Effectiveness of Low-Cost Polyurethane Film in Reducing Dermatitis Severity in Breast Cancer Patients With Higher Fitzpatrick Skin Types Undergoing Hypofractionated Irradiation With Simultaneous Integrated Boost: An Intrapatient Randomized Controlled Trial.

Abstract

Radiation dermatitis is the most common side effect for patients undergoing hypofractionated adjuvant whole breast radiation therapy. We assessed the effectiveness of prophylactic polyurethane film dressings in reducing the radiation dermatitis severity. In this intrapatient randomized controlled trial, 34 patients were enrolled. Each patient's breast was covered with a polyurethane dressing on one-half, whereas the other bare half served as a control, during hypofractionated whole breast radiation therapy with simultaneous tumor-bed boost. Dermatitis severity was evaluated using the Common Terminology Criteria for Adverse Events version 5 (CTCAEv5), Catterall Skin Scoring Profile, and Radiation-Induced Skin Reaction Assessment Scale (RISRAS). Majority of patients had higher Fitzpatrick skin types, that is, 4 and 5 (85.3%), whereas type 3 comprised 14.7%. Four patients developed stretch edema at the film's lateral border after the second radiation fraction. Trimming the lateral edge resolved the issue in 3 cases, whereas one required complete film removal. At the conclusion of radiation, incidence of CTCAEv5 grade ≥2 dermatitis was 0% in the film group, compared with 42.4% in the control group (P < .05) according to observer 1, and 0% versus 39.4% (P < .05) as per observer 2. At 1-month follow-up, the rates of grade ≥2 dermatitis were 12.9% in the film group versus 35.5% in the control group (P < .05) as assessed by observer 1, and 12.9% versus 32.3% (P < .05) according to observer 2. At the end of radiation and the first-month follow-up, median Catterall Skin Scoring Profile score was 2 versus 3 (P < .05), and median RISRAS score was 6 versus 7 (P < .05). The RISRAS patient component indicated significant reduction in pain, tenderness, discomfort, and itching on the film side at the end of radiation (P < .05). None of the patients developed grade 3 or 4 dermatitis. Prophylactic polyurethane film is an affordable intervention in reducing the acute radiation dermatitis severity and improves patient-reported outcomes in breast cancer with Fitzpatrick skin types 3-5.