A recent study conducted at the Montefiore Einstein Cancer Center has demonstrated that a low-cost antibacterial treatment regimen can prevent acute radiation dermatitis.
Acute radiation dermatitis (ARD), is a condition commonly found in those undergoing cancer radiation treatment, affecting as many as 95% of patients. This condition is marked by symptoms such as redness, soreness, itching, or peeling of the skin. More severe instances may result in considerable swelling and painful skin ulcers, significantly impacting the quality of life of the patient. However, our understanding of why ARD occurs remains limited, and there are no widely adopted, standardized methods for preventing its severe form.
Researchers at Montefiore Einstein Cancer Center (MECC) have found that many cases of ARD involve a common skin bacterium and that a simple, low-cost treatment can prevent severe cases, potentially setting a new standard of care for people undergoing radiation therapy.
"Until now, ARD was assumed to result simply from the skin being burned by the radiation, which meant that not much could be done to prevent it," said Beth N. McLellan, M.D. director, supportive oncodermatology at Montefiore Einstein Cancer Center, chief of the division of dermatology at Montefiore Health System and Albert Einstein College of Medicine, and senior author of the two studies. "The readily available treatment we've developed and clinically tested could potentially save hundreds of thousands of people each year in the U.S. from severe ARD and its excruciating side effects."
Identifying the Source
Staphylococcus aureus (SA) bacteria, often shortened to "staph," typically live harmlessly on the skin, often in the nose and armpits. But, they can cause infections if the skin is broken by a cut. Radiation weakens the skin's structure at the treatment site and can result in infection by allowing SA to break through the skin's outer layer. Courses of radiation therapy—routinely requiring daily treatments over several weeks—increase the risk of skin infection to occur.
Since SA is implicated in common skin disorders that lead to a breakdown in the skin such as eczema, Dr. McLellan and her colleagues reasoned that the bacteria might also play a role in ARD. In one of the JAMA Oncology studies, the MECC researchers enrolled 76 patients undergoing radiation therapy for cancer. Bacterial cultures were collected from patients before and after radiation treatment, from three different body sites: inside the nose, from skin in the radiated area, and from skin on the side of the body not exposed to radiation.
Before treatment, approximately 20% of patients tested positive for SA but did not have an active infection. Following treatment, 48% of those patients who developed severe ARD tested positive for the presence of SA, compared with only 17% of patients who developed the mildest form of the condition. Many patients with SA on their skin also tested positive for nasal SA, suggesting that SA from the nose might be infecting the skin.
"This study clearly showed that SA plays a major role in ARD," said Dr. McLellan. "The good news is we have a lot of tools to fight this bacteria. In a second study, we tested a topical antibacterial drug combination we thought would be effective and easy for people to use."
Preventing Severe ARD
The second study enrolled 77 patients undergoing radiation therapy, all but two of whom had breast cancer. Participants were randomized to receive either the standard of care at MECC (normal hygiene and moisturizing treatment such as Aquaphor), or the experimental antibacterial regimen. This treatment involved using the body cleanser chlorhexidine along with mupirocin 2% nasal ointment twice a day for five days, every other week, throughout their radiation treatment.
Although more than half the patients treated with the antibacterial regimen developed mild-to-moderate ARD, no patients developed moist desquamation—the most severe type of ARD that causes the skin to break down and develop sores—and no patients experienced adverse effects from the treatment. In contrast, severe ARD affected 23% of participants receiving the standard of care.
"Our regimen is simple, inexpensive, and easy so we believe it should be used for everyone undergoing radiation therapy, with no need to first test individuals for SA," said Dr. McLellan. "I expect this will completely change protocols for people undergoing radiation therapy for breast cancer."
Dr. McLellan also noted: "Like most of our trials at MECC, a majority of our participants were Black and Hispanic members of our community, meaning this protocol is generalizable and effective for people of different races and ethnicities. This is especially important because people with darker skin types are more likely to develop severe ARD."
References: "Bacterial Decolonization for Prevention of Radiation Dermatitis – A Randomized Clinical Trial" by Yana Kost, Alana Deutsch, Karolina Mieczkowska, Roya Nazarian, Ahava Muskat, H. Dean Hosgood, Juan Lin, Johanna P. Daily, Nitin Ohri, Rafi Kabarriti, Kosaku Shinoda and Beth N. McLellan, 4 May 2023, JAMA Oncology.
