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Topical corticosteroids for the prevention of severe radiation dermatitis: a systematic review and meta-analysis

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Abstract

Purpose

Radiation dermatitis (RD) is a frequently occurring adverse reaction during radiotherapy in cancer patients. While the use of topical corticosteroids (TCs) is common for the treatment of RD, its role in preventing severe reactions remains unclear. This systematic review and meta-analysis aim to evaluate the evidence on the use of TCs as prophylaxis of RD.

Methods

A systematic search was conducted using OVID MedLine, Embase, and Cochrane databases (between 1946 and 2023) to identify studies examining TC use in the prevention of severe RD. Statistical analysis was completed using RevMan 5.4 to calculate pooled effect sizes and 95% confidence intervals. Forest plots were then developed using a random effects model.

Results

Ten RCTs with a total of 1041 patients met the inclusion criteria. Six studies reported on mometasone furoate (MF) and four studies reported on betamethasone. Both TCs were associated with a significant improvement in the prevention of moist desquamation [OR = 0.34, 95% CI [0.25, 0.47], p < 0.00001], but betamethasone was found to be more effective than MF [OR = 0.29, 95% CI [0.18, 0.46], p < 0.00001 and OR = 0.39, 95% CI [0.25, 0.61], p < 0.0001, respectively]. A similar finding was seen in reducing the development of grade 2 or higher RD according to the Radiation Therapy Oncology Group scale.

Conclusions

The current evidence supports the use of TCs in preventing severe reactions of RD. Both MF and betamethasone were found to be effective; however, betamethasone, a higher potency TC, is more effective despite MF being more commonly reported in literature.

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Acknowledgements

S.T., G.Z., and M.T. 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 MASCC Oncodermatology Study Group, respectively. S.T., M.T., J.R.W., C.v.d.H., M.B., P.B., E.C., and T.B. are all members of the MASCC Oncodermatology Study Group.

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Authors and Affiliations

  1. Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    Samantha Tam

  2. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Grace Zhou

  3. Allegheny Health Network, Drexel University College of Medicine, Pittsburgh, PA, USA

    Mark Trombetta

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

    Saverio Caini & Mara Beveridge

  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. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Henry Lam

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

    Pierluigi Bonomo

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

    Edward Chow

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

    Tara Behroozian

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  1. Samantha Tam
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by S.T., G.Z., M.T., S.C., and T.B. H.L. performed the literature search. The first draft of the manuscript was written by S.T., G.Z., and M.T., 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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Tam, S., Zhou, G., Trombetta, M. et al. Topical corticosteroids for the prevention of severe radiation dermatitis: a systematic review and meta-analysis. Support Care Cancer 31, 382 (2023). https://doi.org/10.1007/s00520-023-07820-5

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