Effectiveness of Topical Aloe Vera Versus Betamethasone in the Prevention of Radiation-induced Dermatitis in Patients With Head and Neck Cancer Treated With Definitive Chemoradiotherapy in Tele Cobalt Machine

Effectiveness of Topical Aloe Vera Versus Betamethasone in the Prevention of Radiation-induced Dermatitis in Patients With Head and Neck Cancer Treated With Definitive Chemoradiotherapy in Tele Cobalt Machine | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of Topical Aloe Vera Versus Betamethasone in the Prevention of Radiation-induced Dermatitis in Patients With Head and Neck Cancer Treated With Definitive Chemoradiotherapy in Tele Cobalt Machine Joydeep Nath, Apurba K Kalita, Jyotiman Nath, Mouchumee Bhattacharyya, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7162796/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Interruptions in radiotherapy due to dermatitis increase recurrence risk. Despite multiple studies, no standard approach exists for managing radiation dermatitis. This study aimed to compare the effectiveness of Aloe Vera versus Betamethasone in preventing radiation dermatitis in head and neck cancer patients undergoing definitive chemoradiotherapy. Methodology: A prospective randomized trial was conducted with 79 patients receiving chemoradiotherapy. Participants were assigned to either Aloe Vera Gel (n=39) or Betamethasone Cream (n=40). RID was assessed weekly using Radiation Therapy Oncology Group (RTOG) criteria, focusing on onset, severity, and progression of dermatitis. Results: The Aloe Vera group experienced a delayed onset of dermatitis compared to the Betamethasone group (mean: 4 weeks vs. 3.68 weeks). By the end of treatment, 76.9% of Aloe Vera patients had Grade 1 dermatitis, with 23.1% progressing to Grade 2 or higher. In the Betamethasone group, 60% had Grade 1 dermatitis, while 40% developed Grade 2 or higher. While the difference was not statistically significant, Aloe Vera showed a trend toward lower severity and fewer cases of severe dermatitis. Conclusion: Aloe Vera Gel may offer an advantage over Betamethasone in delaying the onset and reducing the progression of radiation-induced dermatitis. While both treatments are effective, Aloe Vera appears to be a safer option with fewer severe skin reactions. Larger studies are recommended to confirm these findings and explore combination therapies for better management of RID. Radiation-induced dermatitis Aloe Vera Gel Betamethasone Cream chemoradiotherapy head and neck cancer skin toxicity RTOG grading Figures Figure 1 Figure 2 INTRODUCTION Each year, over 800,000 new head and neck cancer (HNC) cases are diagnosed, making it the 6th most common cancer globally. The most frequent HNC sites vary regionally [ 1 ], with HPV-linked oropharyngeal cancers rising in developed countries [ 2 ]. Asia, particularly India, contributes over half of global HNC cases. In India, HNCs account for 30% of cancers in men and 11–16% in women. Northeastern states show the highest incidence, with ASIRs of 31.7/100,000 in men and 10.1/100,000 in women [ 3 ]. Khasi Hills East and Kamrup Urban lead among men, while Papumpare and Kamrup Urban top the list for women [ 4 ]. Standard HNC treatments include surgery, radiotherapy, and chemotherapy, often used in combination. Radiation therapy, alone or with cisplatin/carboplatin, is particularly effective [ 5 ]. The head and neck region's complex anatomy increases the risk of radiation dermatitis (RID), affecting up to 95% of patients [ 6 – 9 ]. RID usually appears within two weeks of treatment, triggered by ionizing radiation damaging basal keratinocytes, hair follicle stem cells, and melanocytes [ 10 ]. Continued radiation impairs epidermal renewal, worsening skin damage. RID severity depends on radiation dose, field size, technique, concurrent chemotherapy, and patient factors [ 11 ]. Management traditionally involves topical steroids, non-steroidal agents, metals, and dressings. Recently, natural products like aloe-vera, milk thistle, and calendula have shown promise [ 12 ]. Aloe-vera, well-researched in dermatology, has demonstrated anti-inflammatory, wound-healing, and protective effects against radiation and chemical-induced skin damage. It is increasingly used in managing atopic and radiation-induced dermatitis [ 13 , 14 ]. Despite global and Indian research, no standard protocol exists for RID prevention or treatment. Management is often guided by clinician experience [ 15 ]. Topical steroids remain widely used, but their immunosuppressive effects may increase infection risks, potentially worsening dermatitis and affecting treatment adherence [ 16 ]. Given these concerns, the present study aims to assess the effectiveness of topical Aloe-vera in preventing radiation-induced dermatitis and compare it with conventionally used topical steroids at many institutions, including ours. METHODS AND MATERIALS Study Design and Setting : This open-label, hospital-based, prospective randomized trial was conducted in the Radiation Oncology Department at Dr. B. Borooah Cancer Institute, Guwahati, over one year (March 2023 – February 2024). Participants : Patients aged 18–70 years with histopathologically confirmed squamous cell carcinoma of the oropharynx, hypopharynx, or larynx, planned for definitive chemoradiotherapy on a telecobalt machine using conventional technique, and with a Karnofsky Performance Score ≥ 70, were included. Exclusion criteria were postoperative cases; nasopharyngeal, sinus, or salivary gland tumors; prior head and neck RT; chronic skin disorders; chronic steroid use; or known Aloe vera allergy. Sample Size and Randomization : Using standard formulas, the estimated sample size was 74. After adjusting for a 10% non-response rate, 82 patients were randomized 1:1 via simple random sampling into two arms: Aloe-vera (Arm A) and Betamethasone (Arm B). Intervention and General Care : Participants were instructed on uniform skin care practices. The topical agents were applied twice daily (≥ 6-hour interval), avoiding use within 4 hours before or after radiotherapy. Applications began on day 1 of RT and continued for 6 weeks post-RT. Treatment Protocol : All patients underwent standard pre-RT evaluation, including dental prophylaxis and speech therapy. Radiotherapy was delivered via telecobalt using the shrinking field technique to a total dose of 70 Gy in 35 fractions (2 Gy/day). Concurrent chemotherapy included weekly IV cisplatin (40 mg/m²) for 5–7 cycles. Assessment and Follow-Up : Dermatitis was assessed weekly using RTOG acute radiation morbidity criteria by a single reviewer. Key outcomes included onset, progression, maximum grade, and healing time of radiation dermatitis. Follow-ups occurred at 3 weeks, 6 weeks, and 3 months post-treatment. Statistical Analysis: Data were analysed using SPSS v25. Categorical variables were presented as frequencies and percentages. Continuous variables were expressed as mean ± SD. Between-group comparisons were done using Chi-square test, independent t-test, and repeated measures ANOVA. A p-value < 0.05 was considered statistically significant. RESULTS 82 patients were randomly assigned, with 41 participants allocated to Arm A and 41 to Arm B. Analysis was done in 39 patients in Arm A and 40 in Arm B. Thus, a total of 79 subjects were included in the ultimate analysis. The baseline characteristics of the study population were comparable between the Aloe Vera and Betamethasone groups. The mean ages were 53.54 ± 6.76 and 55.68 ± 7.22 years, respectively (p = 0.681), with similar age and sex distributions. No significant differences were found in behavioural risk factors such as tobacco use, alcohol consumption, or betel nut chewing. Co-morbidities, Karnofsky Performance Score (KPS), primary tumour site, TNM stage, and histological subtypes were also comparable between the groups. Most patients had TNM stage IVA disease, and moderately differentiated squamous cell carcinoma was the predominant histology in both arms. Concurrent chemotherapy with cisplatin was administered to most patients; a few received carboplatin due to renal dysfunction. The number of chemotherapy cycles and overall treatment time (OTT) were not significantly different between the groups. A Chi-square analysis confirmed no significant difference in OTT distribution (p = 0.239). Detailed baseline characteristics are presented in Table 1 . Table 1 Distribution of study participants Parameter Arm (n) p-value Aloe (39) Betamethasone (40) 0.681 Age (years) 53.54 ± 6.76 55.68 ± 7.22 Age groups 60 5 (12.8%) 11 (27.5%) Sex Male 38 (97.4%) 37 (92.5%) 0.481 Female 1 (2.6%) 3(7.5%) Behavioural Risk factors Tobacco Chewer Yes 36 (92.3%) 34 (85.0%) 0.481 No 3 (7.7%) 6(15.0%) Tobacco smoker Yes 17 (43.6%) 14 (35.0%) 0.291 No 17 (56.4%) 26 (65.0%) Alcohol Drinker Yes 15 (38.5%) 9 (22.5%) 