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Barrier Films and Dressings for the Prevention of Acute Radiation Dermatitis: A Systematic Review and Meta-Analysis

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A Correction to this article was published on 12 May 2023

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Abstract

Purpose

This systematic review and meta-analysis aimed to evaluate the efficacy of barrier films and dressings in preventing acute radiation dermatitis (RD).

Methods

OVID Medline, Embase, and Cochrane databases were searched from 1946 to September 2020 to identify randomized controlled trials on the use of barrier films or dressings to prevent RD. For comparable outcomes between studies, pooled effect sizes and 95% confidence intervals (CI) were calculated using the random effects analysis in RevMan 5.4.

Results

Fourteen and 11 studies were included in the qualitative and quantitative analyses, respectively. Five types of barrier films used for RD were identified: Hydrofilm, StrataXRT®, Mepitel® Film, 3 M™ Cavilon™ No-Sting Barrier Film, and silver leaf nylon dressing. Hydrofilm and Mepitel Film significantly reduced the development of RD grade ≥ 2 in breast and head and neck cancer patients (RR 0.32, 95%CI 0.19, 0.56, p < 0.0001; RR 0.21, 95%CI 0.05, 0.89, p = 0.03, resp.). Moreover, Hydrofilm had a beneficial effect on patient-reported outcomes (PROs) (SMD -0.75, 95%CI -1.2, -0.29, p = 0.001). The meta-analyses on the other barrier films did not show any significant effect.

Conclusion

This review and meta-analysis demonstrated that Hydrofilm and Mepitel Film could effectively reduce RD severity and improve PROs. The evidence is generally weak for all the studies on barrier films and dressings due to a limited study number, high risk of bias, small sample sizes, and minimal comparable outcome measures. It’s potential has been proven, but future research in this field is recommended to confirm the efficacy of these products and assess real-world feasibility.

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References

  1. Lilla C, Ambrosone CB, Kropp S, Helmbold I, Schmezer P, von Fournier D et al (2007) Predictive factors for late normal tissue complications following radiotherapy for breast cancer. Breast Cancer Res Treat 106(1):143–150. https://doi.org/10.1007/s10549-006-9480-9

    Article  PubMed  Google Scholar 

  2. McQuestion M (2011) Evidence-based skin care management in radiation therapy: clinical update. Semin Oncol Nurs 27(2):e1-17. https://doi.org/10.1016/j.soncn.2011.02.009

    Article  PubMed  Google Scholar 

  3. Rosenthal A, Israilevich R, Moy R (2019) Management of acute radiation dermatitis: A review of the literature and proposal for treatment algorithm. J Am Acad Dermatol 81(2):558–567. https://doi.org/10.1016/j.jaad.2019.02.047

    Article  PubMed  Google Scholar 

  4. Xie Y, Wang Q, Hu T, Chen R, Wang J, Chang H et al (2021) Risk Factors Related to Acute Radiation Dermatitis in Breast Cancer Patients After Radiotherapy A Systematic Review and Meta-Analysis. Front Oncol 11:738851. https://doi.org/10.3389/fonc.2021.738851

    Article  PubMed  PubMed Central  Google Scholar 

  5. Giro C, Berger B, Bolke E, Ciernik IF, Duprez F, Locati L et al (2009) High rate of severe radiation dermatitis during radiation therapy with concurrent cetuximab in head and neck cancer: results of a survey in EORTC institutes. Radiother Oncol 90(2):166–171. https://doi.org/10.1016/j.radonc.2008.09.007

    Article  CAS  PubMed  Google Scholar 

  6. Herst PM (2014) Protecting the radiation-damaged skin from friction: a mini review. J Med Radiat Sci 61(2):119–125. https://doi.org/10.1002/jmrs.46

    Article  PubMed  PubMed Central  Google Scholar 

  7. Haruna F, Lipsett A, Marignol L (2017) Topical Management of Acute Radiation Dermatitis in Breast Cancer Patients A Systematic Review and Meta-Analysis. Anticancer Res 37(10):5343–53. https://doi.org/10.21873/anticanres.11960

    Article  PubMed  Google Scholar 

  8. Sprigle S, Caminiti R, Varenberg M (2021) Friction characteristics of preventative wound dressings under clinically-relevant conditions. Wound Repair Regen 29(2):280–283. https://doi.org/10.1111/wrr.12880

