Complementary therapies to reduce Radiation side-effects

Hyperbaric Oxygen Therapy (HBOT)

This review says: We included 19 trials in this review (2286 participants: 1103 allocated to HBOT and 1153 to control). For head and neck cancer, there was an overall reduction in the risk of dying at both one year and five years after therapy, and some evidence of improved local tumour control immediately following irradiation…There was a lower incidence of local recurrence of tumour when using HBOT at both one and five years … There was also some evidence with regard to the chance of metastasis at five years.

Study with 411 patients: A positive outcome from hyperbaric treatment occurred in 94% of patients with osteoradionecrosis of the jaw, 76% of patients with cutaneous radionecrosis that caused open wounds, 82% of patients with laryngeal radionecrosis, 89% of patients with radiation cystitis, 63% of patients with gastrointestinal radionecrosis, and 100% of patients who were treated in conjunction with oral surgery in a previously irradiated jaw. CONCLUSIONS: The outcomes of 411 patients collected prospectively over 8 years strongly supported the efficacy of hyperbaric oxygen treatment for the 6 conditions evaluated.

Explore Hyperbaric Oxygen Therapy (HBOT) for relief of side-effects

Radiation: Human studies

Calendula officinalis (common marigold)
A Study of 254 breast cancer patients who were to receive postoperative radiation therapy was divided into two groups of equal size. Each group had either trolamine (a topical cream) or calendula applied on the irradiated fields after each session. Patients receiving calendula had significantly lower rates of grade 2 or higher acute dermatitis and significantly reduced radiation-induced pain.

Cranberry
A Study of 40 men with prostate cancer reports that men taking highly standardized cranberry capsules once a day, during and for 2 weeks after completion of radiation therapy, decreased the incidence and severity of certain aspects of cystitis, including incidence of pain/burning, in men with prostate cancer compared with placebo capsules.
Hamilton K, Bennett NC, Purdie G, Herst PM. Standardized cranberry capsules for radiation cystitis in prostate cancer patients in New Zealand: a randomized double blinded, placebo controlled pilot study. Support Care Cancer. 2015 Jan;23(1):95-102. doi: 10.1007/s00520-014-2335-8. Epub 2014 Jul 4. PMID: 24993395.

Green tea (EGCG)
A prospective study of 49 breast cancer patients states that as soon as Grade I dermatitis was documented, the EGCG solution of 660 μmol/L was applied for an average duration of 4 weeks. Of note, 15 patients regressed to Grade 0 skin toxicity (meaning no symptoms) with EGCG. EGCG reduced pain in 85.7% of patients, burning sensation in 89.8%, itching in 87.8%, pulling in 71.4%, and tenderness in 79.6%.

Honey 

A Study of 50 cancer patients reported that honey mitigates radiation-induced mucositis and that the protective effect does not interfere with tumour cell killing.

Poly-MVA

Medical oncologist and homoeopathic physician, Dr James W. Forsythe, conducted a Poly-MVA outcome-based investigation on various Stage IV Cancers in Reno, Nevada and saw encouraging results. “We have seen patients go into full remission with aggressive, stage IV cancers, and we see continued positive responses in others with previously chemo-resistant cancer. Other benefits from Poly-MVA are a significantly improved quality of life and a substantial reduction in the number and severity of side effects from chemo and radiation therapies.”

Silymarin (Milk Thistle extract)
A randomised clinical trial found that 30 cancer patients who took silymarin for 6 weeks following radiation therapy had lower rates of radiation-related mucositis compared to those who did not. Another study in women with breast cancer found that a silymarin-based cream helped prevent skin rashes from radiation therapy.

Laboratory studies

Black Grape juice 
Study: Results suggest that Black grape juice is a good protective compound against heart damage caused by radiation.

Coenzyme Q10 (CoQ10)
Study: Our results indicated that rCoQ10 supplementation effectively ameliorated radiation enteropathy.

Cranberry
A Study reports that men, particularly those on low hydration regimens or with baseline urinary symptoms, receiving radiation therapy for prostate cancer may benefit from cranberry supplementation.

