Original colonies

Top Line: A lot of the art of breast irradiation comes in minimizing dermatitis without sacrificing efficacy.

The Study: In this eyebrow-rising phase 2 trial, 80 patients receiving radiation for breast (n=78) or head and neck (n=2) cancer were randomized 1:1 to standard of care +/- intranasal mupirocin ointment twice daily and chlorhexidine body wash once daily for 5 consecutive days prior to radiation and repeated for 5 days every other week during radiation. Why, you ask? The goal was to demonstrate a significant reduction in the incidence of grade 2+ radiation dermatitis. Why, you ask, again? A curious prior discovery was that pretreatment nasal colonization with Staphylococcus aureus was an independent predictor of radiation dermatitis, so the authors figured let’s wipe out the Staph and see what happens. Now it’s your turn to ask, why not? Well, it worked. While nearly a quarter of patients (24%) experienced grade 2 dermatitis with moist desquamation as expected in the standard arm, zero patients experienced it in the decolonization arm.

TBL: While this is a small study, the authors suggest bacterial decolonization as a readily implementable strategy to minimize radiation dermatitis given its negligible cost.