Nasal Colonization With Staph Bacteria Linked to Acute Radiation Dermatitis

FRIDAY, May 12, 2023 (HealthDay News) -- Nasal colonization with Staphylococcus aureus(SA) before radiation therapy (RT) is associated with acute radiation dermatitis (ARD) severity, and bacterial decolonization (BD) is effective for ARD prophylaxis, according to two studies published online May 4 in JAMA Oncology.

Yana Kost, from the Albert Einstein College of Medicine in Bronx, New York, and colleagues conducted a prospective cohort study to examine whether nasal colonization with SA before RT is associated with ARD severity in patients with breast or head and neck cancer. Data were included for 76 patients, all of whom developed ARD: 61.8, 28.9, and 9.2 percent had grade 1, 2, and 3, respectively. The researchers found that patients who developed grade 2 or higher versus grade 1 ARD had a greater prevalence of baseline nasal SA colonization (34.5 versus 12.8 percent).

In a second study, Kost and colleagues conducted a phase 2/3 randomized clinical trial involving patients with breast cancer or head and neck cancer (75 and two, respectively) receiving RT with curative intent. Participants were randomly assigned to receive BD or standard of care (39 and 38 patients, respectively). The researchers found that none of the patients treated with BD and 23.7 percent treated with standard of care developed grade 2 or higher ARD with moist desquamation. The results were similar for the 75 patients with breast cancer (none and 21.6 percent, respectively). The mean ARD grade was significantly lower for patients treated with BD versus standard of care (1.2 versus 1.6).

"The results of this randomized clinical trial suggest that BD is effective for ARD prophylaxis, specifically for patients with breast cancer, and support the further investigation of BD for ARD prophylaxis," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text 1 (subscription or payment may be required)

Abstract/Full Text 2 (subscription or payment may be required)

Association of Staphylococcus aureus Colonization With Severity of Acute Radiation Dermatitis in Patients With Breast or Head and Neck Cancer

Key Points

Question Is Staphylococcus aureus (SA) colonization associated with acute radiation dermatitis (ARD) severity in patients with breast or head and neck cancer?

Findings This cohort study of 76 patients with breast or head and neck cancer found that nasal SA colonization prior to radiation therapy was present in 35% of patients who developed grade 2 or higher ARD compared with 13% of patients who developed grade 1 ARD, a significant difference.

Meaning The findings suggest that SA colonization may be associated with grade 2 or higher ARD development in patients with breast or head and neck cancer.

Abstract

Importance Pathogenesis of acute radiation dermatitis (ARD) is not completely understood. Pro-inflammatory cutaneous bacteria may contribute to cutaneous inflammation after radiation therapy.

Objective To evaluate whether nasal colonization with Staphylococcus aureus (SA) before radiation therapy is associated with ARD severity in patients with breast or head and neck cancer.

Design, Setting, and Participants This prospective cohort study with observers blinded to colonization status was conducted from July 2017 to May 2018 at an urban academic cancer center. Patients aged 18 years or older with breast or head and neck cancer and plans for fractionated radiation therapy (≥15 fractions) with curative intent were enrolled via convenience sampling. Data were analyzed from September to October 2018.

Exposures Staphylococcus aureus colonization status before radiation therapy (baseline).

Main Outcomes and Measures The primary outcome was ARD grade using the Common Terminology Criteria for Adverse Event Reporting, version 4.03.

Results Among 76 patients analyzed, mean (SD) age was 58.5 (12.6) years and 56 (73.7%) were female. All 76 patients developed ARD: 47 (61.8%) with grade 1, 22 (28.9%) with grade 2, and 7 (9.2%) with grade 3. The prevalence of baseline nasal SA colonization was higher among patients who developed grade 2 or higher ARD compared with those who developed grade 1 ARD (10 of 29 [34.5%] vs 6 of 47 [12.8%]; P = .02, by χ² test).

Conclusions and Relevance In this cohort study, baseline nasal SA colonization was associated with development of grade 2 or higher ARD in patients with breast or head and neck cancer. The findings suggest that SA colonization may play a role in the pathogenesis of ARD.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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