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BROOKLYN 2 RADIOTHERAPY Patries HERST

Fri 30 th Aug 2013 Session 2 / Talk 5 11:40 – 12:00. BROOKLYN 2 RADIOTHERAPY Patries HERST. ABSTRACT

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BROOKLYN 2 RADIOTHERAPY Patries HERST

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  1. Fri 30th Aug 2013 Session 2 / Talk 5 11:40 – 12:00 BROOKLYN 2 RADIOTHERAPY Patries HERST • ABSTRACT Purpose: Severe acute radiation-induced skin reactions occur in a significant proportion of women who receive radiation therapy for breast cancer. We previously showed that soft silicone dressings decreased the severity of severe skin reactions by 40% when applied from the onset of erythema. Here we report the effect of a transparent silicone film on the severity of skin reactions and the incidence of moist desquamation when used from the beginning of treatment in breast cancer patients. Methods and Material: A total of 80 women were recruited from Dunedin Hospital. The breast or chest wall was randomly divided into lateral and medial halves at the start of radiation therapy treatment; one half was treated with Mepitel Film, the other half with aqueous cream. Skin reactions were assessed using the Radiation-Induced Skin Reaction Assessment Scale. Results: Mepitel Film prevented the onset of moist desquamation in all patients and decreased the severity of skin reactions by more than 80%. Patients preferred the film and found it very comfortable to wear. Conclusions: Mepitel Film prevents moist desquamation when used prophylactically

  2. Mepitel Film for Radiation-Induced Skin Reactions Dean Paterson, Prashika Poonam, Noelle Bennett, Annie Sutherland, Ruth Peszynski, Meredith van Beekhuizen, Katie Diggelmann, Marieke Jasperse, Patries Herst NZIMRT, 2013

  3. Rationale • Unavoidable side effect of external beam RT • No standard treatment • Form protective barrier • Inert • Adhere to healthy skin but do not stick to open wounds • Decrease the severity of erythema by 30% in a pilot study of 30 breast cancer patients. • (Diggelmann et al. Br J Radiol 83, 2010)

  4. Erythema Eligibility • Post-mastectomy • No metastatic disease • No previous RT to chest • Able to attend follow up • Good performance status In-Patient Randomization Mepilex Aqueous cream 2] % MD 3] time to MD Moist desquamation Assessment Standard dressings Mepilex RISRAS • 3x a week during TMT • 1x a week for 4 weeks after TMT completion 4] time to healing Healing Stage III RCT: Mepilex Lite: Management Trial Auckland (ARO), Palmerston North, Wellington, Dunedin 80 patients enrolled, 74 analysed 1] severity

  5. RISRAS Results of 74 mastectomy patients Decrease in overall skin reaction severity: 40% p<0.001 Paterson et al., Journal of Cancer Science and Therapy 4(11) 347-356 (2012)

  6. Moist Desquamation Results • Decreased the area of MD by 49% • Did not affect % MD or time to MD/healing • Fall off in shower or when perspiring, do not stick well in axilla • Are not transparent: can’t see tattoos • Have a small bolus effect (0.5mm), so must be removed during RT

  7. We need something better: Mepitel Film? • Same features as MepilexLite • Much thinner, transparent and more sticky than dressings and negligible bolus effect (0.1mm) Lateral Medial

  8. Eligibility In-Patient Randomization • No metastatic disease • No previous RT to chest • Able to attend follow up • Good performance status 1] severity Mepitel Film Aqueous cream 2] % MD Assessment • RISRAS • 3x a week during TMT • 1x a week for 4 weeks after TMT completion Moist desquamation Stage III RCT: Mepitel Film Dunedin: 80 patients (both breast and mastectomy) Start of RT treatment

  9. RISRAS Scores of 78 patients Decrease in severity of skin reactions: 92% P<0.001

  10. Moist Desquamation Results No Moist Desquamation under the Film

  11. No Moist Desquamation under the Film

  12. Interesting finding Stressed patients have worse skin reactions

  13. Conclusions Is Mepitel Film the answer to RT-induced acute skin reactions? Try it out and let me know……

  14. Acknowledgements Rouse Educational Trust Trial Participants Staff from Departments: Southern DHB Capital and Coast DHB Mid-Central DHB Auckland Regional Oncology Funding

  15. Difference not due to differences in dose between Film and cream covered skin. Areas measured and compared: • Axilla (2TLDs) • IFM fold (4 TLDs) • Superior-medial (5 TLDs) • Inferior Lateral (5 TLDs)

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