What is the appropriate skin cleaning method for nasopharyngeal cancer radiotherapy patients? A randomized controlled trial.

PURPOSE: To determine the effect of various cleaning methods for skin with acute radiation dermatitis (RD) in patients treated for nasopharyngeal carcinoma (NPC). METHODS: A total of 168 NPC inpatients were randomized, while 152 patients completed the whole trial and the data were analyzed. Patients were randomly divided into the non-washing group (Group 1), washing with water alone group (Group 2), and washing with water and soap group (Group 3). All three groups received intensity-modulated radiation therapy (IMRT) with other treatments. Follow-up from recruitment or the initial radiotherapy dose to 1 month after the final radiotherapy dose. CONSORT checklist was applied as the reporting guidelines for this study. The study evaluated a range of endpoints, including incidence, timing, severity of acute RD, and quality of life (QOL). RESULTS: There were no allergic reactions or aggravating in both washing groups during the whole treatment. The incidence of acute RD was 100% in all three groups, while the incidence of severe RD (grades 2-3) differed among groups (Group 1 vs. Group 2 vs. Group 3: 51% vs. 23.5% vs. 18%; P = 0.001), washing moderately reduced severity compared with patients without washing. Washing also delayed the onset time of acute RD; the incidence of acute RD was significantly lower than non-washing during the first 20 fractions (P < 0.001). What is more, washing reduced the incidence of moist desquamation (25.5% vs. 5.9% vs. 6%; P = 0.003) and helped relieve itching (6.49 +/- 2.09 vs. 4.90 +/- 1.90 vs. 4.00 +/- 1.58; P < 0.001). There were no significant differences among groups with respect to pain or burning sensation. Washing improved QOL on physical (64.37 +/- 4.08 vs. 67.41 +/- 4.05 vs. 71.30 +/- 4.87; P < 0.001), emotional (61.47 +/- 4.75 vs. 65.75 +/- 3.46 vs. 70.80 +/- 3.27; P < 0.001), and social functional dimensions (62.64 +/- 3.57 vs. 64.87 +/- 3.88 vs. 68.04 +/- 4.89; P < 0.001) at the end of radiotherapy, and the outcome was similar at 1 month after radiotherapy (P < 0.05). Washing with water and soap was the most effective way to reduce itching and improving QOL among the three groups (P < 0.05). CONCLUSION: Washing irradiated skin reduces the occurrence and severity of acute radiation dermatitis. CLINICAL TRIAL INFORMATION: ChiCTR2000038231, date of registration 09.18.2020.