What is your strategy for managing radiation dermatitis in breast cancer in the prophylactic, erythema/dry desquamation, and moist desquamation stages?

Good question. Everyone seems to have a favorite home remedy with very little good supporting data. I am unaware of any good prophylaxis rx. The best thing is good treatment planning to minimize inhomogeneity. There are phase III data demonstrating the efficacy of soap and water cleansing for rx of both dry and moist desquamation. Do it daily. Topical steroids are not effective and should be avoided. I have found dry powdered corn starch useful for relief of itching. It should be discontinued if moist desquamation develops. Topical antibiotics / silvadene are overused leading to increased antibiotic resistance and should be reserved for cases where there is obvious infection. For dry desquamation, any lubricating cream may be helpful. For m...

Radiation dermatitis is influenced by several factors which makes prophylaxis and management unique to the patient.

I consider the following when deciding on prophylaxis:

Patient factors: Breast size (A-B cup, vs C-DD or larger etc), Obesity-Inframmamary folds and axillary folds, supraclav/neck folds. I worry less about small cup sizes (especially with hypofrac).

Technique, Fractionation and Dosimetry: Conventional fractionation (more risk) vs. Hypofractionation, Prone (less risk) vs. Supine, >105% in inframammary and axillary folds.

Situation: Whole breast (less) vs. Regional Nodes vs. Chest Wall.

I routinely use mometasone daily, before XRT in large breasted (every D-cup or higher, select C cup based on body habitus and dosimetry), reg...

- We routinely give all patients calendula lotion for which there is contradictory prospective data but below is a trial supporting its reduction of acute dermatitis: https://www.ncbi.nlm.nih.gov/pubmed/15084618

- We give steroids as needed (hydrocortisone or mometasone) for increasing erythema and pruritis despite calendula use.

- In the setting if skin breakdown, we give patients xeroform dressings.

- For post-mastectomy patients in whom we bolus, we prescribe mometasone and give calendula from RT start and have them use both prophylactically.

This is still a very important issue for our patients. At my institution we've had good success using Mepitel Film for prophylaxis of radiation dermatitis in breast patients. https://www.ncbi.nlm.nih.gov/pubmed/24486117

We use it standardly for our high risk breast patients with very good results. There is really no moist desquamation development even with high doses or bolus usage. However, this doesn't work well for many subsets of patients (i.e. Head & Neck).