***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to determine the effectiveness of granulocyte-macrophage colony-stimulating factor ( GM-CSF ) impregnated gauze in preventing or healing radiation-induced dermatitis . Sixty-one patients were irradiated for vulvar carcinoma . Thirty-seven applied steroid cream at irradiated areas throughout radiotherapy ( Group A ) and 24 patients applied additionally GM-CSF impregnated gauze ( 40 micrcog/cm2 of skin-irradiated area , twice per day ) in addition to the steroid cream , after 20 Gy of irradiation ( Group B ) . The score of skin reactions ( P=0.008 , chi2 test ) and the time interval of radiotherapy interruption ( P=0.037 , Mann-Whitney U test ) were statistically significantly reduced in Group B patients . Multivariate analysis of variance showed for this group not only a significant reduction in the Sum of Gross Dermatitis Scoring ( P<0.001 , adjusted for Duration of Dermatitis ) but also a significant reduction of the healing time ( P=0.02 , adjusted for Sum of Gross Dermatitis Scoring ) . The pain grading was less ( P=0.014 , chi2 test ) and pain reduction was noticed sooner after the application of GM-CSF impregnated gauze ( P=0.0017 , Mann-Whitney U test ) . Multivariate logistic regression analysis showed that the only significant effect on dermatitis score is due to Body Mass Index ( P=0.034 ) and the application of GM-CSF ( P=0.008 ) . GM-CSF impregnated gauze can be effective in preventing and healing radiation-induced dermatitis and in reducing the interruption intervals of radiotherapy for vulvar carcinomas PURPOSE The effectiveness of nonsteroid topical agents for the prevention of acute dermatitis during adjuvant radiotherapy for breast carcinoma has not been demonstrated . The goal of this study was to compare the effectiveness of  calendula  ( Pommade au Calendula par Digestion ; Boiron Ltd , Levallois-Perret , France ) with that of trolamine ( Biafine ; Genmedix Ltd , France ) , which is considered in many institutions to be the reference topical agent . PATIENTS AND METHODS Between July 1999 and June 2001 , 254 patients who had been operated on for breast cancer and who were to receive postoperative radiation therapy  were r and omly allocated to application of either trolamine ( 128 patients ) or calendula ( 126 patients ) on the irradiated fields after each session . The primary end point was the occurrence of acute dermatitis of grade 2 or higher . Prognostic factors , including treatment modalities and patient characteristics , were also investigated . Secondary end points were the occurrence of pain , the quantity of topical agent used , and patient satisfaction . RESULTS The occurrence of acute dermatitis of grade 2 or higher was significantly lower ( 41 % v 63 % ; P < .001 ) with the use of calendula than with trolamine . Moreover , patients receiving calendula had less frequent interruption of radiotherapy and significantly reduced radiation-induced pain .  Calendula was considered to be more difficult to apply , but self-assessed satisfaction was greater . Body mass index and adjuvant chemotherapy before radiotherapy after lumpectomy were significant prognostic factors for acute dermatitis . CONCLUSION Calendula is highly effective for the prevention of acute dermatitis of grade 2 or higher and should be proposed for patients undergoing postoperative irradiation for breast cancer Acute skin reactions , such as erythema and moist desquamation , constitute major problems during radiotherapy of superficially located tumours . There are no drugs available for the skin care . Sucralfate , a widely used anti-ulcer drug , has anti-inflammatory properties , and it activates cell proliferation . Based on these data and our previous experience of sucralfate cream on the aging skin we performed a double-blind r and omized study to compare the efficacy of sucralfate cream to a base cream in 50 breast cancer patients receiving postoperative electron beam therapy to their chest wall . The acute radiation reaction of the skin was statistically significantly prevented by the sucralfate cream . The recovery of the skin was also significantly faster in the sucralfate cream group . Side-effects due to the cream were rare Purpose : The use of additional therapy with an oral enzyme preparation containing trypsin , chymotrypsin and papain has been suggested for the reduction of toxicity due to radiation therapy . This study was conducted to test the efficacy and tolerability of this enzyme combination in preventing or reducing the acute side effects of radiation therapy in patients with locally advanced cervical cancer . Methods : A prospect i ve , r and omised , open , clinical trial was carried out on 120 patients ( aged 24–85 