Abstract 540P
Background
Radiation dermatitis (RD) is a common side effect in breast cancer survivors receiving adjuvant radiotherapy. This systematic review and network meta-analysis (NMA) aims to understand the comparative efficacy of different topical steroids based on existing randomised controlled trials (RCTs).
Methods
Medline, EMBASE and Cochrane Central were searched from database inception to May 2024. RCTs that compared ≥ 1 TCs to placebo or standard of care (SOC) for prevention of RD in breast cancer survivors were included. The primary endpoint is incidence of ≥ Grade 2 RD. Secondary endpoints include incidence of Grade 3 RD, moist desquamation, patient-reported outcomes (PRO) and side effects. Quality appraisal was performed using Cochran’s Risk of Bias tool (v. 2.0) and the certainty of evidence using the confidence in network meta-analysis (CINeMA) framework. We estimated summary odds ratios using NMA with random effects. This NMA is registered on PROSPERO (ID: CRD42024513877).
Results
Eleven RCTs involving 1081 patients met the inclusion criteria. The TCs evaluated were: betamethasone 0.1%, mometasone furoate 0.1% and hydrocortisone 1%. Compared to placebo or SOC, patients treated with betamethasone and mometasone furoate had significantly less ≥ Grade 2 RD (betamethasone: OR 0.20, mometasone: OR 0.58, both p <0.01), but hydrocortisone showed no statistical difference (OR 0.66, p = 0.25). Betamethasone was significantly more effective compared to mometasone (OR = 0.35, p < 0.01). No significant heterogeneity was observed (I2 = 0%, p=0.60). The ranking of TCs from most to least effective in reducing incidence of ≥ Grade 2 RD according to P-scores was: betamethasone (1.00), mometasone furoate (0.55), hydrocortisone (0.41) and placebo/ SOC (0.04). Different PRO measurement tools were used in RCTs, which prevented the pooling of results for NMA. Patient dropouts were uncommon and long-term side effects of TCs were not reported.
Conclusions
Betamethasone 0.1% is the best-in-class TC for prevention of ≥ Grade 2 RD. Future research is needed to study the impact of TCs on patient-reported outcomes and their long-term side effects.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.