|
The Cochrane Collaboration
Cochrane Reviews |
| Explore | New + Updated | Other languages |
|
 |
Topical agents and dressings for fungating woundsAdderley UJ, Smith R
Bookmark this:
     more ...
SummaryTopical agents and dressings for fungating wounds (ulcers caused by cancer)Fungating wounds sometimes occur in people with advanced cancer. Care usually aims to slow down disease progression, and improve quality of life by relieving the physical symptoms caused by the wounds (leakage, bad smell, pain and the risk of haemorrhage) by means of appropriate dressings and other applied treatments. There is weak evidence to suggest that a 6% solution of miltefosine, applied as a fluid to small, superficial fungating wounds on the breast (in people with breast cancer who had previously had either radiotherapy, surgery, hormone therapy or chemotherapy) may slow down the progression of the disease (i.e. extend the time to disease progression). There is very little evidence in this area of medicine, however, and what there is is insufficient to direct practice for improving quality of life or managing wound symptoms in people with fungating wounds. More research is needed in this area.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 18. 2007 AbstractBackgroundFungating wounds arise from primary, secondary or recurrent malignant disease and are associated with advanced cancer. A small proportion of patients may achieve healing following surgical excision, but treatment is usually palliative. Fungating wound management usually aims to slow disease progression and optimise quality of life by alleviating physical symptoms, such as copious exudate, malodour, pain and the risk of haemorrhage, through selection of appropriate dressings and topical agents. ObjectivesTo conduct a systematic review of the evidence of the effects of dressings and topical agents on quality of life, and symptoms that impact on quality of life, in people with fungating malignant wounds. Search strategyFor this first update we searched the Wounds Group Specialised Register (January 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2008), Ovid MEDLINE (1950 to January Week 1 2009), Ovid EMBASE (1980 to 2009 Week 3) and EBSCO CINAHL (1982 to January Week 2 2009). We contacted dressing manufacturers to enquire about ongoing, and recently completed, relevant trials. In addition, citations within obtained papers were scrutinised to identify additional studies. There was no restriction on language or date of publication. Selection criteriaEligible studies comprised randomised controlled trials (RCTs) or, in their absence, controlled clinical trials (CCTs) with a concurrent control group, both published and unpublished, and written in any language. Data collection and analysisData extraction was undertaken by one author and checked for accuracy by a second author. Two review authors independently assessed trial quality. Main resultsTwo trials involving 63 people were included. One RCT in women with superficial breast lesions compared 6% miltefosine solution with placebo and found that miltefosine delayed tumour progression. The study reported that the time to treatment failure was significantly longer in the miltefosine group (median 56 days) than in the placebo group (median 21 days) (P value 0.007, log-rank test). A second trial compared topical metronidazole with placebo and found that metronidazole reduced malodour, although there was no statistically significant difference between the two groups. Both these trials, however, had methodological limitations and the latter was underpowered. Authors' conclusionsThere is weak evidence from one small trial that 6% miltefosine solution applied topically to people with superficial fungating breast lesions (smaller than 1cm) who have received either previous radiotherapy, surgery, hormonal therapy or chemotherapy for their breast cancer, may slow disease progression. There is insufficient evidence in this review to give a clear direction for practice with regard to improving quality of life or managing wound symptoms associated with fungating wounds. More research is needed. |