0.097 No 24 (61.5%) 31 (77.50%) Betelnut Chewer Yes 36 (92.3%) 33 (82.5%) 0.166 No 3 (7.7%) 7 (17.5%) Known Co-morbidities Yes 5 (12.8%) 3 (7.5%) 0.481 No 34 (87.2%) 37 (92.5%) KPS 90 28 (71.8%) 33 (82.5%) 0.260 80 11 (28.2%) 7 (17.5%) Primary site of disease Ca Hypopharynx 16 (41.0%) 10 (25.0%) 0.225 Ca Larynx 12 (30.7%) 12 (30.0%) Ca Oropharynx 11 (28.2%) 18 (45.0%) Stage III 12 (30.7%) 13 (32.5%) 1.000 IVA 23 (59.0%) 24 (60.0%) IVB 4 (10.3%) 3 (7.5%) Histology WDSCC 6 (15.4%) 2 (5.0%) 0.310 MDSCC 29 (74.4%) 33 (82.5%) PDSCC 4 (7.7%) 2 (5.0%) NKSCC 1 (2.6%) 3 (7.5%) No. of Chemo cycles received 3 4 (10.2%) 2 (5%) 0.773 4 4 (10.2%) 3 (7.5%) 5 22 (56.4%) 23 (57.5%) 6 9 (23.2%) 12 (30%) OTT (Days) 60 2 (5.1%) 2 (5%) Table 2 shows the analysis of radiation dermatitis grades across various demographic and clinical variables. Age, sex, Karnofsky Performance Score (KPS), tumour site, TNM stage, and most behavioural factors (tobacco use, smoking, alcohol intake, and betel nut chewing) did not significantly affect grade distribution. However, patients with comorbidities had a significantly higher proportion of Grade 3 dermatitis compared to those without (p = 0.025). Histological subtype also showed significance (p = 0.035), with all patients with non-keratinizing squamous cell carcinoma presenting with Grade 2 reactions. Additionally, the number of chemotherapy cycles had a statistically significant impact on dermatitis severity (p = 0.027), with higher grades observed in patients receiving more cycles. These findings suggest that comorbidities, histological subtype, and chemotherapy burden may influence the severity of radiation dermatitis. Table 2 Association of age and gender with the different grades of dermatitis: Category Sub-category Grade 1 n (%) Grade 2 n (%) Grade3 n (%) Grade4 n (%) Total n (%) p-value Age group 60 8 (50) 5 (31.2) 2 (12.5) 1 (6.3) 16 (100) Sex Male 51 (68) 12 (16) 10 (13.3) 2 (2.7) 75 (100) 1.000 Female 3 (75) 1 (25) 0 (0) 0 (0) 4 (100) Known Comorbidities Yes 4 (50) 0 (0) 4 (50) 0 8 (100) 0.025 No 50 (70.4) 13 (18.3) 6 (8.5) 2 (2.8) 71 (100) KPS Score 90 39 (63.9) 12 (19.7) 8 (13.1) 2 (3.3) 61 (100) 0.455 80 15 (83.3) 1 (5.6) 2 (11.1) 0 (0) 18 (100) Betel nut chewer Yes 48 (69.6) 13 (18.8) 7 (10.1) 1 (1.4) 69 (100) 0.056 No 6 (60) 0 (0) 3 (30) 1 (10) 10 (100) Tobacco chewer Yes 47 (67.1) 12 (17.1) 9 (12.9) 2 (2.9) 70 (100) 1.000 No 7 (77.8) 1 (11.1) 1 (11.1) 0 (0) 9 (100) Tobacco Smoker Yes 21 (67.7) 3 (9.7) 5 (16.1) 2 (6.5) 31 (100) 0.198 No 33 (68.8) 10 (20.8) 5 (10.4) 0 (0) 48 (100) Alcohol drinker Yes 18 (75) 1 (4.2) 3 (12.5) 2 (8.3) 24 (100) 0.050 No 36 (65.5) 12 (21.8) 7 (12.7) 0 (0) 55 (100) Site Ca HPX 18 (69.3) 5 (19.2) 3 (11.5) 0 (0) 26 (100) 0.064 Ca Larynx 17 (70.8) 1 (4.2) 6 (25) 0 (0) 24 (100) Ca OPX 19 (65.6) 7 (24.1) 1 (3.4) 2 (6.9) 29 (100) Stage III 17 (68) 4 (16) 3 (12) 1 (4) 25 (100) 0.738 IVA 32 (68.1) 9 (19.1) 5 (10.6) 1 (2.1) 47 (100) IVB 5 (71.4) 0 (0) 2 (28.6) 0 (0) 7 (100) Histology WDSCC 6 (75) 1 (12.5) 1 (12.5) 0 (0) 8 (100) 0.035 MDSCC 44 (71) 9 (14.5) 8 (12.9) 1 (1.6) 62 (100) PDSCC 4 (80) 0 (0) 0 (0) 1 (20) 5 (100) NKSCC 0 (0) 3 (75) 1 (25) 0 (0) 4 (100) OTT 60 2 (50) 0 (0) 1 (25) 1 (25) 4 (100) No. of CT cycles 3 6 (100) 0 (0) 0 (0) 0 (0) 6 0.027 4 5 (71.4) 0 (0) 2 (28.6) 0 (0) 7 5 33 (73.3) 8 (17.8) 3 (6.7) 1 (2.2) 45 6 10 (47.6) 5 (23.8) 5 (23.8) 1 (4.8) 21 Table 3 shows the weekly progression and follow-up of radiation dermatitis grades in both arms. No patients developed dermatitis after the 1st week. From the 2nd to 5th week, Grade 1 dermatitis increased in both groups without significant differences. By the 6th and 7th weeks, higher grades (Grade 2 and 3) began to appear in both arms, with Grade 4 dermatitis observed only in one patient in the Betamethasone group. At treatment completion, more patients in the Aloe Vera group had Grade 1 dermatitis, while the Betamethasone group showed slightly higher rates of Grades 2 and 4, though the differences remained statistically non-significant (p = 0.104). At 3-week and 6-week follow-ups, most patients had only Grade 1 dermatitis. By 3 months, all patients had recovered, with no remaining skin toxicity. Table 3 Time of development of radiation induced dermatitis Dermatitis Arm Grade p-value 0 n (%) 1 n (%) 2 n (%) 3 n (%) 4 n (%) after 1st week A 39 (100) - - - - -- B 40 (100) - - - - after 2nd week A 37 (94.9) 2 (5.1) - - - 0.615 B 39 (97.5) 1 (2.5) - - - after 3rd week A 25 (64.1) 14 (35.9) - - - 0.176 B 19 (47.5) 21 (52.5) - - - after 4th week A 16 (41) 23 (59) - - - 0.094 B 9 (22.5) 31 (77.5) - - - after 5th week A - 37 (94.9) 2 (5.1) - - 0.675 B - 36 (90) 4 (10) - - after 6th week A - 35 (89.7) 3 (7.7) 1 (2.6) - 0.286 B - 31 (77.5) 8 (20) 1 (2.5) - after 7th week A - 30 (76.9) 8 (20.5) 1 (2.6) - 0.197 B - 24 (60) 10 (25) 4 (10) 2 (5) At conclusion A - 30 (76.9) 4 (10.3) 5 (12.8) - 0.104 B - 24 (60) 12 (30) 3 (7.5) 1 (2.5) At 3weeks A - 38 (97.4) 1 (2.6) - - 0.187 B - 36 (90) 4 (10) - - At 6weeks A 17 (43.6) 22 (56.4) - - - 0.154 B 12 (30) 28 (70) - - - At 3 months A 39 (100) - - - - - B 40 (100) - - - - Both arms showed no statistically significant difference in the mean time to develop Grades 1, 2, or 3 dermatitis. Grade 1 appeared slightly earlier in the Betamethasone arm, while Grade 2 and 3 onset times were comparable across groups. Although a higher proportion of patients in the Betamethasone arm experienced Grade ≥ 2 dermatitis (40% vs. 23.1% in the Aloe Vera arm), this difference was not statistically significant (p = 0.084) as presented in Tables 4 and 5 . Table 4 Comparison of mean time of development of different grades of dermatitis: Parameter Aloe Vera (Mean ± S.D) Betamethasone (Mean ± S.D) p-value Time of development of grade 1 dermatitis in weeks 4 ± 0.973 3.68 ± 0.859 0.120 Time of development of grade 2 dermatitis in weeks 6.33 ± 0.866 6.14 ± 0.864 0.613 Time of development of grade 3 dermatitis in weeks 7.4 ± 0.894 7.29 ± 0.756 0.822 Table 5 The occurrence of maximum dermatitis subdivided in below grade 2 and those at or above grade 2. ARMS Grade < 2 dermatitis Grade ≥ 2 dermatitis p-value Aloe vera, n (%) 30 (76.9%) 9 (23.1%) 0.084 Betamethasone, n (%) 24 (60%) 16 (40%) The mean ARD severity increased over time in both arms, with Betamethasone showing slightly higher scores throughout. At treatment completion, Betamethasone peaked at 1.6 and Aloe Vera at 1.36, showing a significant difference (p = 0.035). Scores declined post-treatment, returning to 0 by three months. Differences were mostly non-significant except after the 7th week. (Fig. 1 ) DISCUSSION Radiation-induced dermatitis (RID) is a frequent and significant side effect of radiotherapy, especially in HNC patients. This risk is notably higher in patients treated with cobalt machines using conventional bilateral open-field techniques which are still commonly used in India due to affordability, ease of maintenance, and cancer care burden. These machines deliver higher skin doses (up to 85% of Dmax), which makes them a practical model for evaluating RID prevention strategies. Despite multiple agents being evaluated for RID prevention, no agent has emerged as the global standard of care. Aloe-vera and betamethasone are two of the most commonly used topical agents, with supportive literature for each [ 15 , 17 – 22 ], but no prior head-to-head comparisons exist. This randomized prospective study is the first, to our knowledge, comparing Aloe-vera with betamethasone in preventing RID in HNC patients receiving concurrent chemoradiotherapy. Most patients developed grade 1 dermatitis, with no statistically significant difference in overall RID severity between the two arms. However, notable trends favoured Aloe-vera. By week 3, 52.5% in the betamethasone arm showed grade 1 dermatitis, compared to 35.9% in the Aloe-vera arm. This persisted into week 4 (77.5% vs. 59%, p = 0.094). By treatment end, grade ≥ 2 dermatitis occurred in 40% of betamethasone patients versus 23.1% in the Aloe-vera group, including one case of grade 4 RID in the betamethasone arm (p = 0.084). (Fig. 2) The mean time to onset of grade 1 RID was slightly longer in the Aloe-vera arm (4 ± 0.973 weeks) versus betamethasone (3.68 ± 0.859 weeks, p = 0.120), suggesting delayed onset. However, progression to grade 2 or 3 dermatitis was similar across both arms. Mean ARD scores were consistently lower in the Aloe-vera group, reaching statistical significance in week 7 only. These findings support Aloe-vera's potential protective role, aligning with the results of Olsen et al. [ 17 ] and Rao et al. [ 19 ]. On the other hand, although betamethasone has shown benefit in previous studies [ 20 , 22 ], its use carries known risks such as skin thinning and immunosuppression [ 21 ]. Tobacco (chewing and smoking), betel nut, and alcohol were commonly used among participants, especially