Bacterial Decolonization Prevents Acute Radiation Dermatitis

M. Alexander Otto, PA, MMS

June 14, 2022

CHICAGO — A standard bacterial decolonization regimen reduced both the incidence and severity of acute radiation dermatitis in patients with breast or head and neck cancer taking part in a randomized trial from the Montefiore Medical Center in New York City.

Patients randomly assigned to the bacterial decolonization arm of the trial applied intranasal mupirocin ointment twice daily and did a chlorhexidine body wash once daily in the 5 days leading up to radiation therapy, and then for 5 days every other week during treatment. This regimen is widely used for decolonization in intensive care units and other settings.

The other patients were randomly assigned to receive standard care, which  included normal hygiene and emollients and silver sulfadiazine cream as needed.

None of the 38 patients in the treatment arm of the trial developed grade 2 or higher radiation dermatitis (RD) with moist desquamation, whereas there were 9 cases of RD among 38 patients (24%) who received standard care (P = .002).

Patients in the treatment group also had a lower median grade of RD at 1.19 vs 1.58 in controls (P = .019), out of a possible score of 5 on the Common Terminology Criteria for Adverse Events (CTCAE) scale.

"Our results support the use of a bacterial decolonization (BD) regimen to prevent moist desquamation in patients receiving radiation therapy (RT) for breast or head and neck cancer," the researchers concluded.

"Our results are very recent," but "we hope … to implement this protocol" at Montefiore, commented lead investigator Yana Kost, BA, a supportive oncodermatology research fellow at the Albert Einstein College of Medicine, part of the Montefiore Health System.

She presented the findings at the American Society of Clinical Oncology annual meeting.

Radiation dermatitis, skin injury induced by radiation therapy, affects up to 95% of cancer patients, particularly with radiation to the breast and head and neck. It can lead to treatment interruptions and cause skin ulcers and necrosis, she explained.

Up to one third of people are colonized with Staphylococcus aureus, and it's known to play a causative role in inflammatory skin diseases such as eczema, Kost said. 

She noted that her team had conducted a previous observational study that led to the randomized trial now being reported. In that previous trial, which involved 76 patients with breast and head and neck cancer patients, those who had substantially higher rates of S aureus colonization at baseline and at the end of RT were found to have developed more severe RD. Baseline nasal colonization proved to be an independent predictor of grade 2 or higher dermatitis. There was no association with other bacteria. 

At the ASCO meeting, invited discussant Randall Kimple, MD, PhD, a radiation oncologist at the University of Wisconsin, Madison, said "I think this is a very nice mechanism-based intervention with good adherence that appears to be effective. This is inexpensive and can be pretty easily integrated into the daily routine. I hope that there are efforts and funding to test this further in a multicenter study."

A Few More Details

None of the patients received topical steroids in the trial; they are not standard of care for RD at Montefiore, Kost said. 

Two patients had head and neck cancer, all the rest breast cancer, and all were scheduled for at least 15 fractions of radiation.

The two arms of the trial were well balanced for age, sex, body mass index, and radiation dose, among other things. There was no difference in the rate of nasal S aureus colonization at baseline, about 15% in both arms.

There were no differences in quality-of-life outcomes between groups, but Kost said the tool used to assess it — SKINDEX-16 — might not have been sensitive enough to capture them.  

No external funding was reported, and Kost reported no relevant financial relationships. Kimple reported honoraria from Galera Therapeutics and is an advisor for Guidepoint Global, Mele Associates, and Systematic Management Services.

American Society of Clinical Oncology annual meeting: Abstract LBA 12003. Presented June 6, 2022.

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape and is also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com

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