title: Phase 2 study of silver leaf dressing for treatment of radiation-induced dermatitis in patients receiving radiotherapy to the head and neck.
abstract: OBJECTIVE
  The use of silver leaf dressing is common in the treatment of burn victims owing to its capacity to improve healing and inherent antimicrobial properties. The goal of this study was to investigate its effectiveness in the treatment of radiation-induced dermatitis in a patient population receiving radiotherapy with or without concurrent chemotherapy for various carcinomas of the head and neck compared with our current standard of care, silver sulfadiazine (Flamazine).
  
  
  METHODS
  Twelve patients presenting with cancers of the head and neck region with Radiation Therapy Oncology Group (RTOG) grade 2 or more skin toxicity were offered topical treatment of silver sulfadiazine and silver leaf dressing. Each patient applied silver-leaf dressing on one side of the neck and silver sulfadiazine on the other. Three independent observers evaluated the patients based on standardized digital photography and regular follow-up by the treating physician. The sign test was used to evaluate whether the observed difference was statistically significant.
  
  
  RESULTS
  There was no improvement in RTOG grade skin toxicity. However, within the same grade, two of three observers agreed on some degree of improvement in the dermatitis with silver leaf dressing compared with silver sulfadiazine. As well, 67% of patients reported improved pain control on the side treated with silver leaf dressing. Sign test analysis indicated that the use of silver-leaf dressing gave significantly superior results when compared with silver sulfadiazine (p = .035).
  
  
  CONCLUSIONS
  Silver leaf dressing does not appear to be superior to our standard treatment for radiation-induced dermatitis when the RTOG grading system is used. It does, however, seem to reduce the severity of reaction within the same grade, accelerate healing, and provide improved pain control over standard treatment. It shows promise regarding symptom control and merits further investigation.
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec. pvavassis.hmr@ssss.gouv.qc.ca
authors.forename: Peter
authors.initials: P
authors.lastname: Vavassis
authors.forename: Michel
authors.initials: M
authors.lastname: Gelinas
authors.forename: Jean
authors.initials: J
authors.lastname: Chabot Tr
authors.forename: Phuc Felix
authors.initials: PF
authors.lastname: Nguyen-Tân
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001458:Bandages; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D011855:Radiodermatitis / Q000188:drug therapy*; D012834:Silver / Q000008:administration & dosage*; D012837:Silver Sulfadiazine / Q000008:administration & dosage*; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000891:Anti-Infective Agents, Local; D012834:Silver; D012837:Silver Sulfadiazine