in males, reflecting national trends [ 23 – 27 ]. Grade ≥ 2 RID was more frequent among tobacco users, and grade 4 RID was seen only in those with tobacco history, consistent with Porock et al. [ 28 ]. Alcohol use was significantly associated with more severe RID (p = 0.05), a finding not supported by Rades et al. [ 29 ]. Betel nut chewers formed the majority (87%), but interestingly, grade 3 and 4 RID were more common among non-chewers (p = 0.056), likely due to small non-chewer sample size. Age and gender were not significantly associated with dermatitis severity (p = 0.348 and p > 0.05 respectively), although conflicting evidence exists [ 30 ]. Notably, all patients with grade > 2 RID were male. A significant association between comorbidities (e.g., diabetes, hypertension) and higher-grade RID was observed (p = 0.025), aligning with Xie et al. [ 31 ]. No association was seen with KPS score (p = 0.455), contrasting with findings by Zhou et al. [ 32 ] and Yao et al. [ 33 ]. Disease-related factors such as site and stage of disease showed non-significant but suggestive trends. Grade 4 dermatitis occurred only in oropharyngeal cancers (p = 0.064), potentially due to deeper dose prescriptions. Stage IVB patients had the highest proportion of grade 3 RID, supporting a trend toward higher toxicity with advanced stage, partially matching results by Meyer et al. [ 34 ] and Chugh et al. [ 35 ]. Histology showed a statistically significant association with RID severity (p = 0.035), with higher-grade dermatitis observed in patients with PDSCC and NKSCC. Most prior studies have not explored histological impact on RID, warranting further exploration. OTT showed no significant association (p = 0.140), but higher grades of RID were more frequent in patients with treatment delays > 60 days, indicating possible causation. Most patients completing treatment within < 51 days had grade 1 RID, especially in the Aloe-vera arm. Number of chemotherapy cycles was significantly associated with dermatitis severity (p = 0.027), consistent with Chugh et al. [ 35 ], Iacovelli et al. [ 36 ], Tejwani et al. [ 37 ], and He et al. [ 38 ]. Higher-grade RID was more frequent in patients receiving ≥ 6 cycles of cisplatin [ 39 ]. Despite lack of statistically significant superiority, Aloe-vera consistently showed trends favouring lower onset, severity, and progression of RID compared to betamethasone. No patients in the Aloe-vera arm developed grade 4 dermatitis. This suggests that Aloe-vera, with its antioxidant, anti-inflammatory, and skin-regenerating properties [ 17 , 19 ], may offer a safer, more tolerable alternative for patients, especially those wary of corticosteroid side effects [ 21 ]. Strengths of this study include a prospective randomized design, standardized RTOG-based assessment, and its focus on a high-risk population. Limitations include its single-institution setting, small sample size, and lack of blinding, which may have introduced bias. Future research should focus on larger, multicentric trials to validate these findings and explore long-term effects of Aloe-vera and betamethasone in RID management across different cancer types. CONCLUSION This study compared Aloe Vera and Betamethasone for managing radiation-induced dermatitis. While both showed similar trends, Aloe Vera slightly delayed onset and was associated with lower severity at peak (p = 0.035). More patients in the Betamethasone group developed Grade ≥ 2 dermatitis (40% vs. 23.1%, p = 0.084). Though not all differences were statistically significant, Aloe Vera may be a promising alternative. Larger studies are needed to validate these findings. Declarations Funding: The authors declare that no funds, grants, or other support were received during the study. Competing Interests: None. Author Contributions: Study conception, design, material preparation was performed by Dr. Joydeep Nath, Dr. Apurba K Kalita, Dr. Jyotiman Nath, Dr. Mouchumee Bhattacharyya and Dr. Yanpothung Yanthan. Data Collection was done by Dr. Joydeep Nath, Dr. Jahnabi Das, Dr. Kaushik J Kataki, Dr. Poragmoni Bora, Dr. Saswati Datta, Dr. Hafizul I Pathan and Dr. Md Mostafijur Rahaman. Statistical analysis was done by Dr. Julee Rajkhowa. The first draft of the manuscript was written by Dr. Joydeep Nath and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data Availability: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval: The study was approved by the IEC/BBCI/2023/Project No.13000516 and conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants, and confidentiality was strictly maintained. Consent to participate: Informed consent was obtained from all individual participants included in the study. References Global Cancer Statistics 2022 GLOBOCAN Estimates Of Incidence And Mortality Worldwide For 36 Cancers In 185 Countries Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Et Al (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates Of Incidence And Mortality Worldwide ] For 36 Cancers In 185 Countries. CA: A Cancer Journal For Clinicians. ;71(3):20949 Baruah Mn Trends In The Incidence Of Head And Neck Cancer In Northeast India: Five Year Single Center Study Report Of National Cancer Registry Programme 2020 [Internet]. [Cited 2024 Jun 25]. 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Revista Portuguesa De Estomatologia Med Dentária E Cirurgia Maxilofacial 57(4):229–235 Warnakulasuriya S, Chen T (2022) Areca Nut And Oral Cancer: Evidence From Studies Conducted In Humans. J Dent Res 101(10):1139–1146 Singh Pk, Yadav A, Singh L, Mazumdar S, Sinha Dn, Straif K, Et Al (2021). Areca Nut Consumption With And Without Tobacco Among The Adult Population: A Nationally Representative Study From India. Bmj Open. ;11(6) Huang Cj H, My F, Pt, Chen F, Wang Y (2019) Randomized Double-Blind, Placebo-Controlled Trial Evaluating Oral Glutamine On Radiation-Induced Oral Mucositis And Dermatitis In Head And Neck Cancer Patients. Am J Clin Nutr 109(3):606–614 Porock D, Nikoletti S, Cameron F (2004) The Relationship Between Factors That Impair Wound Healing And The Severity Of Acute Radiation Skin And Mucosal Toxicities In Head And Neck Cancer. Cancer Nurs 27(1):71–78 Rades D, Zwaan I, Janssen S, Yu Ny S, Se, Idel C, Et Al (2023) Evaluation Of The Impact Of Smoking And Alcohol Consumption On Toxicity And Outcomes Of Chemoradiation For Head And Neck Cancer. Anticancer Res 43(2):823–830 Córdoba Ee, Lacunza E, Güerci A Clinical Factors Affecting The Determination Of Radiotherapy-Induced Skin Toxicity In Breast Cancer. [Cited 2024 Jul 25]; Available From: Https://Www.E-Roj. Org/Journal/View.Php?Number = 1512 Xie Y, Hu T, Chen R, Chang H, Wang Q, Cheng J (2023) Predicting Acute Radiation Dermatitis In Breast Cancer: A Prospective Cohort Study. BMC Cancer 23:537 Zhou Z, Lin J, Wang Y, Chen Y, Zhang Y, Ding X, Et Al (2024) Acute Radiation Skin Injury In Stage Iii-Iv Head And Neck Cancer: Scale Correlates And Predictive Model. World J Surg Oncol 22:195 Yao Z, Cheng B, Morbidity (2021) In Patients With Nasopharyngeal Carcinoma And Radiation-Induced Skin Lesions: Cause, Risk Factors, And Dermatitis Evolution And Severity. Adv Skin Wound Care. ;34(12) Meyer F, Fortin A, Wang C, Liu G, Bairati I (2012) Predictors Of Severe Acute And Late Toxicities In Patients With Localized Head-And-Neck Cancer Treated With Radiation Therapy. Int J Radiat Oncol Biol Phys 82(4):1454–1462 Chugh R, Bisht YS, Nautiyal V, Jindal R (2021) Factors Influencing The Severity Of Acute Radiation-Induced Skin And Mucosal Toxicity In Head And Neck Cancer. Cureus 13(9):E18147 Iacovelli Na, Torrente Y, Ciuffreda A, Guardamagna Va, Gentili M, Giacomelli L (2020) Et Al. Topical Treatment Of Radiation-Induced Dermatitis: Current Issues And Potential Solutions. Drugs Context 9:2020–2024 Tejwani A, Wu S, Jia Y, Agulnik M, Millender L, Lacouture M (2009) Increased Risk Of High-Grade Dermatologic Toxicities With Radiation Plus Epidermal Growth Factor Receptor Inhibitor Therapy. Cancer 115(6):1286–1299 He Y, Guo T, Guan H, Wang J, Sun Y, Peng X (2018) Concurrent Chemoradiotherapy Versus Radiotherapy Alone For Locoregionally Advanced Nasopharyngeal Carcinoma In The Era Of Intensity-Modulated Radiotherapy: A Meta-Analysis. Cancer Manag Res 10:1419–1428 Sunku R, Kalita Ak, Bhattacharyya M, Medhi Pp, Bansal S, Borah L, Et Al. Effect Of Corticosteroid Ointment On Radiation Induced… Indian Journal Of Cancer. [Cited 2024 Jul 14]; Available From: Https://Journals.Lww.Com/Indianjcancer/Fulltext/2021/58010/Effect_Of_Corticosteroid_Ointment_On_Radiation.15.Aspx Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7162796","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488807076,"identity":"08f046cd-a67a-4d23-bfba-72fa237ec550","order_by":0,"name":"Joydeep