Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
John Cavenagh, MBA, PhD, PA-C
Objective: The objective of this selective EBM review is to determine whether or not topical corticosteroids prevent and/or reduce symptoms and severity of radiation dermatitis in breast cancer patients receiving radiation therapy to the chest wall. Study Design: Review of three double blind randomized controlled clinical trials (RCTs) published in 2002, 2007, and 2011 Data Sources: Three peer-reviewed RCTs were found using PubMed. These studies compared topical corticosteroid use against various placebos in the treatment of radiation dermatitis Outcomes Measured: Severity of radiation dermatitis as reported using quality of life questionnaires, Skindex scores, and Radiation Therapy Oncology Group (RTOG) scaling. Significant outcomes were evaluated through the use of p-values and t-tests. Results: Schmuth et al (2002) found significant difference between the two treatment arms for embarrassment (p<0.05) and approached significance for dimensions of fear (p=0.06) and physical discomfort (p=0.057). Furthermore, while all dimensions worsened in the dexpanthenol treated group, only four of seven dimensions worsened in the corticosteroid group. In Miller et al (2011) itching, irritation, the persistence of symptoms, the recurrence of toxicity symptoms, and annoyance with dermatitis were all reduced by a statistically significant fraction in the treatment group compared with the placebo group in the Skindex-16. The total Skindex-16 score, however, did not reach statistical significance between the MMF arm and placebo arm with a p=0.07. In Omidvari et al (2007) all patients developed some degree of radiation dermatitis. However, patients receiving betamethasone had less severe acute radiation dermatitis than the petrolatum receiving or control groups throughout the course of the study; this difference was only significant by the end of the third week (p=0.027). Conclusion: Conflicting results from these three RCTs demonstrates that the use of topical corticosteroids in the prevention and treatment of radiation dermatitis is inconclusive
Doenges, Rebekah R., "Do topical corticosteroids improve the [skin] side effects of radiation in terms of radiation dermatitis for women undergoing radiation treatment for breast cancer?" (2015). PCOM Physician Assistant Studies Student Scholarship. 219.