Fri 30th Aug 2013
Session 2 / Talk 5
11:40 – 12:00
BROOKLYN 2
RADIOTHERAPY
Patries HERST
ABSTRACT
Purpose: Severe acute radiation-induced skin reactions occur in a significant proportion of
women who receive radiation therapy for breast cancer. We previously showed that soft
silicone dressings decreased the severity of severe skin reactions by 40% when applied from
the onset of erythema. Here we report the effect of a transparent silicone film on the severity
of skin reactions and the incidence of moist desquamation when used from the beginning of
treatment in breast cancer patients.
Methods and Material: A total of 80 women were recruited from Dunedin Hospital. The
breast or chest wall was randomly divided into lateral and medial halves at the start of
radiation therapy treatment; one half was treated with Mepitel Film, the other half with
aqueous cream. Skin reactions were assessed using the Radiation-Induced Skin Reaction
Assessment Scale.
Results: Mepitel Film prevented the onset of moist desquamation in all patients and
decreased the severity of skin reactions by more than 80%. Patients preferred the film and
found it very comfortable to wear.
Conclusions: Mepitel Film prevents moist desquamation when used prophylactically

Mepitel Film
for Radiation-Induced Skin Reactions
Dean Paterson, Prashika Poonam, Noelle Bennett, Annie Sutherland, Ruth
Peszynski, Meredith van Beekhuizen, Katie Diggelmann, Marieke Jasperse,
Patries Herst
NZIMRT, 2013
Rationale

Unavoidable side effect of external beam RT

No standard treatment

Form protective barrier

Inert

Adhere to healthy skin but do not stick to open wounds

Decrease the severity of erythema by 30% in a pilot study
of 30 breast cancer patients.
(Diggelmann et al. Br J Radiol 83, 2010)
Stage III RCT: Mepilex Lite: Management Trial
Auckland (ARO), Palmerston North, Wellington, Dunedin
80 patients enrolled, 74 analysed
Erythema
Eligibility
• Post-mastectomy
• No metastatic disease
• No previous RT to chest
In-Patient Randomization
• Able to attend follow up
• Good performance status
Mepilex
Aqueous cream
1] severity
Assessment
2] % MD
3] time to MD
RISRAS
• 3x a week during TMT
• 1x a week for 4 weeks after
TMT completion
Mepilex
Moist desquamation
Standard dressings
4] time to healing
Healing
RISRAS (total scores between 0 and 36)*
Researcher Component (total scores between 0 and 24)
Erythema
(E)
0
Normal skin
1
Dusky pink
2
Dull red
3
Brilliant red
4
Deep redpurple
Dry Desquamation
(DD)
0
Normal skin
1
(<25%)**
2
(25%-50%)
3
(50%-75%)
4
(>75%)
Moist
Desquamation
(MD)
0
Normal skin
1.5
(<25%)
3.0
(25%-50%)
4.5
(50%-75%)
6
(>75%)
Necrosis
(N)
0
Normal skin
2.5
(<25%)
5.0
(25%-50%)
7.5
(50%-75%)
10
(>75%)
Patient Component (total scores between 0 and 12)
Symptoms
Not at all
A little
Quite a bit
Very much
Do you have any tenderness,
discomfort of pain of your skin in
the treatment area?
0
1
2
3
Does your skin in the treatment area
itch?
0
1
2
3
Do you have a burning sensation of
your skin in the treatment area?
0
1
2
3
To what extent has your skin
reactions and your symptoms
affected your day to day activities?
0
1
2
3
RISRAS Results of 74 mastectomy patients
Decrease in overall
skin reaction
severity: 40%
p<0.001
Paterson et al., Journal of
Cancer Science and Therapy
4(11) 347-356 (2012)
Moist Desquamation Results
 Decreased the area of MD by 49%
 Did not affect % MD or time to MD/healing
 Fall off in shower or when perspiring, do not
stick well in axilla
 Are not transparent: can’t see tattoos
 Have a small bolus effect (0.5mm), so must be
removed during RT
We need something better: Mepitel Film?
 Same features as Mepilex Lite
 Much thinner, transparent and more sticky than
dressings and negligible bolus effect (0.1mm)
Lateral
Medial
Stage III RCT: Mepitel Film
Dunedin: 80 patients (both breast and mastectomy)
Eligibility
Start of RT treatment
• No metastatic disease
• No previous RT to chest
In-Patient Randomization
• Able to attend follow up
• Good performance status
Mepitel Film
Aqueous cream
Assessment
RISRAS
• 3x a week during TMT
• 1x a week for 4 weeks
after TMT completion
1] severity
2] % MD
Moist desquamation
RISRAS Scores of 78 patients
Decrease in
severity of skin
reactions: 92%
P<0.001
Moist Desquamation Results
Treatment
# Patches
Mastectomy
MD
% MD
Aqueous Cream (n=34)
Mepitel (n=34)
8
0
24%
0%
No mastectomy
Aqueous Cream (n=44)
Mepitel (n=44)
12
0
27%
0%
Total
Aqueous Cream (n=78)
Mepitel (n=78)
20
0
26%
0%
No Moist Desquamation under the Film
No Moist Desquamation under the Film
Interesting finding
Stressed patients have worse skin reactions
Conclusions
Mepilex Lite
Mepitel Film
Trial Type Management
Prevention
RISRAS
< 40%
< 90%
% MD
Same as control
No MD at all
Patients
“Very comforting and
easy to use”
“Film? What film? I forgot
it was there”
Is Mepitel Film the answer to RT-induced acute skin reactions?
Try it out and let me know……
Acknowledgements
Trial Participants
Staff from Departments:
Southern DHB
Capital and Coast DHB
Mid-Central DHB
Auckland Regional Oncology
Funding
Rouse Educational Trust
Difference not due to differences in dose
between Film and cream covered skin.
Areas measured and compared:




Axilla (2TLDs)
IFM fold (4 TLDs)
Superior-medial (5 TLDs)
Inferior Lateral (5 TLDs)