Effectiveness of skin protectors and calendula officinalis for prevention and treatment of radiodermatitis: an integrative review

Simões, Fabiana Verdan; Santos, Valdete Oliveira; Silva, Rodrigo Nogueira da; Silva, Rafael Celestino da

doi:10.1590/0034-7167-2019-0815

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (suppl 5) • 2020 • https://doi.org/10.1590/0034-7167-2019-0815 copy

Effectiveness of skin protectors and calendula officinalis for prevention and treatment of radiodermatitis: an integrative review

Eficacia de los protectores de la piel y Calendula officinalis para la prevención y tratamiento de la radiodermatitis: revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the effectiveness of skin protectors and Calendula officinalis for prevention and treatment of radiodermatitis.

Method:

an integrative review conducted at CINAHL, Cochrane Library, Embase, MEDLINE/PubMed, IBECS, LILACS, and Web of Science. The final sample consisted of five studies, four clinical studies and one preclinical. Critical appreciation and narrative synthesis of the findings were carried out.

Results:

the Cavilon™ skin protector was more effective than Sorbolene (cream with 10% glycerin) and less effective than Mometasone Furoate cream. Calendula officinalis was more effective than Trolamine and essential fatty acids and less effective than Ching Wan Hung^® for prevention and treatment of radiodermatitis.

Conclusion:

data confirm the potential of Calendula officinalis for prevention and treatment of radiodermatitis and point to promising results regarding skin protector use; however, there is a need for further testing as to the effectiveness of such products.

Descriptors:
Neoplasms; Radiodermatitis; Calendula; Oncology Nursing; Review

Problem/Outcome	Intervention	Alternative Intervention
Radiation injuries Radiodermatitis Radiation-induced skin toxicity	Barrier film Skin film Barrier film Protective film Skin protector	Calendula officinalis

Database

Search strategy

Embase

('radiation dermatitis'/of OR 'radiation injury'/of OR 'radiation dermatitis':ti,ab,kw OR 'radiodermatitis':ti,ab,kw OR 'radioepithelitis':ti,ab,kw OR 'radiation injuries':ti,ab,kw OR 'radiation injury':ti,ab,kw OR 'radiation-induced dermatitis':ti,ab,kw OR 'radiation-induced skin toxicity':ti,ab,kw) AND ('barrier film':ti,ab,kw OR 'barrier films':ti,ab,kw OR nsbf OR 'film barrier':ti,ab,kw OR 'film barriers':ti,ab,kw OR 'barrier product':ti,ab,kw OR 'barrier products':ti,ab,kw OR 'moisture barrier':ti,ab,kw OR 'moisture barriers':ti,ab,kw OR 'liquid-film':ti,ab,kw OR 'liquid-films':ti,ab,kw OR 'cutaneous protector':ti,ab,kw OR 'cutaneous protectors':ti,ab,kw OR 'skin protector':ti,ab,kw OR 'skin protectors':ti,ab,kw OR 'skin protectant':ti,ab,kw OR 'skin protectants':ti,ab,kw OR 'skin film':ti,ab,kw OR 'skin films':ti,ab,kw OR spray*:ti,ab,kw OR 'calendula'/exp OR 'calendula extract'/de OR 'calendula officinalis extract'/de OR 'calendula':ti,ab,kw) AND ([English]/lim OR [Portuguese]/lim OR [Spanish]/lim) AND [Embase]/lim