Flaxseed
A Study indicates that dietary flaxseed is a potential agent for mitigating radiation damage, and that its mitigating properties may prove a critical milestone in the development of non-toxic radiation mitigators.

Glutamine (amino acid)
A Study reports topical oral swish and swallow glutamine and a disaccharide, such as trehalose, has potential to ameliorate not only Oral Mucositis, but also esophagitis and enteritis after cancer chemotherapy and radiation. A small amino acid intervention may make a difference and possibly contribute to better overall nutritional status, improved survival with fewer complications, and ultimately less sarcopenia and lymphopenia.

Hesperidin
A Study states demonstrated significant neuroprotection after radiation-induced brain injury.

Lycopene
A Study concluded lycopene may act as a radiomitigator but only when applied at a low concentration 24 hours after irradiation, but not 8 days after irradiation. Lycopene may be used in clinical practice for the protection of healthy tissues of radiology patients.

Probiotics
A Study states radiotherapy, chemotherapy and immunotherapy compromise the gut microbiome of patients…recent studies have suggested that LGG [a probiotic] is able to modulate the immune system, reducing the detrimental toxic intestinal effects following pelvic radiotherapy.

Soy isoflavones
A Study: Soy isoflavones given pre- and postradiation protected the lungs against adverse effects of radiation, including skin injury, hair loss, increased breathing rates, inflammation, pneumonitis and fibrosis, providing evidence for a radioprotective effect of soy.

Turmeric (Curcuma longa)
A Study: antioxidant treatment with curcumin prior to irradiation provides effective protection against intestinal damage, suggesting that clinical transfer is feasible. Therefore, curcumin can be very useful in cancer patients receiving radiotherapy.

Zinc 
A Study: Zinc Sulphate seems to have beneficial effects on postponing the start of radiodermatitis and decreasing the severity of radiation-induced dermatitis.

Cannabis

Study: Nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana.

Acupressure bands

Study of 88 patients: The present study supports previous experimental research showing that acupressure bands are effective in controlling nausea and extends these positive findings to the population of patients experiencing radiation therapy-related nausea. It is noteworthy that prior to entering the study, all patients experienced nausea and that this nausea was not completely controlled by their physician-provided antiemetic regimen. Nausea for cancer treatments, once it occurs, is often very difficult to control and yet these simple bands were effective in that effort. It is a low-cost, nonintrusive, safe adjunct to standard antiemetics that has great patient acceptance.

Butyrate

Study of 20 patients with ARP [acute radiation proctitis] found: Topical sodium butyrate, unlike other therapeutic regimens used so far, proved effective in the treatment of ARP.

Ozone therapy

Study: In conclusion, our results show a significant, and clinically relevant, effect of ozone therapy in the management of radiation-induced rectal bleeding. Following ozone therapy, the requirements for blood transfusions were significantly decreased as was the need for endoscopic procedures. The grades of toxicity (according to the CTCAE scale) were also reduced. These effects were maintained over the course of protracted follow-up, and no adverse impact on survival was noted. We believe the local application of ozone therapy can be useful as adjuvant treatment in managing radiation proctitis…

Quercetin

Study: In conclusion, the present study provides new evidence that quercetin may have a role in the management of radiation induced fibrosis. Coupled with previously published data reporting sensitization of tumor cells to irradiation with quercetin treatment, these data strongly support the further evaluation of quercetin and its bioactive metabolites, as a radiation mitigator.

Soy isoflavone 

Study of 42 prostate cancer patients: Forty-two patients with prostate cancer were randomly assigned to receive 200 mg soy isoflavone (Group 1) or placebo (Group 2) daily for 6 mo beginning with the first day of radiation therapy…Only 26 and 27 patients returned completed questionnaires at 3 and 6 mo, respectively. At each time point, urinary, bowel, and sexual adverse symptoms induced by radiation therapy were decreased in the soy isoflavone group compared to placebo group. At 3 mo, soy-treated patients had less urinary incontinence, less urgency, and better erectile function as compared to the placebo group. At 6 mo, the symptoms in soy-treated patients were further improved as compared to the placebo group. These patients had less dripping/leakage of urine (7.7% in Group 1 vs. 28.4% in Group 2), less rectal cramping/diarrhea (7.7% vs. 21.4%), and less pain with bowel movements (0% vs. 14.8%) than placebo-treated patients. There was also a higher overall ability to have erections (77% vs. 57.1%). The results suggest that soy isoflavones taken in conjunction with radiation therapy could reduce the urinary, intestinal, and sexual adverse effects in patients with prostate cancer.

