Fernández-Castro Mercedes, Martín-Gil Belén
Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid., Valladolid, España.
Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid., Valladolid, España.
Enferm Clin. 2015 Nov-Dec;25(6):327-43. doi: 10.1016/j.enfcli.2015.06.003. Epub 2015 Oct 21.
After radiation therapy most patients experience acute skin toxicity to some degree. The purpose of this systematic review is to assess the available evidence concerning the effectivity of topical therapies on patients with breast cancer that experience radiodermatitis after radiotherapy.
The review included clinical trials aimed to evaluate topical therapies for prevention or treatment of acute radiodermatitis in women with breast cancer, which were published between 2009 and 2014. The bibliographic search was carried out in the following databases: PubMed, Cinahl, Cochrane Plus, IBECS and LILACS. The studies were selected independently by peer reviewers using the Critical Appraisal Skills Programme in its Spanish version.
86 bibliographical references were identified. Twenty full-text articles of clinical trials were assessed and two were excluded because they were not completed; 12 of clinical trials evaluated topical treatment with creams and ointments, three with corticosteroid creams and other three with dressings. The effectivity of human epidermal growth factor cream, linoleic acid emulsion, topical silver sulfadiazine, corticosteroids creams and polyurethane dressings has been shown in these clinical trials.
Given that radiodermatitis is a dynamic process, these topical agents were effective in different stages of skin toxicity. Some of them delayed the onset, others decreased the development and severity of acute skin toxicity degree and others improved the subjective symptoms (itching, pain, burning). Only polyurethane dressings suggest effectiveness in all stages of skin toxicity, in prevention, management of the different skin toxicity degrees and improvement of wellbeing.
大多数患者在放射治疗后会出现一定程度的急性皮肤毒性反应。本系统评价的目的是评估有关局部治疗对乳腺癌放疗后发生放射性皮炎患者有效性的现有证据。
该评价纳入了旨在评估局部治疗对乳腺癌女性急性放射性皮炎预防或治疗效果的临床试验,这些试验发表于2009年至2014年之间。在以下数据库进行文献检索:PubMed、Cinahl、Cochrane Plus、IBECS和LILACS。由同行评审员使用西班牙语版的批判性评估技能计划独立选择研究。
共识别出86篇参考文献。评估了20篇临床试验全文文章,其中2篇因未完成而被排除;12项临床试验评估了乳膏和软膏的局部治疗,3项评估了皮质类固醇乳膏,另外3项评估了敷料。这些临床试验已证明人表皮生长因子乳膏、亚油酸乳液、局部用磺胺嘧啶银、皮质类固醇乳膏和聚氨酯敷料的有效性。
鉴于放射性皮炎是一个动态过程,这些局部用药在皮肤毒性的不同阶段均有效。其中一些延迟了发病,另一些降低了急性皮肤毒性程度的发展和严重程度,还有一些改善了主观症状(瘙痒、疼痛、烧灼感)。只有聚氨酯敷料在皮肤毒性的所有阶段、预防、不同皮肤毒性程度的管理以及改善舒适度方面均显示出有效性。