• Incidence of severe (grade ≥ 3) radiation dermatitis [ Designated as safety issue: Yes ]
• Time to onset of severe radiation dermatitis [ Designated as safety issue: Yes ]
• Duration of severe radiation dermatitis [ Designated as safety issue: Yes ]
• Overall quality of life (QOL) as measured by Linear Analogue Self-Assessment (LASA) [ Designated as safety issue: No ]
• QOL domains as measured by LASA [ Designated as safety issue: No ]
• Skin toxicity as measured by Skindex-16 [ Designated as safety issue: Yes ]
• Skin toxicity as measured by the Skin Toxicity Assessment Tool [ Designated as safety issue: Yes ]
• Frequency and severity of adverse events reported by the patient in the Symptom Experience Diary and assessed clinically by NCI CTCAE v3.0 [ Designated as safety issue: Yes ]

• Incidence of severe (grade ≥ 3) radiation dermatitis
• Time to onset of severe radiation dermatitis
• Duration of severe radiation dermatitis
• Overall quality of life (QOL) as measured by Linear Analogue Self-Assessment (LASA)
• QOL domains as measured by LASA
• Skin toxicity as measured by Skindex-16
• Skin toxicity as measured by the Skin Toxicity Assessment Tool
• Frequency and severity of adverse events reported by the patient in the Symptom Experience Diary and assessed clinically by NCI CTCAE v3.0

RATIONALE: Steroid therapy, such as mometasone furoate, may prevent radiation dermatitis caused by radiation therapy. It is not yet known whether mometasone furoate is more effective than a placebo in preventing radiation dermatitis.

PURPOSE: This randomized phase III trial is studying mometasone furoate to see how well it works compared to a placebo in preventing radiation dermatitis in patients undergoing radiation therapy to the breast or chest wall for invasive breast cancer or ductal carcinoma in situ.

OBJECTIVES:

Primary

• Compare the efficacy of mometasone furoate vs placebo, in terms of decreased maximal severity of radiation dermatitis, in patients undergoing primary or adjuvant radiotherapy to the breast or chest wall for invasive breast cancer or ductal carcinoma in situ.

Secondary

• Compare the incidence of severe (grade ≥ 3) radiation dermatitis in patients treated with these drugs.
• Compare the time to onset and duration of severe radiation dermatitis in these patients.
• Assess skin toxicity and quality of life of these patients.
• Assess the adverse event profile of mometasone furoate in these patients.
• Compare skin toxicity data, in terms of provider-completed and patient-reported assessments, of patients treated with these drugs.

OUTLINE: This is a randomized, double-blind, placebo-controlled study. Patients are stratified according to radiation field (breast [post-lumpectomy] vs chest wall [post-mastectomy]), regional lymph nodes (treated vs not treated), and planned total radiation dose (including boost) (50-55 Gy vs > 55 Gy). Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients apply mometasone furoate cream once daily to the treatment area (breast or chest wall) for the duration of planned radiotherapy.
• Arm II: Patients apply an identical-appearing placebo cream to the treatment area as in arm I.

Patients complete questionnaires and a symptom experience diary at baseline and periodically during study for quality of life, skin toxicity, and adverse event assessment.

After completion of radiotherapy, patients are followed for 2 weeks.

PROJECTED ACCRUAL: A total of 148 patients will be accrued for this study.

• Breast Cancer
• Dermatologic Complications
• Radiation Toxicity
• Skin Reactions Secondary to Radiation Therapy

• Drug: mometasone furoate
• Other: placebo

• Experimental: Patients apply mometasone furoate cream once daily to the treatment area (breast or chest wall) for the duration of planned radiotherapy.
• Placebo Comparator: Patients apply an identical-appearing placebo cream to the treatment area as in arm I.

DISEASE CHARACTERISTICS:

• Histologically confirmed diagnosis of primary invasive breast cancer or ductal carcinoma in situ

• Planning to undergo ≥ 5 weeks of continuous definitive or adjuvant external-beam radiotherapy to 1 of the following sites:

  • Whole breast (as part of breast-conservation therapy)

  • Chest wall (as part of post-mastectomy irradiation)

    • Treatment of regional lymph nodes (i.e., axillary, supraclavicular, or internal mammary) allowed

• Must meet the following criteria for planned radiotherapy:

  • Planned total radiation dose ≥ 5,000 Gy and daily radiation dose between 1.75 and 2.12 Gy
  • No planned split-course radiotherapy
  • No partial breast treatment, defined as treatment of < 75% of the breast parenchyma
  • Intensity-modulated radiotherapy planning and delivery, conventional radiotherapy, or 3-dimensional radiotherapy techniques allowed

• Must be entered on study within 7 days prior to beginning radiotherapy

  • Must start study drug prior to receiving the third radiotherapy fraction
• No preexisting skin breakdown within the planned radiotherapy field at the time of study entry
• No bilateral breast cancer treatment
• No inflammatory carcinoma of the breast
• Hormone receptor status not specified

PATIENT CHARACTERISTICS:

• Male or female
• Menopausal status not specified
• ECOG performance status 0-2
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• Able to complete questionnaires independently or with assistance
• No known allergy or hypersensitivity to mometasone furoate (Elocon® or generic cream), imidazolidinyl urea, or formaldehyde

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• No prior radiotherapy to the planned radiotherapy treatment area

• No concurrent or planned leukotriene inhibitors, including the following:

  • Zafirleukast
  • Monteleukast
  • Zileuton

• No concurrent or planned use of any prescription or over-the-counter medications containing hydrocortisone or any other cortisone or steroid-containing preparations (systemic, local, or topical) including, but not limited to, the following creams or ointments:

  • Cortaid®
  • Cortizone 10®
  • Tucks®
  • Preparation H®
• No other concurrent topical agents (e.g., lotions, aloe vera) to radiotherapy field during study treatment