Psyllium (a plant fiber)

Study: Psyllium fiber is a well-tolerated, low-cost, effective intervention for reducing the incidence and severity of radiation-induced diarrhea in patients undergoing pelvic radiation treatment for prostate or gynecologic cancer.

L-carnosine 

Study: This randomized phase III trial showed that ZLC [The Zinc-L-carnosine], which is suitable for all patients whatever their comorbidities, significantly prevented or delayed the onset of RT [radiation therapy]-related dysphagia, reducing the need for steroid therapy.

Transcutaneous electrical nerve stimulation (TENS) 

Study:Twenty-nine of 30 patients showed increased saliva flow during stimulation. A statistically significant improvement in saliva production (P < 0.05) during stimulation was noted…The interval to the application of TENS after radiotherapy significantly influenced the improvement in salivary flow.
Extra-oral application of TENS is effective in increasing the whole salivary flow in most of the post-radiated oral cavity/oropharyngeal cancer patients with xerostomia.

Quercetin 

Study: Overall, these results indicated that quercetin acted as a promising radiosensitizer through p53-dependent ER stress signals.

EGCG (Green Tea extract)

Study: Conclusions: The use of EGCG could enhance the effect of conventional cancer therapies through additive or synergistic effects as well as through amelioration of deleterious side effects… As shown in this review, sensitization and synergistic effects of EGCG when used in combination with radio- or chemotherapy may imply reductions in the required doses and, as a consequence, decreased risk of toxicity.

Statins 

Study: These findings reveal that simvastatin may be a potent therapeutic agent for co-treatment with radiation to overcome radioresistance in PC [prostate cancer] cells.

Curcumin 

Study: In conclusion, curcumin sensitizes human HCC [Hepatocellular carcinoma] cells to radiation…In addition, curcumin combined with radiation may have therapeutic potential for patients with HCC.

Resveratrol

Study: In summary, RSV [Resveratrol] enhances radiation sensitivity in PCA [prostate cancer] by inhibiting cell proliferation and promoting cell senescence and apoptosis in vitro.

Genistein

Study: Previous studies have shown that genistein can sensitize cancer cells to radiation. Hillman et al . found that the combination of genistein and radiation showed an enhanced inhibitory effect on DNA synthesis in and growth of prostate cancer cells

Ashwagandha

Study:  It is concluded that Ashwagandha, in addition to having a tumor inhibitory effect, also acts as a radiosensitizer and heat enhances these effects.

Vitamin D3 

Study: The finding implicates that vitamin D may be a useful radiation sensitizer in human lung cancer cells.

Sulforaphane

Study: Sulforaphane is a promising agent in the treatment of head and neck cancer due to its antiproliferative and radio-sensitizing properties. A combination of sulforaphane and radiation decreases clonogenic [colony of cancer cells] survival.

Eicosapentaenoic acid (EPA)

Study: u-3 Polyunsaturated fatty acids (PUFAs) might be used as adjuvant for cancer therapy. They could inhibit tumor progression in breast, skin and prostate cancers. The adjuvant use of u-3 PUFAs increased chemo-and radio-sensitivity in different cancers.

Boswellia serrata (plant extract)

Study: Combination of AKBA [Boswellia serrata] with radiotherapy was found to inhibit factors which involved in cell death regulation, tumor progression and radioresistence, therefore it may serve as a novel approach for GBM patients.

HBOT to reduce severe late side effects of radiation

This study says
an estimated 5%–10% of patients will eventually develop severe late effects after radiotherapy…As an example, individuals experiencing chronic radiation cystitis may face recurrent bleeding, pain, and loss of bladder control, limiting their ability to work, travel, or engage socially. Furthermore, associated symptoms can incite anxiety of tumor recurrence, negatively affecting quality of life.