years ) with locally advanced , biopsy-proven carcinomas of the uterine cervix ( stages IIa , IIb or IIIb ) . Patients received 50 Gy of external radiation therapy over a period of 5 weeks , followed by intra-cavitary brachytherapy ( 20–30 Gy ) . Patients assigned to the test group ( 60 patients ) received additional treatment with enzymes . Patients were evaluated at weekly intervals for acute radiation therapy-related side effects , according to the RTOG/EORTC grading criteria , and then after the end of radiation therapy for another 8 weeks . Occurrence of adverse events , if any , was also recorded . Results : The study revealed that the maximum extent of acute radiation side effects was reduced in the enzyme group : skin reactions ( mean : 0.97 vs 1.68 in the control group , P < 0.001 ) , vaginal mucosal reactions ( 0.55 vs 0.85 , P=0.10 ) , genitourinary symptoms ( 0.93 vs 1.38 , P < 0.001 ) and gastrointestinal reactions ( 1.12 vs 1.30 , P=0.12 ) . The sum-scores during treatment , expressed as area under the curve , were significantly less in the enzyme treated patients . In the follow-up visits all observed side effects of radiation therapy were of lower intensity in the enzyme group than in the control group . Conclusions : In patients with locally advanced cancer of the uterine cervix , oral enzyme therapy was found to be effective in significantly reducing radiation therapy-related side effects such as genitourinary symptoms , subcutaneous changes and reactions of the vaginal mucosa BACKGROUND AND PURPOSE We evaluated sucralfate , well-known in the treatment of gastric ulcers , in relation to its possible reduction of radiation-induced acute complications in the treatment of head and neck cancers . MATERIAL S AND METHODS One hundred two patients were r and omized in a double-blind placebo-controlled prospect i ve setting . All patients were treated to a minimum dose of 55 Gy in 5 weeks . Oral intake of sucralfate was started at the beginning of radiotherapy and continued during the whole treatment at a dose of 1 g six times a day . All patients were scored according to a scoring system developed in our department . Weight was checked once a week . RESULTS Comparing the time course of the mean scores for subjective intolerance , mucositis , dysphagia , dermatitis and nausea , no statistically significant differences between the two treatment arms ( sucralfate , n = 38 ; placebo , n = 45 ) were observed . The mean weight loss in the sucralfate arm was 1.6 + /- 3.4 kg while it was 1.3 + /- 2.0 kg in the placebo arm . Apart from gastrointestinal upset , the administration of sucralfate did not cause any side-effects . CONCLUSION This trial produced no clinical evidence indicating that the oral intake of sucralfate reduces the acute radiation-induced side-effects . Therefore , we do not recommend the prophylactic use of sucralfate in patients with head and neck cancer treated by radiotherapy The aim of the study was to compare the effect of a gentian violet topical application with that of a moist dressing ( hydrocolloid ) on the rate and efficacy of  radiotherapy-induced  moist desquamation wound healing and the patients ' satisfaction level with each method . This prospect i ve r and omized clinical trial used a stratified sampling design . A sample of 39 patients with 60 wounds had their wounds assessed on alternate days in terms of several wound-healing parameters including wound size , wound pain , incidence of infection , and time required for healing . Patient satisfaction with each treatment was evaluated at the completion of the study . Gentian violet significantly decreased wound size and reduced wound pain . However , this treatment received significantly lower ratings for dressing comfort and dressing aesthetic acceptance . Nevertheless , the time required for healing was not statistically different in the two groups . These findings suggest that the lower score of dressing satisfaction level in the gentian violet group may result from the skin discoloration and drying effects of the treatment , which renders patients unable to move or stretch their skin . Although the aim is to have complete wound healing , this may not be realistic for many lesions such as radiotherapy-induced moist desquamation wounds . The best evidence on which to make decisions about individual care can now be based on patients ' own perception of quality R and omized trials have shown that sucralfate is effective in the management of acute radiation reactions such as oesophagitis , mucositis and proctitis . However , at the time of commencement of the present trial , it had never been used in the management of moist desquamation of the skin . The purpose of the present study was to assess the