.

Conclusion

Our results confirm that trolamine emulsion significantly reduces the intensity of acute dermatitis following 3D-CRT with weekly cisplatin in HNSCC.

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References

  1. Aygenc E, Celikkanat S, Kaymakci M et al (2004) Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study. Otolaryngol Head Neck Surg 130:351–356

    Article  PubMed  Google Scholar 

  2. Birnbaum A, Dipetrillo T, Rathore R et al (2010) Cetuximab, paclitaxel, carboplatin, and radiation for head and neck cancer: a toxicity analysis. Am J Clin Oncol 33(2):144–147

    PubMed  CAS  Google Scholar 

  3. Boisnic S, Branchet-Gumila M-C, Nizri D et al (2003) Histochemical and biochemical modifications induced by experimental irradiation of human skin maintained in survival conditions and modulation by application of an emulsion containing trolamine. Int J Tissue React 25:9–18

    PubMed  CAS  Google Scholar 

  4. Bolderston A, Lloyd NS, Wong RK et al (2006) The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer 14:802–817

    Article  PubMed  Google Scholar 

  5. Bonner JA, Raisch KP, Trummell HQ et al (2000) Enhanced apoptosis with combination C225/radiation treatment serves as the impetus for clinical investigation in head and neck cancers. J Clin Oncol 18:47S–53S

    PubMed  CAS  Google Scholar 

  6. Bonner JA, Harari PM, Giralt J et al (2006) Radiotherapy plus cetuximab for squamous cell carcinoma of the head and neck. N Engl J Med 354:567–578

    Article  PubMed  CAS  Google Scholar 

  7. Campbell IR, Illingworth MH (1992) Can patients wash during radiotherapy to the breast or chest wall? A randomized controlled trial. Clin Oncol (R Coll Radiol) 4:78–82

    Article  CAS  Google Scholar 

  8. Common Terminology Criteria for Adverse Events v3.0 (CTCAE): http://ctep.cancer.gov/forms/CTCAEv3.pdf

  9. Elliott EA, Wright JR, Swann RZ et al (2006) Phase III Trial of an emulsion containing trolamine for the prevention of radiation dermatitis in patients with advanced squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group Trial 99-13. J Clin Oncol 24(13):2092–2097

    Article  PubMed  CAS  Google Scholar 

  10. Fisher J, Scott C, Stevens R et al (2000) Randomized phase III study comparing usual supportive care to Biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: Radiation Therapy Oncology Group (RTOG) 97-13. Int J Radiat Oncol Biol Phys 48:1307–1310

    Article  PubMed  CAS  Google Scholar 

  11. Glees JP, Mameghan-Zadeh H, Sparkers CG (1979) Effectiveness of topical steroids in the control of radiation dermatitis: a randomised trial using 1% hydrocortisone cream and 0.05% clobetasone butyrate (Eumovate). Clin Radiol 30:397–403

    Article  PubMed  CAS  Google Scholar 

  12. Gupta T, Agarwal JP, Ghosh-Laskar S et al (2009) Radical radiotherapy with concurrent weekly cisplatin in loco-regionally advanced squamous cell carcinoma of the head and neck: a single-institution experience. Head Neck Oncol 1(1):17

    Article  PubMed  Google Scholar 

  13. Halperin EC, Gaspar L, George S et al (1993) A double-blinded, randomized prospective trial to evaluate tropical vitamin C solution for the prevention of radiation dermatitis. Int J Radiat Oncol Biol Phys 26:413–416

    Article  PubMed  CAS  Google Scholar 

  14. Huang SM, Harari PM (2000) Modulation of radiation response after epidermal growth factor receptor blockade in squamous cell carcinomas: inhibition of damage repair, cell cycle kinetics, and tumor angiogenesis. Clin Cancer Res 6:2166–2174

    PubMed  CAS  Google Scholar 

  15. Liguori V, Guillemin C, Pesce GF et al (1997) Double-blind, randomized clinical study comparing hyaluronic acid cream to placebo in patients treated with radiotherapy. Radiother Oncol 42:155–161