Despite recent technical advances with modern radiotherapy techniques, these adverse events reportedly still occur in a relevant 16% of patients. A 2023 systematic review (nine studies; 1308 patients) reported various reductions in fibrosis, lymphedema, pain, shoulder immobility, and skin problems after 20–60 HBOT sessions of 80–90 minutes each.

Black cumin (Nigella sativa)

Study: Our results strongly recommend Nigella sativa oil as a promising natural radioprotective agent against immunosuppressive and oxidative effects of ionizing radiation.

Melatonin

Study: Our results suggest that supplementing cancer patients with adjuvant therapy of melatonin may reduce patients suffering from toxic therapeutic regimens such as chemotherapy and/or radiotherapy and may provide an alleviation of the symptoms due to radiation-induced organ injuries.

Physical Exercise 

Study: The findings in this narrative review show that exercise training is beneficial during active RT [radiation therapy] treatment and appears to be an effective and crucial component to counteract the side effects induced by RT.

Selenium

Study: This paper summarized 16 clinical studies on selenium and radiotherapy conducted from 1987 to 2012. The studies included 1303 cancer patients…Selenium supplementation increased the blood selenium level, improved the general condition of patients, improved quality of life, prevented or reduced the side effects of radiotherapy and did not reduce the effectiveness of radiotherapy or cause any toxicity.
The results of our summary suggest that selenium supplementation in the form of sodium selenite at doses ranging from 200–500 μg daily by oral administration may offer benefits for head and neck cancer; head and neck cancer with lymphedema; and oral, cervical and uterine cancer patients who undergo radiotherapy and have low selenium levels.

Beta-carotene and alpha-tocopherol should be avoided in smokers undergoing radiation therapy.
This randomized trial says: We conducted a randomized trial with alpha tocopherol (400 IU/day) and beta carotene (30 mg/day) supplements among 540 head and neck cancer (HNC) patients treated by radiation therapy. We examined whether smoking during radiation therapy modified the effects of the supplementation on HNC recurrence and on mortality. the interactions between supplementation and cigarette smoking during radiation therapy were statistically significant for HNC recurrence, all-cause mortality and mortality from the initial HNC.

Colostrum

This Review article says: Although contemporary medicine uses disposal agents to alleviate many side effects from cancer therapy, they are moderately effective and have undesirable effects. Thus, new agents are in high demand to assist the basic therapeutic protocols and lower their side effects. The most desirable products should be natural, with a multidirectional effect on the organism, bioavailable, non-toxic, safe (no adverse side effects), easy to self-apply, accepted by a patient and relatively inexpensive. Bovine colostrum (BC) and preparations containing its active ingredients, mainly lactoferrin (LF), meet the requirements of such products, as confirmed by the results of numerous in vitro, animal and clinical trials.

In conclusion, colostrum and colostrum proteins, preferably administered with probiotic bacteria, are highly recommended for inclusion to therapeutic protocols in cancer chemo-and radiotherapy as well as during the surgical treatment of cancer patients.

General protection from radiation

Listening to mindfulness audios during radiation found to improve physical, emotional side effects

by Northwestern University
Men with prostate cancer who are treated with radiation therapy experience significant side effects such as fatigue, sleep problems, anxiety and depressive symptoms. But listening to mindfulness audio recordings significantly eased those symptoms, a new Northwestern Medicine study has found.

While reclining and receiving their daily 5-to-15-minute radiation treatment, men in the study listened to short (3-to-6 minute) audio-based mindfulness recordings that asked them to focus on their breath, posture, sounds and environment.

To the authors’ knowledge, this is the first study to deliver a brief mindfulness intervention during actual radiation treatment versus suggesting patients seek it out in their own time outside the treatment facility, said principal investigator David Victorson.

The study was published on April 30 in the journal Global Advances in Integrative Medicine and Health. “We were really leveraging the fact that they were a captive audience,” said Victorson, professor of medical social sciences at Northwestern University Feinberg School of Medicine. “We’re optimizing their treatment to not just treat their cancer but also get a jump on managing physical and emotional side effects.”
Read full article on Medical Xpress

Supplementation with L. reuteri also delayed the onset of severe oral mucositis and shortened its duration.

Note: L. reuteri is present in unpasteurised sauerkraut.