Nath","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYBACxgYGBgkgLcfPcPgAkJaQIVqLsWTjsQSQFh6ibAJpSdxw+IwBiENYC3N7j+GNDxV3jA2Onfn86kaNBQ8D++GjG/A6rOeMseWMM8/kJM+c3WadcwzoMJ60tBt4tczIMZPmbTtszHfj7DbjHDagFgkeM8Ja/v47nNhw/80z45x/xGphbDicOOHAGebHuW3EaOk5VmzZc+yZsWTDMTPm3D4JHjZCfjFsb95440fNHVBUPv6c861Ojp/98DH8Who4QNFxAMRmkwCT+JSDgDwD+wOYFuYPhFSPglEwCkbByAQAbB9R0tBLVRQAAAAASUVORK5CYII=","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":true,"prefix":"","firstName":"Joydeep","middleName":"","lastName":"Nath","suffix":""},{"id":488807077,"identity":"2ed7dd10-fa46-4731-88b9-8cf205e3ee97","order_by":1,"name":"Apurba K Kalita","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer 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Institute","correspondingAuthor":false,"prefix":"","firstName":"Yanpothung","middleName":"","lastName":"Yanthan","suffix":""},{"id":488807084,"identity":"e4b1a7f7-6165-4d18-94bd-65860bebacaf","order_by":5,"name":"Jahnabi Das","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Jahnabi","middleName":"","lastName":"Das","suffix":""},{"id":488807086,"identity":"cf72611a-09c5-45af-b4f9-5fc7168a6485","order_by":6,"name":"Kaushik J Kataki","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Kaushik","middleName":"J","lastName":"Kataki","suffix":""},{"id":488807088,"identity":"8e423dac-26c4-49dc-a57f-c83f82796e80","order_by":7,"name":"Julee Rajkhowa","email":"","orcid":"","institution":"pragjyotishpur Medical College \u0026 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Julee","middleName":"","lastName":"Rajkhowa","suffix":""},{"id":488807089,"identity":"efd7ddff-1777-4b7b-8c21-027beed2fcf8","order_by":8,"name":"Poragmoni Bora","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Poragmoni","middleName":"","lastName":"Bora","suffix":""},{"id":488807090,"identity":"4b10c0db-b7d4-413e-a669-7306203bacd2","order_by":9,"name":"Saswati Datta","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Saswati","middleName":"","lastName":"Datta","suffix":""},{"id":488807091,"identity":"9736e295-3d10-4aa6-8059-7684ce35b013","order_by":10,"name":"Hafizul I Pathan","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Hafizul","middleName":"I","lastName":"Pathan","suffix":""},{"id":488807092,"identity":"72ed7e01-40b9-433b-a3e9-36d43711616c","order_by":11,"name":"Md Mostafijur Rahaman","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Md","middleName":"Mostafijur","lastName":"Rahaman","suffix":""}],"badges":[],"createdAt":"2025-07-19 07:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7162796/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7162796/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87665524,"identity":"8fe56d97-ed72-43e5-9eba-03d77940798c","added_by":"auto","created_at":"2025-07-27 11:04:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":392703,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrendline chart of mean acute dermatitis comparing treatment arms:\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7162796/v1/4ad03260167662c3a04c1b6d.png"},{"id":87665526,"identity":"3a42ec7d-e9fd-48e6-9627-f7e33857ef9a","added_by":"auto","created_at":"2025-07-27 11:04:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":913132,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDifferent grades of dermatitis:\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7162796/v1/3f019ee217fb074ac2a9e444.png"},{"id":87666333,"identity":"df705f21-145c-4ed8-a3c8-12115b5a1940","added_by":"auto","created_at":"2025-07-27 11:20:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2814625,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7162796/v1/d79b43f9-c8c2-46b8-afb5-8fe183795386.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffectiveness of Topical Aloe Vera Versus Betamethasone in the Prevention of Radiation-induced Dermatitis in Patients With Head and Neck Cancer Treated With Definitive Chemoradiotherapy in Tele Cobalt Machine\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEach year, over 800,000 new head and neck cancer (HNC) cases are diagnosed, making it the 6th most common cancer globally. The most frequent HNC sites vary regionally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], with HPV-linked oropharyngeal cancers rising in developed countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Asia, particularly India, contributes over half of global HNC cases. In India, HNCs account for 30% of cancers in men and 11–16% in women. Northeastern states show the highest incidence, with ASIRs of 31.7/100,000 in men and 10.1/100,000 in women [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Khasi Hills East and Kamrup Urban lead among men, while Papumpare and Kamrup Urban top the list for women [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStandard HNC treatments include surgery, radiotherapy, and chemotherapy, often used in combination. Radiation therapy, alone or with cisplatin/carboplatin, is particularly effective [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The head and neck region's complex anatomy increases the risk of radiation dermatitis (RID), affecting up to 95% of patients [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. RID usually appears within two weeks of treatment, triggered by ionizing radiation damaging basal keratinocytes, hair follicle stem cells, and melanocytes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Continued radiation impairs epidermal renewal, worsening skin damage.\u003c/p\u003e\u003cp\u003eRID severity depends on radiation dose, field size, technique, concurrent chemotherapy, and patient factors [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Management traditionally involves topical steroids, non-steroidal agents, metals, and dressings. Recently, natural products like aloe-vera, milk thistle, and calendula have shown promise [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Aloe-vera, well-researched in dermatology, has demonstrated anti-inflammatory, wound-healing, and protective effects against radiation and chemical-induced skin damage. It is increasingly used in managing atopic and radiation-induced dermatitis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite global and Indian research, no standard protocol exists for RID prevention or treatment. Management is often guided by clinician experience [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Topical steroids remain widely used, but their immunosuppressive effects may increase infection risks, potentially worsening dermatitis and affecting treatment adherence [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven these concerns, the present study aims to assess the effectiveness of topical Aloe-vera in preventing radiation-induced dermatitis and compare it with conventionally used topical steroids at many institutions, including ours.\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cp\u003e\u003cb\u003eStudy Design and Setting\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThis open-label, hospital-based, prospective randomized trial was conducted in the Radiation Oncology Department at Dr. B. Borooah Cancer Institute, Guwahati, over one year (March 2023 – February 2024).\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003ePatients aged 18–70 years with histopathologically confirmed squamous cell carcinoma of the oropharynx, hypopharynx, or larynx, planned for definitive chemoradiotherapy on a telecobalt machine using conventional technique, and with a Karnofsky Performance Score ≥ 70, were included. Exclusion criteria were postoperative cases; nasopharyngeal, sinus, or salivary gland tumors; prior head and neck RT; chronic skin disorders; chronic steroid use; or known Aloe vera allergy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample Size and Randomization\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eUsing standard formulas, the estimated sample size was 74. After adjusting for a 10% non-response rate, 82 patients were randomized 1:1 via simple random sampling into two arms: Aloe-vera (Arm A) and Betamethasone (Arm B).\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention and General Care\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eParticipants were instructed on uniform skin care practices. The topical agents were applied twice daily (≥ 6-hour interval), avoiding use within 4 hours before or after radiotherapy. Applications began on day 1 of RT and continued for 6 weeks post-RT.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTreatment Protocol\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eAll patients underwent standard pre-RT evaluation, including dental prophylaxis and speech therapy. Radiotherapy was delivered via telecobalt using the shrinking field technique to a total dose of 70 Gy in 35 fractions (2 Gy/day). Concurrent chemotherapy included weekly IV cisplatin (40 mg/m²) for 5–7 cycles.