Patient Outcomes with a Transparent Film Dressing for Reducing Acute Dermatitis from Post-Mastectomy Radiotherapy

Dermatitis remains a source of morbidity for post-mastectomy radiotherapy (PMRT) patients. We retrospectively report our experience, including patient-reported outcomes (PROs), with a transparent film dressing (Mepitel film) for reducing acute dermatitis from PMRT. Patients who underwent prophylactic application of Mepitel film over the irradiated chest wall during PMRT for breast cancer at our institution between September 2015 and August 2019 were included. Mepitel films were regularly checked every 1-2 weeks during treatment and changed or patched as needed. Adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 5. Selected PROs at baseline, PMRT completion, and 3-month follow-up were obtained from the PRO-CTCAE and the Breast Cancer Treatment Outcomes Scale. Descriptive and univariate analyses (e.g., Wilcoxon signed-rank test) were performed using SPSS Statistics Version 25. 139 patients with a mean (standard deviation) age of 52 (12) years at the time of treatment met the eligibility criteria. PMRT was administered with protons in 102 (73.4%) and photons in 37 (26.6%). Approximately half (50.4%) of patients had breast reconstruction at the time of PMRT. The median (range) number of total fractions given was 25 (15-33) with a median (range) total dose of 5000 (4005-6625) cGy. Chest wall boost was administered in 21 (15.1%), and lymph node boost in 26 (18.7%). Skin boluses were used in 35 (95%) of the 37 patients treated with photons. One (1.4%) patient developed an allergic reaction to Mepitel before treatment during a sampling trial. 24 (17.5%) discontinued Mepitel before PMRT completion, most commonly due to a skin reaction (allergic or irritation) (16 (11.7%)), or difficulty with its use (poor adherence, intolerance, or discomfort) (8 (5.8%)). The median (range) number of Mepitel patching and re-applications during PMRT was 3 (0-10). 71 (51.1%) patients developed grade 1 dermatitis, 60 (43.2%) developed grade 2 dermatitis, and eight (5.8%) developed grade 3 dermatitis. On a 5-point Likert scale (0 meaning not at all and 5 meaning very severe), the median self-rated severity at PMRT completion and 3-months were 2 (mild; range 1-5; n = 86) and 1 (none; range 1-4; n = 82), respectively. Self-reported ratings of other PROs (bleeding or leaking fluid, blistering, tenderness/discomfort, tightness, telangiectasia, flaking/peeling, changes in skin color, and itchiness) on a 10-point Likert scale were as expected. The use of Mepitel films in patients undergoing PMRT with photon- and proton-based radiotherapy is feasible. Rates of acute skin toxicity compare favorably with historical controls. Based on this preliminary experience, a phase 3 randomized controlled trial (A221803) comparing Mepitel versus best supportive care for patients undergoing PMRT is pending.