Up to 95 percent of patients who receive radiation therapy for cancer have acute radiation dermatitis (ARD), which is characterized by red, painful, itchy, or peeling skin.
Although little is known about why the condition develops and no standardized treatments have been widely adopted to prevent severe ARD, severe cases can lead to significant swelling and painful skin ulcers that can significantly reduce quality of life.
A common skin bacterium is implicated in many cases of ARD, and researchers at the Montefiore Einstein Cancer Center (MECC) have shown that a straightforward and affordable treatment can prevent serious cases and potentially create a new standard of care for people receiving radiation therapy.
“Until now, ARD was thought to be the result of simply burned skin from radiation, which meant there wasn’t much that could be done to prevent it,” said Beth N. McLellan, MD, director of supportive oncodermatology at Montefiore Einstein Cancer Center, lead author. from the Department of Dermatology at Montefiore Health System and Albert Einstein College of Medicine and lead author of the two studies.
“The readily available treatment we have developed and clinically tested could potentially save hundreds of thousands of people each year in the US from severe ARD and its excruciating side effects.”
Staphylococcus aureus (SA), often abbreviated to “staph”, usually lives harmlessly on the skin, often in the nose and armpits. However, they can cause infections if the skin is broken by an incision.
Radiation weakens the skin structure at the treatment site and can lead to infection by allowing SA to break through the outer layer of skin. Courses of radiation therapy routinely requiring daily treatments for several weeks increase the risk of skin infection.
Since SA is involved in common skin disorders that lead to skin breakdown, such as eczema, Dr. McLellan and her colleagues reasoned that bacteria may also play a role in ARD. In one of the JAMA Oncology studies, MECC researchers included 76 patients undergoing radiation therapy for cancer.
Bacterial cultures taken from patients before and after radiation
Bacterial cultures were taken from patients before and after radiation treatment from three different places on the body: inside the nose, from the skin in the irradiated area, and from the skin on the side of the body that was not exposed to radiation.
Before treatment, approximately 20% of patients tested positive for SA but did not have an active infection. After treatment, 48% of patients who developed severe ARD tested positive for SA, compared with only 17% of patients who developed the mildest form of the disease. Many patients with cutaneous SA also tested positive for nasal SA, suggesting that SA from the nose can infect the skin.
“This study clearly showed that SA plays a major role in ARD,” said Dr. McLellan. “The good news is that we have a lot of tools to fight this bacteria. In the second study, we tested a combination of topical antibacterial drugs that we thought would be effective and easy for people to use.”
The second study included 77 patients undergoing radiation therapy, all but two of whom had breast cancer. Although more than half of the patients treated with the antibacterial regimen developed mild to moderate ARD, no patients developed wet desquamation the most severe type of ARD that causes skin breakdown and ulceration and no patients experienced adverse effects from the treatment. In contrast, severe ARD affected 23% of participants who received standard care.
“Our regimen is simple, cheap and easy, so we believe it should be used for anyone undergoing radiation therapy, without the need to first test individuals for SA,” said Dr. McLellan. “I expect it will completely change the protocols for people undergoing radiation therapy for breast cancer.”
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