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAssessment and Follow-Up\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eDermatitis was assessed weekly using RTOG acute radiation morbidity criteria by a single reviewer. Key outcomes included onset, progression, maximum grade, and healing time of radiation dermatitis. Follow-ups occurred at 3 weeks, 6 weeks, and 3 months post-treatment.\u003c/p\u003e\u003ch2\u003eStatistical Analysis:\u003c/h2\u003e\u003cp\u003eData were analysed using SPSS v25. Categorical variables were presented as frequencies and percentages. Continuous variables were expressed as mean ± SD. Between-group comparisons were done using Chi-square test, independent t-test, and repeated measures ANOVA. A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e82 patients were randomly assigned, with 41 participants allocated to Arm A and 41 to Arm B. Analysis was done in 39 patients in Arm A and 40 in Arm B. Thus, a total of 79 subjects were included in the ultimate analysis. The baseline characteristics of the study population were comparable between the Aloe Vera and Betamethasone groups. The mean ages were 53.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76 and 55.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.22 years, respectively (p\u0026thinsp;=\u0026thinsp;0.681), with similar age and sex distributions. No significant differences were found in behavioural risk factors such as tobacco use, alcohol consumption, or betel nut chewing. Co-morbidities, Karnofsky Performance Score (KPS), primary tumour site, TNM stage, and histological subtypes were also comparable between the groups. Most patients had TNM stage IVA disease, and moderately differentiated squamous cell carcinoma was the predominant histology in both arms. Concurrent chemotherapy with cisplatin was administered to most patients; a few received carboplatin due to renal dysfunction. The number of chemotherapy cycles and overall treatment time (OTT) were not significantly different between the groups. A Chi-square analysis confirmed no significant difference in OTT distribution (p\u0026thinsp;=\u0026thinsp;0.239). Detailed baseline characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of study participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eArm (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eAloe (39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBetamethasone (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.681\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e53.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge groups\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e8 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.291\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e26 (66.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (55%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e5 (12.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (27.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e38 (97.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37 (92.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.481\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e1 (2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3(7.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBehavioural Risk factors\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTobacco Chewer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (92.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (85.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.481\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (7.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6(15.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTobacco smoker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (43.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (35.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.291\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (56.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (65.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAlcohol Drinker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (38.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (22.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.097\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (61.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31 (77.50%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBetelnut Chewer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (92.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33 (82.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (7.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnown Co-morbidities\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (12.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.481\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (87.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37 (92.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKPS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (71.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33 (82.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.260\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (28.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrimary site of disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eCa Hypopharynx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (41.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.225\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eCa Larynx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (30.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eCa Oropharynx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (28.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18 (45.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eIII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (30.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (32.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eIVA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (59.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eIVB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (10.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eWDSCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (15.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.310\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eMDSCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29 (74.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33 (82.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003ePDSCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (7.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (5.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eNKSCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo. of Chemo cycles received\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.773\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (56.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (57.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e9 (23.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (30%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOTT (Days)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (51.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (32.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.239\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e51\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (43.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (5.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the analysis of radiation dermatitis grades across various demographic and clinical variables. Age, sex, Karnofsky Performance Score (KPS), tumour site, TNM stage, and most behavioural factors (tobacco use, smoking, alcohol intake, and betel nut chewing) did not significantly affect grade distribution. However, patients with comorbidities had a significantly higher proportion of Grade 3 dermatitis compared to those without (p\u0026thinsp;=\u0026thinsp;0.025). Histological subtype also showed significance (p\u0026thinsp;=\u0026thinsp;0.035), with all patients with non-keratinizing squamous cell carcinoma presenting with Grade 2 reactions. Additionally, the number of chemotherapy cycles had a statistically significant impact on dermatitis severity (p\u0026thinsp;=\u0026thinsp;0.027), with higher grades observed in patients receiving more cycles. These findings suggest that comorbidities, histological subtype, and chemotherapy burden may influence the severity of radiation dermatitis.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation of age and gender with the different grades of dermatitis:\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGrade 1\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGrade 2\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGrade3\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGrade4\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (73.