    Article  PubMed  Google Scholar 

  9. Bernatchez SF, Mengistu GE, Ekholm BP, Sanghi S, Theiss SD (2015) Reducing Friction on Skin at Risk: The Use of 3M(™) Cavilon(™) No Sting Barrier Film. Adv Wound Care (New Rochelle) 4(12):705–710. https://doi.org/10.1089/wound.2015.0628

    Article  PubMed  Google Scholar 

  10. Woo KY, Beeckman D, Chakravarthy D (2017) Management of Moisture-Associated Skin Damage: A Scoping Review. Adv Skin Wound Care 30(11):494–501. https://doi.org/10.1097/01.ASW.0000525627.54569.da

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fernandez-Castro M, Martin-Gil B, Pena-Garcia I, Lopez-Vallecillo M, Garcia-Puig ME (2017) Effectiveness of semi-permeable dressings to treat radiation-induced skin reactions. A systematic review. Eur J Cancer Care (Engl) 26(6). https://doi.org/10.1111/ecc.12685.

  12. Schmeel LC, Koch D, Stumpf S, Leitzen C, Simon B, Schuller H et al (2018) Prophylactically applied Hydrofilm polyurethane film dressings reduce radiation dermatitis in adjuvant radiation therapy of breast cancer patients. Acta Oncol 57(7):908–915. https://doi.org/10.1080/0284186X.2018.1441542

    Article  CAS  PubMed  Google Scholar 

  13. Schmeel LC, Koch D, Schmeel FC, Bucheler B, Leitzen C, Mahlmann B et al. (2019) Hydrofilm Polyurethane Films Reduce Radiation Dermatitis Severity in Hypofractionated Whole-Breast Irradiation: An Objective, Intra-Patient Randomized Dual-Center Assessment. Polymers (Basel) 11(12). https://doi.org/10.3390/polym11122112.

  14. Ahn S, Sung K, Kim HJ, Choi YE, Lee YK, Kim JS et al (2020) Reducing Radiation Dermatitis Using a Film-forming Silicone Gel During Breast Radiotherapy A Pilot Randomized-controlled Trial. In Vivo 34(1):413–22. https://doi.org/10.21873/invivo.11790

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Chan RJ, Blades R, Jones L, Downer TR, Peet SC, Button E et al (2019) A single-blind, randomised controlled trial of StrataXRT(R) - A silicone-based film-forming gel dressing for prophylaxis and management of radiation dermatitis in patients with head and neck cancer. Radiother Oncol 139:72–78. https://doi.org/10.1016/j.radonc.2019.07.014

    Article  CAS  PubMed  Google Scholar 

  16. Meuleneire F (2014) A vapour-permeable film dressing used on superficial wounds. Br J Nurs 23(15):S36, S8-43. https://doi.org/10.12968/bjon.2014.23.Sup15.s36

  17. Moller PK, Olling K, Berg M, Habaek I, Haislund B, Iversen AM et al (2018) Breast cancer patients report reduced sensitivity and pain using a barrier film during radiotherapy - A Danish intra-patient randomized multicentre study. Tech Innov Patient Support Radiat Oncol 7:20–25. https://doi.org/10.1016/j.tipsro.2018.05.004

    Article  PubMed  PubMed Central  Google Scholar 

  18. Graham P, Browne L, Capp A, Fox C, Graham J, Hollis J et al (2004) Randomized, paired comparison of No-Sting Barrier Film versus sorbolene cream (10% glycerine) skin care during postmastectomy irradiation. Int J Radiat Oncol Biol Phys 58(1):241–246. https://doi.org/10.1016/s0360-3016(03)01431-7

    Article  PubMed  Google Scholar 

  19. Holder IA, Durkee P, Supp AP, Boyce ST (2003) Assessment of a silver-coated barrier dressing for potential use with skin grafts on excised burns. Burns 29(5):445–448. https://doi.org/10.1016/s0305-4179(03)00046-9

    Article  PubMed  Google Scholar 

  20. Wright JB, Lam K, Buret AG, Olson ME, Burrell RE (2002) Early healing events in a porcine model of contaminated wounds: effects of nanocrystalline silver on matrix metalloproteinases, cell apoptosis, and healing. Wound Repair Regen 10(3):141–151. https://doi.org/10.1046/j.1524-475x.2002.10308.x

    Article  PubMed  Google Scholar 

  21. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  22. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. https://doi.org/10.1136/bmj.39489.470347.AD

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hadorn DC, Baker D, Hodges JS, Hicks N (1996) Rating the quality of evidence for clinical practice guidelines. J Clin Epidemiol 49(7):749–754. https://doi.org/10.1016/0895-4356(96)00019-4