    Article  PubMed  CAS  Google Scholar 

  16. Lin LC, Que J, Lin LK, Lin FC (2006) Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. Int J Radiat Oncol Biol Phys 65:745–750

    Article  PubMed  CAS  Google Scholar 

  17. Lokkevik E, Skovlund E, Reitan JB et al (1996) Skin treatment with bepanthen cream versus no cream during radiotherapy. Acta Oncol 35:1021–1026

    Article  PubMed  CAS  Google Scholar 

  18. Maddocks-Jennings W, Wilkinson JM, Shillington D (2005) Novel approaches to radiotherapy-induced skin reactions: a literature review. Complement Ther Clin Pract 11(4):224–231

    Article  PubMed  Google Scholar 

  19. Maiche AG, Gröhn P, Mäki-Hokkonen H (1991) Effects of chamomile cream and almond ointment on acute radiation skin reaction. Acta Oncol 30(3):395–396

    Article  PubMed  CAS  Google Scholar 

  20. Maiche AG, Isokangas OP, Gröhn P (1994) Skin protection by sucralfate cream during electron beam therapy. Acta Oncol 33:201–203

    Article  PubMed  CAS  Google Scholar 

  21. McQuestion M (2006) Evidence-based skin care management in radiation therapy. Semin Oncol Nurs 22:163–173

    Article  PubMed  Google Scholar 

  22. Milas L, Mason K, Hunter N et al (2000) In vivo enhancement of tumor radioresponse by C225 antiepidermal growth factor receptor antibody. Clin Cancer Res 6:701–708

    PubMed  CAS  Google Scholar 

  23. Perez-Soler R, Zou Y, Li T et al (2006) Topical vitamin K3 (Vit K3, menadione) prevents erlotinib and cetuximab-induced EGFR inhibition in the skin. J Clin Oncol 24(18S) (Abstr 3036)

  24. Protera ME, Lookingbill DF, Stryker JA (1982) Prophylaxis of radiation dermatitis with topical cortisone cream. Radiology 143:775–777

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  26. Segaert S, Van Cutsem E (2005) Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol 16:1425–1433

    Article  PubMed  CAS  Google Scholar 

  27. Segaert S, Tabernero J, Chosidow O et al (2005) The management of skin reactions in cancer patients receiving epidermal growth factor receptor targeted therapies. J Dtsch Dermatol Ges 3:599–606

    Article  PubMed  Google Scholar 

  28. Szumacher E, Wighton A, Franssen E et al (2001) Phase II study assessing the effectiveness of Biafine cream as a prophylactic agent for radiation induced acute skin toxicity to the breast in women undergoing radiotherapy with concomitant CMF chemotherapy. Int J Radiat Oncol Biol Phys 51:81–86

    PubMed  CAS  Google Scholar 

  29. Tejwani A, Wu S, Jia Y, Agulnik M, Millender L, Lacouture ME (2009) Increased risk of high-grade dermatologic toxicities with radiation plus epidermal growth factor receptor inhibitor therapy. Cancer 115(6):1286–1299

    Article  PubMed  CAS  Google Scholar 

  30. Wang R, Wu F, Wang D, Liu K (2008) Clinical effect of Biafine* in preventing and treating radioactive skin destruction of nasopharyngeal carcinoma patients caused by concurrent intensity-modulated radiotherapy and chemotherapy. Chin J Clin Oncol 5(1):58–63

    Article  Google Scholar 

  31. Wickline MM (2004) Prevention and treatment of acute radiation dermatitis: a literature review. Oncol Nurs Forum 31(2):237–247

    Article  PubMed  Google Scholar 

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Correspondence to René-Jean Bensadoun.

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Abbas, H., Bensadoun, RJ. Trolamine emulsion for the prevention of radiation dermatitis in patients with squamous cell carcinoma of the head and neck. Support Care Cancer 20, 185–190 (2012). https://doi.org/10.1007/s00520-011-1110-3

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  • DOI: https://doi.org/10.1007/s00520-011-1110-3

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