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.348\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (72.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e48 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (31.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eKnown Comorbidities\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (70.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (18.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e71 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eKPS Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (63.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (19.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (13.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.455\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (83.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eBetel nut chewer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e69 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTobacco chewer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47 (67.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e70 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (77.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTobacco Smoker\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (67.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (16.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.198\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (68.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e48 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAlcohol drinker\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (65.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (21.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (12.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e55 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eSite\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCa HPX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (69.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCa Larynx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (70.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCa OPX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (65.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (24.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e29 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eStage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.738\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIVA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (68.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (19.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (10.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIVB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eHistology\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWDSCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMDSCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (14.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e62 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePDSCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNKSCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eOTT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (72.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e33 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.140\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (66.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eNo. of CT cycles\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (73.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (47.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (23.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (23.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the weekly progression and follow-up of radiation dermatitis grades in both arms. No patients developed dermatitis after the 1st week. From the 2nd to 5th week, Grade 1 dermatitis increased in both groups without significant differences. By the 6th and 7th weeks, higher grades (Grade 2 and 3) began to appear in both arms, with Grade 4 dermatitis observed only in one patient in the Betamethasone group. At treatment completion, more patients in the Aloe Vera group had Grade 1 dermatitis, while the Betamethasone group showed slightly higher rates of Grades 2 and 4, though the differences remained statistically non-significant (p\u0026thinsp;=\u0026thinsp;0.104). At 3-week and 6-week follow-ups, most patients had only Grade 1 dermatitis. By 3 months, all patients had recovered, with no remaining skin toxicity.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTime of development of radiation induced dermatitis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDermatitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eArm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u003cp\u003eGrade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eafter 1st week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003cp\u003e(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003cp\u003e(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eafter 2nd week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003cp\u003e(94.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.615\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003cp\u003e(97.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eafter 3rd week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003cp\u003e(64.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003cp\u003e(35.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003cp\u003e(47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003cp\u003e(52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eafter 4th week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003cp\u003e(41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003cp\u003e(59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.094\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003cp\u003e(77.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eafter 5th week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37\u003c/p\u003e\u003cp\u003e(94.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.675\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003cp\u003e(90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eafter 6th week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35\u003c/p\u003e\u003cp\u003e(89.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.286\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003cp\u003e(77.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eafter 7th week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003cp\u003e(76.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(20.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.197\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003cp\u003e(60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003cp\u003e(25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAt conclusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003cp\u003e(76.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(12.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.104\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003cp\u003e(60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003cp\u003e(30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAt 3weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003cp\u003e(97.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.187\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003cp\u003e(90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAt 6weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003cp\u003e(43.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003cp\u003e(56.