Skin Sealant Delays Onset of Radiation-Induced Dermatitis

LONG BEACH, Calif--Use of a polymer adhesive skin sealant (PASS) can help breast cancer patients complete prescribed radiation therapy without interruptions due to radiation-induced dermatitis, Robert H. Goebel, MD, JD, reported at a poster session of the San Antonio Breast Cancer Symposium.

In a prospective evaluation, 2 of 55 patients (3.6%) required interruption or modification of therapy protocols while using the protective sealant. In contrast, 55 of 142 patients (38.7%) in a matched, historical control group did not complete irradiation as prescribed.

"If you look at recent studies of radiation therapy in breast cancer, skin toxicity is becoming the treatment-limiting effect," said Dr. Goebel, medical director of oncology services at Long Beach Community Hospital. "The sealant doesn’t necessarily reduce the incidence of skin irritation, but it does delay the onset of skin toxicity so that a woman can complete the prescribed course of radiation therapy. The irritation also tends to be a little less severe when the sealant is used."

The sealant, which already is commercially available (as Superskin, from MedLogic Global Corporation), has been used previously to prevent pressure sores in bedridden patients and to reduce skin irritation in recent amputees.

Dr. Goebel credited one of his own patients with the idea for using the sealant in breast cancer patients. He said the woman was familiar with the sealant’s use for prevention of pressure sores and also had several acquaintances who had severe skin irritation during irradiation related to breast cancer.

Dr. Goebel and his collaborators at Memorial Hospital Cancer Center, Colorado Springs, Colorado, prospectively studied the sealant in 55 breast cancer patients with planned radiation therapy after surgery for breast cancer (plus 3 patients with head and neck cancer). The patients applied the sealant every other day for the duration of the irradiation protocol.

"When the sealant is applied to the skin, it dries quickly and provides a protective barrier," he explained. "The sealant comes off during natural desquamation, which is why it has to be applied every other day."

The sealant typically is applied to skin areas most prone to irritation during radiation therapy, such as the inframammary fold and the base of the axilla.

With use of the sealant, one patient had interruption of radiation therapy because of skin irritation and another patient required a treatment modification, for a 3.6% incidence of treatment-limiting dermatitis. A review of 142 matched historical controls showed that 25 had treatment interruption and 30 required protocol modifications because of skin irritation, resulting in a 39% incidence.

Skin toxicity, such as increased pigmentation and erythema, did occur in the treated patients. However, desquamation scores tended to be lower than those of untreated historical controls, and the onset of toxicity was later, usually after completion of radiation therapy.

Dr. Goebel and his colleagues have begun a randomized, controlled trial of the sealant in breast cancer patients undergoing radiation therapy.