Topical agents and dressings for fungating wounds

Fungating wounds arise from primary, secondary or recurrent malignant disease and are associated with advanced cancer. A small proportion of patients may achieve healing following surgical excision but treatment is usually palliative. Fungating wound management usually aims to slow disease progression and optimise quality of life by alleviating physical symptoms, such as copious exudate, malodour, pain and the risk of haemorrhage, through appropriate dressing and topical agent selection.

To conduct a systematic review of the evidence of the effects of dressings and topical agents on quality of life and symptoms that impact on quality of life in people with fungating malignant wounds.

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Wounds Group Specialised Register in August 2006. The Cochrane Breast Cancer Group and the Pain and Palliative Care Group were contacted for relevant studies. The Allied and Complementary Medicine (AMED) database was searched in January 2007. There was no restriction on language or date of publication.

Randomised controlled trials (RCTs) or, in their absence, controlled clinical trials (CCTs) with a concurrent control group, both published and unpublished, and written in any language, were eligible for inclusion.

Data extraction was undertaken by one author and checked for accuracy by a second author. Two review authors independently assessed trial quality.

Two trials involving 63 people were included. One RCT in women with superficial breast lesions compared 6% miltefosine solution with placebo and found that miltefosine delayed tumour progression. However, this trial had methodological limitations. A second trial compared topical metronidazole with placebo and found that metronidazole reduced malodour. However, this trial also had methodological limitations and was underpowered.

There is weak evidence from one small trial that 6% miltefosine solution applied topically to people with superficial fungating breast lesions (smaller than 1cm) who have received either previous radiotherapy, surgery, hormonal therapy or chemotherapy for their breast cancer may slow disease progression. There is insufficient evidence in this review to give a clear direction for practice with regard to improving quality of life or managing wound symptoms associated with fungating wounds. More research is needed.