value of sucralfate cream in the management of moist desquamation during radiotherapy . Patients who developed moist desquamation during radiation were eligible . Patients were stratified by site of radiotherapy into three groups : ( i ) the head and neck ; ( ii ) the breast ; and ( iii ) other sites . Patients were r and omized to receive 10 % sucralfate in sorbolene cream or sorbolene alone . Patients ' pain and skin healing were assessed by using linear analogue self- assessment ( LASA ) scales and by serial measurement of the desquamated area . Due to poor patient accrual , the trial was terminated after 2 years and 39 patients . No statistically significant difference was found between the two arms in either time from r and omization to healing or improvement in pain score . Twenty patients in the sucralfate arm took a geometric mean of 14.8 days to heal whereas 19 patients receiving sorbolene alone took a geometric mean of 14.2 days . The ratio of mean times of healing , 1.043 , is not statistically different from 1 ( P = 0.86 ; 95 % CI = 0.65 , 1.67 ) . A total of 75 % of the patients reported pain relief on application of either cream . Mean LASA scores for pain for each day after r and omization were compared by treatment arm and there was no statistically significant difference ( P = 0.32 ) . The present trial was unable to show a difference in terms of time to healing or pain relief in the treatment of moist desquamation . The small number of patients in the trial gave a wide confidence interval for treatment difference , implying that an important effect of sucralfate has not been excluded . Given the poor accrual in the present , single-institution study , future studies may need to be multi-institutional and we encourage other centres to perform r and omized trials in the management of moist desquamation A total of 99 patients receiving adjuvant radiotherapy to the breast or chest wall were r and omized to one of three washing policies : ( 1 ) not washing , ( 2 ) washing with water alone , and ( 3 ) washing with soap and water . Fifty-three of the patients were treated without the use of bolus , and 46 patients were treated using bolus for 10 to 15 of the 20 treatment fractions . Approximately half of the patients r and omized to washing were  tattooed . Subjective and objective measurements of acute skin reactions were found to be less in the two groups r and omized to washing . There was little difference between the two washing groups . These findings were the same whether or not bolus was used . It is concluded that washing of the skin should be encouraged in patients undergoing radiotherapy associated with low skin doses BACKGROUND Two prospect i ve trials were design ed to determine whether there may be a role for inflammatory mediators in human skin  erythema at both high and low doses per fraction and for ' out of field ' effects . METHODS Trial 1 . Effects of topical indomethacin ( 1 % ) and hydrocortisone ( 1 % ) applied before and during radiotherapy were compared for erythema induced by 20 Gy in four fractions ( n = 26 , 6 MV ) . Trial 2 . Effects of topical hydrocortisone ( 1 % ) applied before and during radiotherapy and no medication were compared for erythema induced by 1 , 3 , 5 and 7 Gy in five fractions ( n = 21 , 120 kV ) . Erythema was measured using reflectance spectrophotometry ( RFS ) and laser Doppler ( LD ) on a weekly basis . RESULTS Trial 1 . A bi-phasic reaction time course was suggested in two-thirds of the cases . The first phase did not appear to be influenced by hydrocortisone cream but the second was significantly attenuated . Indomethacin had no effect on either reaction phase . Erythema measured several centimetres outside of the field was reduced by hydrocortisone but not by indomethacin . Trial 2 . Trial 2 confirmed the presence of measurable erythema , invisible to the eye , that coincided in its time course to the first phase of erythema noted in trial 1 . This reaction was more intense than predicted by the LQ formula and was 
    Output:
    
Some evidence suggested topical steroid creams and calendula ointment might be effective .
Conclusions Skin washing , including gentle washing with water alone with or without mild soap , should be permitted in patients receiving radiation therapy to prevent acute skin reaction .
There is insufficient evidence to support or refute specific topical or oral agents for the prevention or management of acute skin reaction .
In the expert opinion from the SCGG , the use of a plain , non-scented , lanolin-free hydrophilic cream may be helpful in preventing radiation skin reactions .
In addition , a low dose ( i.e. , 1 % ) corticosteroid cream may be beneficial in the reduction of itching and irritation