    Article  CAS  PubMed  Google Scholar 

  24. Yan J, Yuan L, Wang J, Li S, Yao M, Wang K et al (2020) Mepitel Film is superior to Biafine cream in managing acute radiation-induced skin reactions in head and neck cancer patients: a randomised intra-patient controlled clinical trial. J Med Radiat Sci 67(3):208–216. https://doi.org/10.1002/jmrs.397

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wooding H, Yan J, Yuan L, Chyou TY, Gao S, Ward I et al (2018) The effect of Mepitel Film on acute radiation-induced skin reactions in head and neck cancer patients: a feasibility study. Br J Radiol 91(1081):20170298. https://doi.org/10.1259/bjr.20170298

    Article  PubMed  Google Scholar 

  26. Rades D, Narvaez CA, Splettstosser L, Domer C, Setter C, Idel C et al (2019) A randomized trial (RAREST-01) comparing Mepitel(R) Film and standard care for prevention of radiation dermatitis in patients irradiated for locally advanced squamous cell carcinoma of the head-and-neck (SCCHN). Radiother Oncol 139:79–82. https://doi.org/10.1016/j.radonc.2019.07.023

    Article  PubMed  Google Scholar 

  27. Herst PM, Bennett NC, Sutherland AE, Peszynski RI, Paterson DB, Jasperse ML (2014) Prophylactic use of Mepitel Film prevents radiation-induced moist desquamation in an intra-patient randomised controlled clinical trial of 78 breast cancer patients. Radiother Oncol 110(1):137–143. https://doi.org/10.1016/j.radonc.2014.01.005

    Article  CAS  PubMed  Google Scholar 

  28. Shaw SZ, Nien HH, Wu CJ, Lui LT, Su JF, Lang CH (2015) 3M Cavilon No-Sting Barrier Film or topical corticosteroid (mometasone furoate) for protection against radiation dermatitis: A clinical trial. J Formos Med Assoc 114(5):407–414. https://doi.org/10.1016/j.jfma.2013.04.003

    Article  CAS  PubMed  Google Scholar 

  29. Lam AC, Yu E, Vanwynsberghe D, O’Neil M, D’Souza D, Cao J et al (2019) Phase III Randomized Pair Comparison of a Barrier Film vs Standard Skin Care in Preventing Radiation Dermatitis in Post-lumpectomy Patients with Breast Cancer Receiving Adjuvant Radiation Therapy. Cureus 11(6):e4807. https://doi.org/10.7759/cureus.4807

    Article  PubMed  PubMed Central  Google Scholar 

  30. Niazi TM, Vuong T, Azoulay L, Marijnen C, Bujko K, Nasr E et al (2012) Silver clear nylon dressing is effective in preventing radiation-induced dermatitis in patients with lower gastrointestinal cancer: results from a phase III study. Int J Radiat Oncol Biol Phys 84(3):e305–e310. https://doi.org/10.1016/j.ijrobp.2012.03.062

    Article  CAS  PubMed  Google Scholar 

  31. Aquino-Parsons C, Lomas S, Smith K, Hayes J, Lew S, Bates AT et al (2010) Phase III Study of Silver Leaf Nylon Dressing vs Standard Care for Reduction of Inframammary Moist Desquamation in Patients Undergoing Adjuvant Whole Breast Radiation Therapy. J Med Imaging Radiat Sci 41(4):215–221. https://doi.org/10.1016/j.jmir.2010.08.005

    Article  PubMed  Google Scholar 

  32. Rades D, Narvaez CA, Splettstößer L, Dömer C, Setter C, Idel C et al (2019) A randomized trial (RAREST-01) comparing Mepitel® Film and standard care for prevention of radiation dermatitis in patients irradiated for locally advanced squamous cell carcinoma of the head-and-neck (SCCHN). Radiother Oncol 139:79–82. https://doi.org/10.1016/j.radonc.2019.07.023

    Article  PubMed  Google Scholar 

  33. Niculescu AG, Grumezescu AM (2022) An Up-to-Date Review of Biomaterials Application in Wound Management. Polymers (Basel) 14(3). https://doi.org/10.3390/polym14030421.

