Zhang, Y., Zhang, S., & Shao, X. (2013). Topical agent therapy for prevention and treatment of radiodermatitis: A meta-analysis. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 21(4), 1025–1031.

To review the evidence regarding efficacy of topical treatments to prevent and manage radiodermatitis through meta-analysis and systematic review

Databases searched were Cochrane, MEDLINE, PubMed, and Web of Science. Keywords used were radiodermatitis, skin reaction, prevention, treatment, erythema, and desquamation, among others. Studies were included in the review if they

• Were randomized controlled trials
• Evaluated topical versus non-topical agent therapy
• Reported incidence of grade 2 or higher radiodermatitis for prophylactic trials and incidence of wound healing for treatment trials
• Were written in English.
   

Seventy-three references were retrieved. Study quality was rated using the Jadad Scale.

• The final number of studies included was 20, with 14 prevention trials and 6 treatment trials.
• The sample size ranged from 33–340 across studies.

Effect of topical agents for prevention showed no significant differences across all trials between intervention and control groups (relative risk [RR] = 0.90)  There was no significant difference across control and intervention groups for topical agent use in wound healing (RR = 1.01). There was high heterogeneity in both analyses. All topical agents were considered together, with no analysis of different types of agents.

Findings suggest that overall, the use of topical agents is not effective for either prevention or treatment of radiodermatitis. The findings are similar to those of other systematic reviews in the topic that have shown there is insufficient evidence in this area to recommend any particular topical agent.

• The analysis considered all types of agents, from enzymes to steroids in a single analysis. 
• Given the varied mechanisms of action, the appropriateness of the study is questionable. There is, however, insufficient evidence to do meta-analysis within interventions, because many have only been tested with one study.

There is a continued need for well-designed research in the area of prevention and management of radiodermatitis.