DOI: 10.1001/jamaoncol.2023.0444
News
Lipid nanoparticles discovered that can deliver mRNA directly into heart muscle cells
Cardiovascular disease continues to be the leading cause of death worldwide. But advances in heart-failure therapeutics have stalled, largely due to the difficulty of delivering treatments at the cellular level. Now, a UC Berkeley-led [...]
The basic mechanisms of visual attention emerged over 500 million years ago, study suggests
The brain does not need its sophisticated cortex to interpret the visual world. A new study published in PLOS Biology demonstrates that a much older structure, the superior colliculus, contains the necessary circuitry to perform the [...]
AI Is Overheating. This New Technology Could Be the Fix
Engineers have developed a passive evaporative cooling membrane that dramatically improves heat removal for electronics and data centers Engineers at the University of California San Diego have created an innovative cooling system designed to greatly enhance [...]
New nanomedicine wipes out leukemia in animal study
In a promising advance for cancer treatment, Northwestern University scientists have re-engineered the molecular structure of a common chemotherapy drug, making it dramatically more soluble and effective and less toxic. In the new study, [...]
Mystery Solved: Scientists Find Cause for Unexplained, Deadly Diseases
A study reveals that a protein called RPA is essential for maintaining chromosome stability by stimulating telomerase. New findings from the University of Wisconsin-Madison suggest that problems with a key protein that helps preserve chromosome stability [...]
Nanotech Blocks Infection and Speed Up Chronic Wound Recovery
A new nanotech-based formulation using quercetin and omega-3 fatty acids shows promise in halting bacterial biofilms and boosting skin cell repair. Scientists have developed a nanotechnology-based treatment to fight bacterial biofilms in wound infections. The [...]
Researchers propose five key questions for effective adoption of AI in clinical practice
While Artificial Intelligence (AI) can be a powerful tool that physicians can use to help diagnose their patients and has great potential to improve accuracy, efficiency and patient safety, it has its drawbacks. It [...]
Advancements and clinical translation of intelligent nanodrugs for breast cancer treatment
A comprehensive review in "Biofunct. Mater." meticulously details the most recent advancements and clinical translation of intelligent nanodrugs for breast cancer treatment. This paper presents an exhaustive overview of subtype-specific nanostrategies, the clinical benefits [...]
It’s Not “All in Your Head”: Scientists Develop Revolutionary Blood Test for Chronic Fatigue Syndrome
A 96% accurate blood test for ME/CFS could transform diagnosis and pave the way for future long COVID detection. Researchers from the University of East Anglia and Oxford Biodynamics have created a highly accurate [...]
How Far Can the Body Go? Scientists Find the Ultimate Limit of Human Endurance
Even the most elite endurance athletes can’t outrun biology. A new study finds that humans hit a metabolic ceiling at about 2.5 times their resting energy burn. When ultra-runners take on races that last [...]
World’s Rivers “Overdosing” on Human Antibiotics, Study Finds
Researchers estimate that approximately 8,500 tons of antibiotics enter river systems each year after passing through the human body and wastewater treatment processes. Rivers spanning millions of kilometers across the globe are contaminated with [...]
Yale Scientists Solve a Century-Old Brain Wave Mystery
Yale scientists traced gamma brain waves to thalamus-cortex interactions. The discovery could reveal how brain rhythms shape perception and disease. For more than a century, scientists have observed rhythmic waves of synchronized neuronal activity [...]
Can introducing peanuts early prevent allergies? Real-world data confirms it helps
New evidence from a large U.S. primary care network shows that early peanut introduction, endorsed in 2015 and 2017 guidelines, was followed by a marked decline in clinician-diagnosed peanut and overall food allergies among [...]
Nanoparticle blueprints reveal path to smarter medicines
Lipid nanoparticles (LNPs) are the delivery vehicles of modern medicine, carrying cancer drugs, gene therapies and vaccines into cells. Until recently, many scientists assumed that all LNPs followed more or less the same blueprint, [...]
How nanomedicine and AI are teaming up to tackle neurodegenerative diseases
When I first realized the scale of the challenge posed by neurodegenerative diseases, such as Alzheimer's, Parkinson's disease and amyotrophic lateral sclerosis (ALS), I felt simultaneously humbled and motivated. These disorders are not caused [...]
Self-Organizing Light Could Transform Computing and Communications
USC engineers have demonstrated a new kind of optical device that lets light organize its own route using the principles of thermodynamics. Instead of relying on switches or digital control, the light finds its own [...]
