Wheatgrass extract as a topical skin agent for acute radiation skin toxicity in breast radiation therapy: a randomised controlled trial

Journal of the Australian Traditional-Medicine Society, Sept, 2006 by Janelle Wheat, Geoff Currie, Kristine Coulter

Abstract

Acute radiation skin toxicity is particularly problematic in breast irradiation and may limit a patient's ability to complete their treatment regime. A variety of topical treatments have been used with limited success to manage acute radiation skin toxicity. This project is a pilot evaluation of wheatgrass as a topical agent, drawing on its reported properties in healing chemical, heat and radiation burns.

Reference

Wheat J, Currie G, Coulter K. Wheatgrass extract as a topical skin agent for acute radiation skin toxicity in breast radiation therapy: a randomised controlled trial. Journal of the Australian Traditional-Medicine Society 2006;12(3):135--137.

Keywords: Wheatgrass; Breast irradiation; Topical agent; Radiation skin toxicity.

Introduction

Acute radiation skin toxicity in breast irradiation occurs in the majority of patients and is more problematic where there is appositional skin, including the inframammary fold (1,2).

Acute radiation skin toxicity during breast irradiation, while common, can vary from mild erythema to brisk moist desquamation (3). Patient discomfort can range from mild irritation to severe pain and, perhaps more importantly, may have a significant bearing on patient tolerance/compliance (1). On occasion, radiation therapy is halted prior to completion of the planned treatment course due to the severity of acute radiation skin toxicity; reducing effectiveness of treatment (3). A variety of topical preparations have been employed for the care of acute radiation skin toxicity although supporting empirical evidence is sparse (4).

There has been significant interest in the healing properties of cereal grasses with a particular interest in the effects of wheatgrass extract; squeezed from the mature sprouts of wheat (Triticum aestivum). Wheatgrass extract is a topical immunomodulator and has been used to boost topical immunity with excellent results demonstrated for promoting healing in burns patients due to re-epithelialisation. Wheatgrass extract decreases the inflammatory response (takes heat and pain away), is a substance P inhibitor, stops subcutaneous bleeding and increases the fibroblastic activity of cells.

Low cost topical agents for management of acute radiation skin toxicity have the potential to offer enormous benefits to the breast cancer patient including; decreased acute and late morbidity, improved short and long term quality of life (QOL), improved tolerance and, therefore, success rate of treatment.

Aims And Objectives

The aim of this pilot study was to evaluate the efficacy of topical application of wheatgrass extract for reducing the incidence, severity and duration of acute radiation skin toxicity in patients receiving breast irradiation for breast cancer. The investigation aimed to determine whether wheatgrass extract provides a protective effect and/or improved cell recovery in breast irradiation, minimising the incidence, time to onset and/or severity of acute radiation skin toxicity.

This research was approved by the Charles Sturt University Ethics in Human Research Committee.

The Research Question

Does topical wheatgrass extract applied prior to and during radiation therapy in breast cancer provide a protective effect for skin leading to decreased morbidity and improved tolerance during breast radiotherapy?

Methodology

This pilot study was a prospective randomised control trial using one control group employing current best practice (sorbelene cream) and one treatment modification group (wheatgrass). Atotal of 30 patients were recruited for the initial pilot phase of this research. One patient was excluded due to insufficient data. All remaining 29 patients satisfied eligibility and exclusion requirements.

Patient recruitment was randomised and blinded to treatment group; that is, each type of cream was re-packaged into identical containers without labelling. The cream was applied thrice daily beginning with the commencement of radiation therapy.

A number of criteria needed to be satisfied for inclusion in the pilot study. Eligibility criteria included:

* Histologically confirmed breast carcinoma diagnosis.

* Minimum dose of 50 Gy to primary site.

* Minimum age of 18 years.

* Zubrod performance status (ZPS) of 0 or 1 (Table 1).

* Ability to conform to treatment regime.

* Informed consent.

Exclusion criteria included:

* Concurrent chemotherapy

* Rash, ulceration, haemorrhage or unhealed scar in treatment area.

* Allergy to wheatgrass extract.

* Local involvement of cancer in the skin.

* History of connective tissue disorder.

* Prior radiation treatment to treatment area.

Acute skin toxicity was recorded according to the Oncology Nursing Society (ONS) scale for acute skin toxicity scale (Table 2) for each patient every week during radiotherapy (1). Quality of life (QOL) was also assessed weekly using the Spitzer QOL rater administered questionnaire (SQLI) (5).

The statistical significance was calculated using Chi-Square analysis for nominal data and Student's t test for continuous data. The [x,.sup.2] Pearson Chi Square test was employed for categorical data with normal distribution and the G2 Likelihood Ratio Chi-Square test for categorical data without normal distribution. The F test analysis of variances was used to determine statistically significant differences within grouped data. A p value less than 0.10 was considered significant.