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22nd June 2022
A solution a green tea extract has been found to reduce both the incidence and severity of radiation-induced dermatitis in women undergoing adjunctive radiotherapy after breast cancer surgery. This was the conclusion of a phase 2 randomised, placebo-controlled trial by a team of Chinese researchers.
Breast cancer affects a large number of women and according to the World Health Organisation, in 2020, there were 2.3 million women diagnosed with breast cancer and and which led to 685 000 deaths. For the treatment of women with breast cancer, the results from a 20-year follow-up study have shown that lumpectomy, i.e., where there is removal of enough normal breast tissue to ensure that the margins of the resected specimen were free of tumour, followed by irradiation, continues to be an appropriate therapy for women, provided an acceptable cosmetic result can be obtained. However, one troublesome adverse effect of radiotherapy is radiation-induced dermatitis (RID) and while the use of topical prophylactic corticosteroids (e.g., mometasone) is recommended to reduce discomfort and itching, there is no evidence to support the superiority for any specific intervention.
To date, there is some, limited data to show that a green tea extract containing epigallocatechin-3-gallate (EGCG) can help with restitution of skin integrity, possibly mediated via an anti-inflammatory effect. Furthermore, some evidence also shows that a green tea extract can reduce the acute skin-induced reactions after radiation which include pain, the burning-feeling, itching, pulling and tenderness. However, whether the use of this extract could actually prevent the development of radiation-induced dermatitis is unclear and was the subject of the present study.
The Chinese team recruited women with breast cancer undergoing postoperative radiotherapy and then randomised them (2:1), to either the green tea extract or placebo (which was a normal saline solution). Both solutions were sprayed to the whole of the radiation field from day one of therapy and continued until two weeks after completion of treatment. An assessment of RID was made weekly using a scale ranging from 0 (no change) to 4 (worse impairment), i.e., higher scores indicate more severe dermatitis. In addition, patient-reported symptoms including pain, itch and tenderness were also included. The primary outcome was the incidence of grade 2 or worse RID whereas secondary outcomes included patient symptoms.
Green tea extract and RID outcomes
A total of 165 women with a median age of 46 years were enrolled and randomised to EGCG or placebo.
During radiotherapy as the dose was increased, RID began to occur two to three weeks after the start of treatment and the mean appearance time was delayed in the EGCG group compared to placebo (3.27 weeks vs 2.89 weeks, p = 0.001).
The incidence of grade 2 or above RID was 50.5% in the green tea extract group and 72.2% in the placebo arm (p = 0.008). In addition, symptom scores were also lower among the women receiving EGCG.
The authors concluded that prophylactic use of a green tea extract significantly reduced both the incidence and severity of RID and that the extract has the potential to become a new choice for skin care in women receiving radiotherapy.
Zhao H et al. Efficacy of Epigallocatechin-3-Gallate in Preventing Dermatitis in Patients With Breast Cancer Receiving Postoperative Radiotherapy: A Double-Blind, Placebo-Controlled, Phase 2 Randomized Clinical Trial JAMA Dermatol 2022