Topical Corticosteroids Recommended for the Treatment of PBT-Induced ARD

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Proton beam therapy has been heavily adopted for treating patients with nasopharyngeal cancer, and a high incidence of severe ARD has been reported in this patient population.

A recent investigation into incidences of severe acute radiation dermatitis (ARD) in patients with nasopharyngeal cancer (NPC) treated by proton beam therapy (PBT) suggested that topical corticosteroids, silver sulfadiazine, and non-adhering silicone dressing were effective for treating the dermatological condition.

In recent years, PBT has been heavily adopted in treating patients with NPC. Despite this, a high incidence of severe ARD has been reported in this patient population.

For this observational study, an investigative team led by Ko-Chun Fang, MD, of the Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, considered treatment outcomes and prognostic factors of patients with NPC who developed ARD from this cancer therapy.

Recruitment and ARD Measurement

Fang and colleagues recruited newly diagnosed patients with NPC who were curatively treated with PBT and received the full treatment course at the proton center of Kaohsiun Chang Gung Memorial Hospital.

Among these patients, 57 were enrolled for data analysis. The median age of this patient group at the time of diagnosis was 48 years, and a majority (73.7%) of these patients were male. Nineteen (33.3%) patients had a smoking habit, and 52 (91.2%) were treated with in combination with chemotherapy.

Weekly ARD was recorded for each patient at their treatment visits, and were based on criteria presented in the Common Terminology Criteria for Adverse Events version 4. Investigators recorded ARD across 9 time points using a 4-grade scale, with grade 4 representing “life-threatening consequences” related to skin necrosis or ulceration of full thickness dermis, among other events.

ARD Incidence and Treatment

In the first 3 weeks of therapy, no patients presented with notable ARD. By weeks 6 through 8, peak incidence of grade 2 (42.1%) and 3 (12.3%) ARD had occurred. No grade 4 ARD was observed.

Regarding treatment strategies, 24 (42.1%) patients received TCS alone, 33 (57.9%) received TCS and silver sulfadiazine, and 25 (43.8%) received non-adhering silicone dressing to cover severe skin wound areas.

A majority of grade 2 and 3 ARD had disappeared by week 11 of the study, with nearly all (93%) patients presenting with grade 1 or lower. Despite this, investigators noted a degree of chronic scar formation in 3 of the 7 patients with grade 3 ARD in follow-ups. All of these cases had a smoking habit, and 1 had diabetes.

With their study, Fang and investigators defined ARD as “a major concern for patients with NPC treated with PBT, especially those with a smoking habit or advanced nodal status”, recommending the use of TCS and topical therapies to reduce the severity of PBT-related ARD cases.

The study, “Acute radiation dermatitis among patients with nasopharyngeal carcinoma treated with proton beam therapy: Prognostic factors and treatment outcomes,” was published online in the International Wound Journal.