  34. Shi C, Wang C, Liu H, Li Q, Li R, Zhang Y et al (2020) Selection of Appropriate Wound Dressing for Various Wounds. Front Bioeng Biotechnol 8:182. https://doi.org/10.3389/fbioe.2020.00182

    Article  PubMed  PubMed Central  Google Scholar 

  35. Weller CD, Team V, Sussman G (2020) First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence. Front Pharmacol 11:155. https://doi.org/10.3389/fphar.2020.00155

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Fong J, Wood F (2006) Nanocrystalline silver dressings in wound management: a review. Int J Nanomedicine 1(4):441–449. https://doi.org/10.2147/nano.2006.1.4.441

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Wan BA, Chan S, Herst P, Yee C, Popovic M, Lee J et al (2019) Mepitel Film and Mepilex Lite for the prophylaxis and treatment of skin toxicities from breast radiation. Breast 46:87–89. https://doi.org/10.1016/j.breast.2019.05.012

    Article  PubMed  Google Scholar 

  38. Micheli C, Palese A, Canzan F, Ambrosi E (2017) No Sting Barrier Film to Protect Skin in Adult Patients: Findings From a Scoping Review With Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 14(5):403–411. https://doi.org/10.1111/wvn.12232

    Article  PubMed  Google Scholar 

  39. Chan RJ, Webster J, Chung B, Marquart L, Ahmed M, Garantziotis S (2014) Prevention and treatment of acute radiation-induced skin reactions: a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 14:53. https://doi.org/10.1186/1471-2407-14-53

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Ginex PK, Backler C, Croson E, Horrell LN, Moriarty KA, Maloney C et al (2020) Radiodermatitis in Patients With Cancer: Systematic Review and Meta-Analysis. Oncol Nurs Forum 47(6):E225–E236. https://doi.org/10.1188/20.ONF.E225-E236

    Article  PubMed  Google Scholar 

  41. Finkelstein S, Kanee L, Behroozian T, Wolf JR, van den Hurk C, Chow E et al (2022) Comparison of clinical practice guidelines on radiation dermatitis: a narrative review. Support Care Cancer. https://doi.org/10.1007/s00520-022-06829-6

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wong RK, Bensadoun RJ, Boers-Doets CB, Bryce J, Chan A, Epstein JB et al (2013) Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer 21(10):2933–2948. https://doi.org/10.1007/s00520-013-1896-2

    Article  PubMed  Google Scholar 

  43. Gosselin T, Ginex PK, Backler C, Bruce SD, Hutton A, Marquez CM et al (2020) ONS Guidelines for Cancer Treatment-Related Radiodermatitis. Oncol Nurs Forum 47(6):654–670. https://doi.org/10.1188/20.ONF.654-670

    Article  PubMed  Google Scholar 

  44. International Society of Nurses in Cancer Care (2021) Evidenced-Based Guidelines for the Prevention and Management of Radiation Dermatitis. https://www.isncc.org/page/radiation-dermatitis. Accessed 14 November 2022.

  45. Behroozian T, Milton L, Zhang L, Lou J, Karam I, Lam E et al (2021) How do patient-reported outcomes compare with clinician assessments? A prospective study of radiation dermatitis in breast cancer. Radiother Oncol 159:98–105. https://doi.org/10.1016/j.radonc.2021.03.020

    Article  PubMed  Google Scholar 

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Acknowledgements

J.R. and M.A. are joint first authors. P.B., E.C., and T.B. are joint senior authors. J.R.W. and C.v.d.H. are the Chair and Vice-Chair of the Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology Study Group, respectively. M.A., J.R., S.B., J.R.W., C.v.d.H., M.B., P.B., E.C., and T.B. are members of the MASCC Oncodermatology Study Group.

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Authors and Affiliations

  1. Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, Hasselt University, Hasselt, Belgium

    Jolien Robijns

  2. Department of Biomedical, Experimental, and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy

    Michele Aquilano

  3. Department of Health and Family Welfare, Government of West Bengal, Burdwan Medical College and Hospital, The West Bengal University of Health Sciences, West Bengal, India

    Suvam Banerjee

  4. Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy

    Saverio Caini

  5. Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, NY, USA

    Julie Ryan Wolf

  6. Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands

    Corina van den Hurk

  7. Department of Dermatology, University Hospitals, Cleveland, OH, USA

    Mara Beveridge

  8. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Henry Lam

  9. Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Pierluigi Bonomo

  10. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Edward Chow

  11. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Tara Behroozian

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by M.A., S.B., J.R., S.C., and T.B. H.L. performed the literature search. The first draft of the manuscript was written by M.A., J.R, and S.B., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tara Behroozian.

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Robijns, J., Aquilano, M., Banerjee, S. et al. Barrier Films and Dressings for the Prevention of Acute Radiation Dermatitis: A Systematic Review and Meta-Analysis. Support Care Cancer 31, 219 (2023). https://doi.org/10.1007/s00520-023-07671-0

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