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Review
. 2024 May 15;16(5):1859-1879.
doi: 10.62347/XLGT5405. eCollection 2024.

The effect of various interventions on the prevention of radiation dermatitis: a network meta-analysis

Hongxin Cao  1   2 , Wangbin Li  2 , Hongyi Cai  3
Affiliations
Review

The effect of various interventions on the prevention of radiation dermatitis: a network meta-analysis

Hongxin Cao et al. Am J Transl Res. .

Abstract

Objective: High doses of radiation, while effective at destroying tumor tissues, also result in radiation dermatitis (RD) at irradiated sites, which is one of the most common complications in cancer radiotherapy. Currently, no standardized protocols for the prevention and treatment of RD have been established in clinical practices, and severe RD can compromise treatment efficacy and reduce patients' quality of life. This systematic review and network meta-analysis (NMA) aims to compare the effectiveness of various interventions in preventing RD in patients.

Methods: As of June 2023, four databases, including PubMed, Embase, Web of Science, and the Cochrane Library, were searched, with a total of 19 interventions obtained for comparative analysis of their effectiveness in preventing RD. The Cochrane risk-of-bias tool was employed to screen literature, extract data, and appraise the quality of the studies by two researchers. Bayesian network meta-analysis (NMA) was conducted utilizing StataSE 15 and R 4.2.3.

Results: A total of 33 studies involving 4307 patients were included in this analysis. From the 33 studies, 19 interventions, encompassing Barrier Films and Dressings (BFD), Boron_Gel, Best supportive care, Corticosteroids_cream, Doxepin_cream, Eau Thermale Avèn_gel, Epidermal Growth Factor_cream, Hyaluronan_cream, Medicinal_Plants, Mineral_Oil, Olive oil and calcium hydroxide (OOCH), Photobiomodulation therapy, Recove_cream, Silicone_gel, Silver sulfadiazine (SSD), Timolol_Gel, Trolamine, VitD_Gel, and VitE_Gel, were retrieved and compared. The NMA results indicated that Hyaluronan_cream (SUCRA: 94.9%) was highly effective in preventing Grade 0/1 RD. Meanwhile, OOCH (SUCRA: 95.7%) demonstrated the most prominent effect in preventing ≥ Grade 2 RD.

Conclusion: The study reveals that Hyaluronan_cream and OOCH are two promising treatments for the prevention of RD in patients undergoing radiotherapy. Future research might focus on validating the efficacy of these two therapies with large sample sizes and on identifying an optimal intervention strategy.

Keywords: Radiation dermatitis; clinical efficacy; network meta-analysis; radiotherapy; topical interventions.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flowchart of literature screening.
Figure 2
Figure 2
Risk of bias plot: in the form of a percentage of each bias risk in all included studies.
Figure 3
Figure 3
Each risk of bias item for the included studies.
Figure 4
Figure 4
The network plot of included treatments in the Grade 0/1 radiation dermatitis network meta-analysis. BSC: Best supportive care; BFD: Barrier Films and Dressings; EAT: Eau Thermale Avèn; EGF: Epidermal Growth Factor; OOCH: Olive oil and calcium hydroxide; PBMT: Photobiomodulation therapy; SSD: Silver sulfadiazine.
Figure 5
Figure 5
Forest and heterogeneity analysis plot for the network meta-analysis of Grade 0/1 radiation dermatitis. BSC: Best supportive care; BFD: Barrier Films and Dressings; EAT: Eau Thermale Avèn; EGF: Epidermal Growth Factor; OOCH: Olive oil and calcium hydroxide; PBMT: Photobiomodulation therapy; SSD: Silver sulfadiazine.
Figure 6
Figure 6
Effects of different intervention measures on patients with Grade 0/1 radiation dermatitis.
Figure 7
Figure 7
Network plot of included treatments for ≥ Grade 2 radiation dermatitis. BSC: Best supportive care; BFD: Barrier Films and Dressings; EAT: Eau Thermale Avèn; EGF: Epidermal Growth Factor; OOCH: Olive oil and calcium hydroxide; PBMT: Photobiomodulation therapy; SSD: Silver sulfadiazine.
Figure 8
Figure 8
Forest and heterogeneity analysis plot of included treatments for ≥ Grade 2 radiation dermatitis. BSC: Best supportive care; BFD: Barrier Films and Dressings; EAT: Eau Thermale Avèn; EGF: Epidermal Growth Factor; OOCH: Olive oil and calcium hydroxide; PBMT: Photobiomodulation therapy; SSD: Silver sulfadiazine.
Figure 9
Figure 9
Effects of different intervention measures on ≥ Grade 2 radiation dermatitis.
Figure 10
Figure 10
Funnel plot for the Grade 0/1 radiation dermatitis network meta-analysis. BSC: Best supportive care; BFD: Barrier Films and Dressings; EAT: Eau Thermale Avèn; EGF: Epidermal Growth Factor; OOCH: Olive oil and calcium hydroxide; PBMT: Photobiomodulation therapy; SSD: Silver sulfadiazine.
Figure 11
Figure 11
Funnel plot for the network meta-analysis of ≥ Grade 2 radiation dermatitis. BSC: Best supportive care; BFD: Barrier Films and Dressings; EAT: Eau Thermale Avèn; EGF: Epidermal Growth Factor; OOCH: Olive oil and calcium hydroxide; PBMT: Photobiomodulation therapy; SSD: Silver sulfadiazine.
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