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.154\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003cp\u003e(30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003cp\u003e(70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAt 3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003cp\u003e(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003cp\u003e(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBoth arms showed no statistically significant difference in the mean time to develop Grades 1, 2, or 3 dermatitis. Grade 1 appeared slightly earlier in the Betamethasone arm, while Grade 2 and 3 onset times were comparable across groups. Although a higher proportion of patients in the Betamethasone arm experienced Grade\u0026thinsp;\u0026ge;\u0026thinsp;2 dermatitis (40% vs. 23.1% in the Aloe Vera arm), this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.084) as presented in Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of mean time of development of different grades of dermatitis:\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAloe Vera (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBetamethasone (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime of development of grade 1 dermatitis in weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.973\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.859\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.120\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime of development of grade 2 dermatitis in weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.866\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.864\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.613\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime of development of grade 3 dermatitis in weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.894\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.756\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.822\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe occurrence of maximum dermatitis subdivided in below grade 2 and those at or above grade 2.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eARMS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade\u0026thinsp;\u0026lt;\u0026thinsp;2 dermatitis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGrade\u0026thinsp;\u0026ge;\u0026thinsp;2 dermatitis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAloe vera, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (76.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (23.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBetamethasone, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (40%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean ARD severity increased over time in both arms, with Betamethasone showing slightly higher scores throughout. At treatment completion, Betamethasone peaked at 1.6 and Aloe Vera at 1.36, showing a significant difference (p\u0026thinsp;=\u0026thinsp;0.035). Scores declined post-treatment, returning to 0 by three months. Differences were mostly non-significant except after the 7th week. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eRadiation-induced dermatitis (RID) is a frequent and significant side effect of radiotherapy, especially in HNC patients. This risk is notably higher in patients treated with cobalt machines using conventional bilateral open-field techniques which are still commonly used in India due to affordability, ease of maintenance, and cancer care burden. These machines deliver higher skin doses (up to 85% of Dmax), which makes them a practical model for evaluating RID prevention strategies.\u003c/p\u003e\u003cp\u003eDespite multiple agents being evaluated for RID prevention, no agent has emerged as the global standard of care. Aloe-vera and betamethasone are two of the most commonly used topical agents, with supportive literature for each [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], but no prior head-to-head comparisons exist. This randomized prospective study is the first, to our knowledge, comparing Aloe-vera with betamethasone in preventing RID in HNC patients receiving concurrent chemoradiotherapy.\u003c/p\u003e\u003cp\u003eMost patients developed grade 1 dermatitis, with no statistically significant difference in overall RID severity between the two arms. However, notable trends favoured Aloe-vera. By week 3, 52.5% in the betamethasone arm showed grade 1 dermatitis, compared to 35.9% in the Aloe-vera arm. This persisted into week 4 (77.5% vs. 59%, p\u0026thinsp;=\u0026thinsp;0.094). By treatment end, grade\u0026thinsp;\u0026ge;\u0026thinsp;2 dermatitis occurred in 40% of betamethasone patients versus 23.1% in the Aloe-vera group, including one case of grade 4 RID in the betamethasone arm (p\u0026thinsp;=\u0026thinsp;0.084). (Fig.\u0026nbsp;2)\u003c/p\u003e\u003cp\u003eThe mean time to onset of grade 1 RID was slightly longer in the Aloe-vera arm (4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.973 weeks) versus betamethasone (3.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.859 weeks, p\u0026thinsp;=\u0026thinsp;0.120), suggesting delayed onset. However, progression to grade 2 or 3 dermatitis was similar across both arms. Mean ARD scores were consistently lower in the Aloe-vera group, reaching statistical significance in week 7 only. These findings support Aloe-vera's potential protective role, aligning with the results of Olsen et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and Rao et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. On the other hand, although betamethasone has shown benefit in previous studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], its use carries known risks such as skin thinning and immunosuppression [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTobacco (chewing and smoking), betel nut, and alcohol were commonly used among participants, especially in males, reflecting national trends [\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Grade\u0026thinsp;\u0026ge;\u0026thinsp;2 RID was more frequent among tobacco users, and grade 4 RID was seen only in those with tobacco history, consistent with Porock et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Alcohol use was significantly associated with more severe RID (p\u0026thinsp;=\u0026thinsp;0.05), a finding not supported by Rades et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Betel nut chewers formed the majority (87%), but interestingly, grade 3 and 4 RID were more common among non-chewers (p\u0026thinsp;=\u0026thinsp;0.056), likely due to small non-chewer sample size.\u003c/p\u003e\u003cp\u003eAge and gender were not significantly associated with dermatitis severity (p\u0026thinsp;=\u0026thinsp;0.348 and p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 respectively), although conflicting evidence exists [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Notably, all patients with grade\u0026thinsp;\u0026gt;\u0026thinsp;2 RID were male.\u003c/p\u003e\u003cp\u003eA significant association between comorbidities (e.g., diabetes, hypertension) and higher-grade RID was observed (p\u0026thinsp;=\u0026thinsp;0.025), aligning with Xie et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. No association was seen with KPS score (p\u0026thinsp;=\u0026thinsp;0.455), contrasting with findings by Zhou et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and Yao et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDisease-related factors such as site and stage of disease showed non-significant but suggestive trends. Grade 4 dermatitis occurred only in oropharyngeal cancers (p\u0026thinsp;=\u0026thinsp;0.064), potentially due to deeper dose prescriptions. Stage IVB patients had the highest proportion of grade 3 RID, supporting a trend toward higher toxicity with advanced stage, partially matching results by Meyer et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and Chugh et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHistology showed a statistically significant association with RID severity (p\u0026thinsp;=\u0026thinsp;0.035), with higher-grade dermatitis observed in patients with PDSCC and NKSCC. Most prior studies have not explored histological impact on RID, warranting further exploration.\u003c/p\u003e\u003cp\u003eOTT showed no significant association (p\u0026thinsp;=\u0026thinsp;0.140), but higher grades of RID were more frequent in patients with treatment delays\u0026thinsp;\u0026gt;\u0026thinsp;60 days, indicating possible causation. Most patients completing treatment within \u0026lt;\u0026thinsp;51 days had grade 1 RID, especially in the Aloe-vera arm.\u003c/p\u003e\u003cp\u003eNumber of chemotherapy cycles was significantly associated with dermatitis severity (p\u0026thinsp;=\u0026thinsp;0.027), consistent with Chugh et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], Iacovelli et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], Tejwani et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], and He et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Higher-grade RID was more frequent in patients receiving\u0026thinsp;\u0026ge;\u0026thinsp;6 cycles of cisplatin [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite lack of statistically significant superiority, Aloe-vera consistently showed trends favouring lower onset, severity, and progression of RID compared to betamethasone. No patients in the Aloe-vera arm developed grade 4 dermatitis. This suggests that Aloe-vera, with its antioxidant, anti-inflammatory, and skin-regenerating properties [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], may offer a safer, more tolerable alternative for patients, especially those wary of corticosteroid side effects [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStrengths of this study include a prospective randomized design, standardized RTOG-based assessment, and its focus on a high-risk population. Limitations include its single-institution setting, small sample size, and lack of blinding, which may have introduced bias.