Acute radiation dermatitis (ARD), a distressing skin condition affecting up to 95% of individuals undergoing cancer radiation treatment, has been a longstanding challenge with limited preventive options.
However, groundbreaking research conducted at the Montefiore Einstein Cancer Center (MECC) has revealed a significant breakthrough.
A comprehensive study conducted by MECC researchers sheds light on the role of a common skin bacterium in ARD and unveils a simple and affordable treatment that can effectively prevent severe cases.
These remarkable findings, published today in JAMA Oncology, have the potential to redefine the standard of care for the millions of individuals undergoing radiation therapy each year to combat cancer.
”Until now, ARD was assumed to result simply from the skin being burned by the radiation, which meant that not much could be done to prevent it,” remarks senior author Beth N. McLellan. “The readily available treatment we’ve developed and clinically tested could potentially save hundreds of thousands of people each year in the U.S. from severe ARD and its excruciating side effects.”
Staphylococcus Aureus: a Key Player in Severe Radiation-Related Skin Condition
Staphylococcus aureus (SA), commonly known as “staph,” resides harmlessly on the skin, often in areas like the nose and armpits. However, when the skin is compromised by a cut or injury, SA can cause infections. During radiation therapy, the skin’s structure at the treatment site weakens, creating an opportunity for SA to breach the outer layer of the skin and trigger infections. The extensive duration of radiation therapy, typically involving daily treatments over several weeks, heightens the risk of skin infections.
Given SA’s association with skin disorders like eczema, Dr. McLellan and her team at Montefiore Einstein Cancer Center hypothesized that this bacterium might also play a role in acute radiation dermatitis (ARD). In a study published in JAMA Oncology, the researchers enrolled 76 cancer patients undergoing radiation therapy. Bacterial cultures were collected before and after radiation treatment from three different body sites: the nasal passages, skin within the radiated area, and non-radiated skin elsewhere on the body.
Before treatment, around 20% of patients tested positive for SA, despite not having an active infection. Following treatment, a striking 48% of patients with severe ARD tested positive for SA presence, compared to only 17% of patients experiencing milder forms of the condition. Furthermore, many patients with SA on their skin also exhibited nasal SA, indicating the potential transmission of SA from the nose to the skin.
“This study clearly showed that SA plays a major role in ARD,” adds Dr. McLellan. “The good news is we have a lot of tools to fight this bacteria. In a second study, we tested a topical antibacterial drug combination we thought would be effective and easy for people to use.”
How-to Prevent Severe Acute Radiation Dermatitis (ARD)
In the second study, 77 patients undergoing radiation therapy, with all but two having breast cancer, were enrolled to investigate preventive measures for Severe ARD. The participants were randomly assigned to either receive the standard care at Montefiore Einstein Cancer Center (MECC), which included regular hygiene and moisturizing treatments such as Aquaphor, or an experimental antibacterial regimen. The regimen involved using the body cleanser chlorhexidine along with mupirocin 2% nasal ointment twice a day for five days, every other week, throughout their radiation treatment.
The results were astounding. While more than half of the patients who received the antibacterial regimen developed mild-to-moderate ARD, not a single patient experienced the most severe form of ARD, moist desquamation, which causes the skin to break down and develop sores. Furthermore, none of the patients encountered any adverse effects from the treatment. In stark contrast, 23% of participants who received the standard care faced the debilitating effects of severe ARD.
“Our regimen is simple, inexpensive, and easy so we believe it should be used for everyone undergoing radiation therapy, with no need to first test individuals for SA,” adds Dr. McLellan. “I expect this will completely change protocols for people undergoing radiation therapy for breast cancer.
“Like most of our trials at MECC, a majority of our participants were Black and Hispanic members of our community, meaning this protocol is generalizable and effective for people of different races and ethnicities. This is especially important because people with darker skin types are more likely to develop severe ARD.”
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