Aquino-Parsons, C., Lomas, S., Smith, K., Hayes, J., Lew, S., Bates, A. T., & Macdonald, A. G. (2010). Phase III study of silver leaf nylon dressing vs standard care for reduction of inframammary moist desquamation in patients undergoing adjuvant whole breast radiation therapy. Journal of Medical Imaging and Radiation Sciences, 41, 215–221.
To evaluate the use of silver leaf nylon dressings as a prophylactic measure to reduce inframammary fold radiation therapy (RT)–induced dermatitis in women receiving adjuvant whole-breast RT compared with standard skin care. The secondary objective was to evaluate if the dressing influenced breast skin–related pain, itching, and burning resulting from whole-breast RT.
Patients were randomized during their first week of RT using a random numbers table after stratification for prior anthracycline-based chemotherapy and duration of RT: short course (42.5 Gy/16 fractions) or extended course (45-50 Gy/25-28 fractions).
Control Arm (n = 103): Standard skin care recommendations included avoiding skin irritants, promoting clean skin using nonalkaline, unscented soap and water and patting skin dry, and maintaining skin hydration with twice daily (BID) application of moisturizing cream (patients chose which brand of cream they used). Pruritis or brisk erythema was managed with topical steroids. Moist desquamation was treated with BID saline compresses and hydrogel or silvadene cream.
Experimental Arm (n = 93): Patients were supplied with dressings, sterile water, a cotton bra in the correct size, gauze, hypoallergenic tape, printed instructions, and teaching performed by RT therapists to show patients how to wear the dressing before day six of RT. Sterile water was used to moisten the dressing before applying it to the inframammary fold with gauze to cover it. This was held in place with the cotton bra and was to be worn 24 hours per day but removed for RT and bathing. The dressing was worn from day 6 of RT until 14 days after completion of whole-breast RT. Women in this arm also received standard skin care instruction. Patients were assessed one week before the last treatment, on the final day of treatment, and one week posttreatment (the time period when RT-induced dermatitis was likely to have appeared in the inframammary fold). Subjective and objective assessments of radiodermatitis in the inframammary fold were performed at these time points.
Canada: The British Columbia Cancer Agency
Patients were undergoing the active treatment phase of care.
The study was a randomized, controlled trial.
The use of silver leaf nylon dressings as a prophylactic measure did not show benefit in reducing the degree of acute inframammary fold radiodermatitis in women receiving adjuvant whole-breast RT.
The prophylactic use of silver leaf nylon dressings decreased the patient-reported symptom of itching on the last day of RT and one week after completion of whole-breast RT. Dressings can provide patient comfort, and the use of dressings is supported perhaps on a more individual per-case basis; however, the results did not demonstrate a significant benefit for prophylactic silver leaf dressing use.