Article identification Year/Country	Outlining/number of participants	Interventions	Outcome
A1⁽¹⁵15 Shaw S-Z, Nien H-H, Wu C-J, Lui LT, Su J-F, Lang C-H. 3M Cavilon No-Sting Barrier Film or topical corticosteroid (mometasone furoate) for protection against radiation dermatitis: a clinical trial. J Formos Med Assoc. 2015;114(5):407-14. doi: 10.1016/j.jfma.2013.04.003 https://doi.org/10.1016/j.jfma.2013.04.0... ⁾ 2015 Taiwan	Randomized Clinical Trial 39 human beings with breast cancer Skin assessment scale: CTCAE, version 3.0	Intraindividual comparisons: Cavilon^™ x without treatment (13); Elomet^® x without treatment (9); Elomet^® x Cavilon^™ (17)	Days for radiodermatitis: Cavilon^™=44.2 x without treatment=46.6 (p=0.196); Elomet^® =52 x without treatment=43 (p=0.092); Elomet^® =53.4 x Cavilon^™=44.5 (p=0.002).
A2⁽²³23 Graham P, Browne L, Capp A, Fox C, Graham J, Hollis J, et al. Randomized, paired comparison of No-Sting Barrier Film versus sorbolene cream (10% glycerine) skin care during postmastectomy irradiation. Int J Radiat Oncol. 2004;58(1): 241-6. doi: 10.1016/S0360-3016(03)01431-7 https://doi.org/10.1016/S0360-3016(03)01... ⁾ 2004 Australia	Randomized Clinical Trial 61 human beings with breast cancer Skin rating scale: RTOG acute skin score	Intraindividual comparisons: Cavilon^™ x Sorbolene cream (61)	Skin reaction score >2: Sorbolene=46% x Cavilon^™=33% (p=0.096).
A3⁽²⁴24 Hu JJ, Cui T, Rodriguez-Gil JL, Allen GO, Li J, Takita C, et al. Complementary and alternative medicine in reducing radiation-induced skin toxicity. Radiat Environ Biophys. 2014;53(3):621-6. doi: 10.1007/s00411-014-0540-y https://doi.org/10.1007/s00411-014-0540-... ⁾ 2014 USA	Pre-Clinical Trial 40 mice Skin rating scale: -------------	Control (10) x Ionizing Radiation: 10 Gy/day for 4 days (10) x Ionizing Radiation + Calendula officinalis (10) x Ionizing Radiation + CWH ointment (10)	On the 14^th day, for erythema: Control=10 without injury; Ionizing radiation=7 without injury, 3 moderate injuries; Ionizing Radiation + Calendula officinalis=8 without injury, 2 moderate injuries; Ionizing Radiation + CWH=10 without injury (p=0.033)
A4⁽⁹9 Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol. 2004;22(8):1447-53. doi: 10.1200/JCO.2004.07.063 https://doi.org/10.1200/JCO.2004.07.063... ⁾ 2004 France	Randomized Clinical Trial 254 human beings with breast cancer Skin rating scale: RTOG acute skin score	Calendula officinalis (126) x Trolamine (128)	Overall skin toxicity (p=<0.001): Calendula officinalis - score 0-1=74, score 2-3=52; Trolamine - score 0-1=47, score 2-3=81
A5⁽²⁵25 Schneider F, Danski MTR, Vayego SA. Usage of Calendula officinalis in the prevention and treatment of radiodermatitis: a randomized double-blind controlled clinical trial. Rev Esc Enferm USP. 2015;49(2):221-8. doi: 10.1590/S0080-623420150000200006 https://doi.org/10.1590/S0080-6234201500... ⁾ 2015 Brazil	Randomized Clinical Trial 51 human beings with head and neck cancer Skin rating scale: RTOG acute skin score	EFA (27) x Calendula officinalis (24)	In the last radiotherapy session, skin toxicity (p => 0.05): EFA - score 0=1, 1=6, 2=3, 3=3; Calendula officinalis - score 0=3, 1=8, 2=1, 3=2

Article identification	1	2	3	4	5	6	7	8	9	10	11	12	13
A1⁽¹⁵15 Shaw S-Z, Nien H-H, Wu C-J, Lui LT, Su J-F, Lang C-H. 3M Cavilon No-Sting Barrier Film or topical corticosteroid (mometasone furoate) for protection against radiation dermatitis: a clinical trial. J Formos Med Assoc. 2015;114(5):407-14. doi: 10.1016/j.jfma.2013.04.003 https://doi.org/10.1016/j.jfma.2013.04.0... ⁾	N	N	N	N	N	N	N	Y	Y	Y	N	Y	Y
A2⁽²³23 Graham P, Browne L, Capp A, Fox C, Graham J, Hollis J, et al. Randomized, paired comparison of No-Sting Barrier Film versus sorbolene cream (10% glycerine) skin care during postmastectomy irradiation. Int J Radiat Oncol. 2004;58(1): 241-6. doi: 10.1016/S0360-3016(03)01431-7 https://doi.org/10.1016/S0360-3016(03)01... ⁾	U	Y	Y	N	N	N	N	N	Y	Y	N	Y	Y
A4⁽⁹9 Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol. 2004;22(8):1447-53. doi: 10.1200/JCO.2004.07.063 https://doi.org/10.1200/JCO.2004.07.063... ⁾	Y	N	N	N	N	Y	N	N	Y	Y	Y	Y	N/A
A5⁽²⁵25 Schneider F, Danski MTR, Vayego SA. Usage of Calendula officinalis in the prevention and treatment of radiodermatitis: a randomized double-blind controlled clinical trial. Rev Esc Enferm USP. 2015;49(2):221-8. doi: 10.1590/S0080-623420150000200006 https://doi.org/10.1590/S0080-6234201500... ⁾	Y	Y	Y	Y	Y	Y	Y	N	N	Y	Y	Y	N/A

Article identification	1	2	3	4	5	6	7	8	9	10
A3⁽²⁴24 Hu JJ, Cui T, Rodriguez-Gil JL, Allen GO, Li J, Takita C, et al. Complementary and alternative medicine in reducing radiation-induced skin toxicity. Radiat Environ Biophys. 2014;53(3):621-6. doi: 10.1007/s00411-014-0540-y https://doi.org/10.1007/s00411-014-0540-... ⁾	N	U	U	U	U	N	U	Y	Y	Y

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[1] Corresponding author: Rafael Celestino da Silva. Email: rafaenfer@yahoo.com.br