\u003c/p\u003e\u003cp\u003eFuture research should focus on larger, multicentric trials to validate these findings and explore long-term effects of Aloe-vera and betamethasone in RID management across different cancer types.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study compared Aloe Vera and Betamethasone for managing radiation-induced dermatitis. While both showed similar trends, Aloe Vera slightly delayed onset and was associated with lower severity at peak (p\u0026thinsp;=\u0026thinsp;0.035). More patients in the Betamethasone group developed Grade\u0026thinsp;\u0026ge;\u0026thinsp;2 dermatitis (40% vs. 23.1%, p\u0026thinsp;=\u0026thinsp;0.084). Though not all differences were statistically significant, Aloe Vera may be a promising alternative. Larger studies are needed to validate these findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy conception, design, material preparation was performed by\u0026nbsp;Dr. Joydeep Nath, Dr. Apurba K Kalita, Dr. Jyotiman Nath, Dr. Mouchumee Bhattacharyya and Dr. Yanpothung Yanthan.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData Collection was done by Dr. Joydeep Nath,\u0026nbsp;Dr. Jahnabi Das, Dr. Kaushik J Kataki, Dr. Poragmoni Bora, Dr. Saswati Datta, Dr. Hafizul I Pathan and Dr. Md Mostafijur Rahaman.\u003c/p\u003e\n\u003cp\u003eStatistical analysis was done by Dr. Julee Rajkhowa.\u003c/p\u003e\n\u003cp\u003eThe first draft of the manuscript was written by Dr. Joydeep Nath and all authors commented on previous versions of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the IEC/BBCI/2023/Project No.13000516 and conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants, and confidentiality was strictly maintained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGlobal Cancer Statistics 2022 GLOBOCAN Estimates Of Incidence And Mortality Worldwide For 36 Cancers In 185 Countries\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Et Al (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates Of Incidence And Mortality Worldwide ] For 36 Cancers In 185 Countries. 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[Cited 2024 Jul 14]\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchmuth M, Wimmer Ma, Hofer S, Sztankay A, Weinlich G, Linder Dm EA (2002) Topical Corticosteroid Therapy For Acute Radiation Dermatitis: A Prospective, Randomized, Double-Blind Study. Br J Dermatol 146(6):983\u0026ndash;991\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUlff E, Maroti M, Serup J, Nilsson M, Falkmer U Prophylactic Treatment With A Potent Corticosteroid Cream Ameliorates Radiodermatitis, Independent Of Radiation Schedule: A Randomized Double Blinded Study. Pubmed [Internet]. [Cited 2024 Jul 14]; Available From: Https://Pubmed.Ncbi.Nlm.Nih.Gov/27913066/\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLarizadeh Mh D, Ma SM (2014) Epidemiological Characteristics Of Head And Neck Cancers In Southeast Of Iran. Iran J Cancer Prev. ;7(2)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTavares C, Guimar\u0026atilde;es J, Lopes O, Felino A, Coimbra F (2016) Epidemiological Profile Of Malignant Oral Cancers In A Population Of Northern Portugal. Revista Portuguesa De Estomatologia Med Dent\u0026aacute;ria E Cirurgia Maxilofacial 57(4):229\u0026ndash;235\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWarnakulasuriya S, Chen T (2022) Areca Nut And Oral Cancer: Evidence From Studies Conducted In Humans. J Dent Res 101(10):1139\u0026ndash;1146\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh Pk, Yadav A, Singh L, Mazumdar S, Sinha Dn, Straif K, Et Al (2021). Areca Nut Consumption With And Without Tobacco Among The Adult Population: A Nationally Representative Study From India. Bmj Open. ;11(6)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang Cj H, My F, Pt, Chen F, Wang Y (2019) Randomized Double-Blind, Placebo-Controlled Trial Evaluating Oral Glutamine On Radiation-Induced Oral Mucositis And Dermatitis In Head And Neck Cancer Patients. Am J Clin Nutr 109(3):606\u0026ndash;614\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePorock D, Nikoletti S, Cameron F (2004) The Relationship Between Factors That Impair Wound Healing And The Severity Of Acute Radiation Skin And Mucosal Toxicities In Head And Neck Cancer. Cancer Nurs 27(1):71\u0026ndash;78\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRades D, Zwaan I, Janssen S, Yu Ny S, Se, Idel C, Et Al (2023) Evaluation Of The Impact Of Smoking And Alcohol Consumption On Toxicity And Outcomes Of Chemoradiation For Head And Neck Cancer. 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Topical Treatment Of Radiation-Induced Dermatitis: Current Issues And Potential Solutions. Drugs Context 9:2020\u0026ndash;2024\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTejwani A, Wu S, Jia Y, Agulnik M, Millender L, Lacouture M (2009) Increased Risk Of High-Grade Dermatologic Toxicities With Radiation Plus Epidermal Growth Factor Receptor Inhibitor Therapy. Cancer 115(6):1286\u0026ndash;1299\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHe Y, Guo T, Guan H, Wang J, Sun Y, Peng X (2018) Concurrent Chemoradiotherapy Versus Radiotherapy Alone For Locoregionally Advanced Nasopharyngeal Carcinoma In The Era Of Intensity-Modulated Radiotherapy: A Meta-Analysis. Cancer Manag Res 10:1419\u0026ndash;1428\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSunku R, Kalita Ak, Bhattacharyya M, Medhi Pp, Bansal S, Borah L, Et Al. Effect Of Corticosteroid Ointment On Radiation Induced\u0026hellip; Indian Journal Of Cancer. [Cited 2024 Jul 14]; Available From: Https://Journals.Lww.Com/Indianjcancer/Fulltext/2021/58010/Effect_Of_Corticosteroid_Ointment_On_Radiation.15.Aspx\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Radiation-induced dermatitis, Aloe Vera Gel, Betamethasone Cream, chemoradiotherapy, head and neck cancer, skin toxicity, RTOG grading","lastPublishedDoi":"10.21203/rs.3.rs-7162796/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7162796/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Interruptions in radiotherapy due to dermatitis increase recurrence risk. Despite multiple studies, no standard approach exists for managing radiation dermatitis. This study aimed to compare the effectiveness of Aloe Vera versus Betamethasone in preventing radiation dermatitis in head and neck cancer patients undergoing definitive chemoradiotherapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e A prospective randomized trial was conducted with 79 patients receiving chemoradiotherapy. Participants were assigned to either Aloe Vera Gel (n=39) or Betamethasone Cream (n=40). RID was assessed weekly using Radiation Therapy Oncology Group (RTOG) criteria, focusing on onset, severity, and progression of dermatitis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The Aloe Vera group experienced a delayed onset of dermatitis compared to the Betamethasone group (mean: 4 weeks vs. 3.68 weeks). By the end of treatment, 76.9% of Aloe Vera patients had Grade 1 dermatitis, with 23.1% progressing to Grade 2 or higher. In the Betamethasone group, 60% had Grade 1 dermatitis, while 40% developed Grade 2 or higher. While the difference was not statistically significant, Aloe Vera showed a trend toward lower severity and fewer cases of severe dermatitis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Aloe Vera Gel may offer an advantage over Betamethasone in delaying the onset and reducing the progression of radiation-induced dermatitis. While both treatments are effective, Aloe Vera appears to be a safer option with fewer severe skin reactions. Larger studies are recommended to confirm these findings and explore combination therapies for better management of RID.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Topical Aloe Vera Versus Betamethasone in the Prevention of Radiation-induced Dermatitis in Patients With Head and Neck Cancer Treated With Definitive Chemoradiotherapy in Tele Cobalt Machine","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-27 10:56:47","doi":"10.21203/rs.3.rs-7162796/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"72e4690a-e940-4283-b5b2-4dc003dd8e71","owner":[],"postedDate":"July 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-27T10:56:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-27 10:56:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7162796","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7162796","identity":"rs-7162796","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}