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Time to ARSR [greater than or equal to] G2 is presented in a Kaplan Meier curve in Figure 1 (censored data).
Time to ARSR Grades 1, 2, and 3 was not significantly different when comparing the CSNF and control group using the exact Fisher test (no censoring).
This is the first study using a combination of a CSNF gel and lotion preventing and rescuing ARSR in patients with breast cancer undergoing postoperative whole breast RT.
In the control group, we used the standard care treatments for ARSR recommended by the SASRO nursing group  similarly to many other Swiss RT departments.
The use of hypofractionation and nodal irradiation was recorded at a higher percentage in the standard group (Table 1), and no increase of ARSR [greater than or equal to] G2 was recorded in either group.
This pilot study demonstrated that the combined use of CSNF gel and lotion delayed the occurrence of ARSR [greater than or equal to] G2 and may reduce the risk of moist desquamation of the irradiated skin by 50% [HR 2.33 (95% CI: 1.15-4.72)].
Several studies analyzing prophylaxis of radiation-induced side effects of patients undergoing postoperative RT showed a similar or even higher magnitude of risk reduction of ARSR [greater than or equal to] G2 .
The second important observation was the improved recovery of ARSR [greater than or equal to] G2 compared to the control group.
When assessing and grading ARSR in our prospective patient cohort, we noted some interobserver variability despite the fact that ARSR appears to be describable in an objective and reproducible manner using the standardized CTCAE v4.03 scoring system.
Absence or inconsistencies of patient-reported outcomes are therefore a major obstacle in clinical studies aiming to improve ARSR in patients undergoing postoperative RT for breast cancer.
Second, the assessment of ARSR was based on ratings by the treating physician and nursing staff, and patient-related outcome measures were not integrated.
There is a medical need for developing a novel concept for prevention of RT-induced ARSR and care of irritated skin, and patients would benefit by improvement of quality of life during and after RT.
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