Radiation therapy side-effects and solutions.

Radiation therapy side-effects and solutions.

What are the risks of Radiation therapy

Sources: National Cancer Institute and the Mayo Clinic

How can I reduce radiation therapy side effects?

Your medical team will prescribe pharmaceutical drugs to deal with some of the side-effects of radiation therapy, but these come with their own risks.

However, there are many other evidence-based solutions you can use to reduce side-effects, make your treatment work better and safer, and significantly improve your chances of survival. These solutions (most of them natural) are listed below – along with scientific studies showing their benefits.

What is the evidence supporting these products?

1. WOUND HEALING

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.

2. PROTECT HEALTHY TISSUES AND ORGANS

Lycopene

Study: In conclusion, our study showed that lycopene may act as a radiomitigator but only when applied at a low concentration 24 h, but not 8 days after irradiation. LYC [lycopene] may be used in clinical practice to protection of healthy tissues of radiology patients as well as in the case of radiological emergency.

Black Grape juice 

Study: Results suggest that BGJ [Black grape juice] is a good protective candidate compound against heart damage from ARS [acute radiation syndrome] and its effects suggest its use as a radiomodifier.

Hesperidin

Study: Hesperidin demonstrated significant neuroprotection after radiation induced brain injury.

Retinol palmitate (a form of vitamin 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.

Flaxseed

Study: Because radiation damage is a multi-faceted phenomenon, any agent or compound that can modify or alter multiple aspects or mechanisms of radiation-induced inflammation and fibrosis while at the same time being both inexpensive and non-toxic is extremely exciting. It is evident from our findings that dietary FS [flaxseed] is a potential agent in mitigating radiation damage and that the discovery of the mitigating properties of FS may prove a critical milestone in the development of non-toxic radiation mitigators.

Probiotics

Study: radiotherapy, chemotherapy and immunotherapy, given their general toxicity, can compromise the gut microbiome of patients…recent studies have suggested that LGG [a probiotic], administered in vivo, is able to modulate the immune system, reducing the detrimental toxic intestinal effects following pelvic radiotherapy.

Calendula officinalis 

Study: …254 patients who had been operated on for breast cancer and who were to receive postoperative radiation therapy were randomly allocated to application of either trolamine (128 patients) or calendula (126 patients) on the irradiated fields after each session.

The occurrence of acute dermatitis of grade 2 or higher was significantly lower (41% v 63%) with the use of calendula than with trolamine. Moreover, patients receiving calendula had less frequent interruption of radiotherapy and significantly reduced radiation-induced pain. Calendula was considered to be more difficult to apply, but self-assessed satisfaction was greater.

Conclusion: Calendula is highly effective for the prevention of acute dermatitis of grade 2 or higher and should be proposed for patients undergoing postoperative irradiation for breast cancer.

Green tea (EGCG)

Study of 49 breast cancer patients: As soon as Grade I dermatitis was documented, the EGCG solution was applied. The average duration of EGCG treatment was 4 weeks. Of note, 15 patients regressed to Grade 0 skin toxicity (meaning no symptoms) with the use of EGCG…This study indicates that application of topical EGCG at a dose of 660 μmol/L may be beneficial in the treatment and management of acute RDS.

Zinc 

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

Turmeric (Curcuma longa)

Study: In conclusion, 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

Coenzyme Q10 (CoQ10)

Study: Administration of rCoQ10 led to its accumulation in the intestine and induced radioprotective effects by inhibiting ROS-mediated apoptosis, thereby preserving intestinal structures. Our results indicated that rCoQ10 supplementation effectively ameliorated radiation enteropathy.

Cranberry

Study:  Men receiving radiation therapy for prostate cancer may benefit from using cranberry capsules, particularly those on low hydration regimens or with baseline urinary symptoms.

Honey 

Study of 50 cancer patients: The results of this study indicate that honey mitigates radiation-induced mucositis and that the protective effect does not interfere with tumor cell killing. The cell culture details indicate that treatment with honey enhanced the radiation-induced cell killing.

Poly-MVA
A proprietary water- and lipid-soluble polymer-based nutritional supplement composed of a complex mixture of alpha-lipoic acid bound to palladium…and other minerals, vitamins and amino acids…Upon oral administration, the alpha-lipoic acid-palladium/vitamin/mineral supplement acts as a free radical scavenger, crosses the cell membrane and is able to transfer electrons from fatty acids to DNA via the electron transport chain in mitochondria, which protects against DNA damage. This could protect non-cancerous cells from the oxidative damage caused by radiation and chemotherapy. In addition, in the hypoxic conditions found within tumors, the excess electrons can generate free radicals within mitochondria and could induce both cytochrome c release and apoptosis. Source: The National Cancer Institute

Glutamine 

Study: Topical oral swish and swallow glutamine and a disaccharide, such as trehalose, has potential to ameliorate not only OM, but also esophagitis and enteritis after cancer chemotherapy and radiation. If cancer patients and caregivers recognize that it is possible to increase mucosal glutamine absorption using disaccharides, there may be less mucosal damage experienced by cancer patients. 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.

Silymarin (Milk Thistle extract)

Published on National Cancer Institute website: A randomized clinical trial of 30 patients with head and neck cancer who had radiation therapy found that those who took silymarin for 6 weeks had lower rates of radiation-related mucositis compared to those who did not.
A nonrandomized observational study in women with breast cancer who had surgery and radiation therapy found that a silymarin-based cream helped prevent patients from having skin rashes from radiation therapy.

3. CEREBRAL EDEMA

Boswellia serrata

Study involving 44 patients:
BS [Boswellia serrata] significantly reduced cerebral edema measured by MRI in the study population. BS could potentially be steroid-sparing for patients receiving brain irradiation.

4. LYMPHEDEMA

Selenium  (Sodium selenite)

Study of 40 patients with breast cancer related lymphedema [BCRL] found: Sodium selenite therapy in combination with CDPT [complex decongestive physiotherapy] is effective in reducing the volume of upper limb in BCRL, and significantly reduce the volume of the affected distal upper limb compared to CDPT alone.

5. NAUSEA AND VOMITING

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.

6. RECTAL BLEEDING

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…

See Ozone therapy page

7. FIBROSIS

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.

8. URINARY, SEXUAL AND INTESTINAL

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.

9. DIARRHEA

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.

10. DYSPHAGIA

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

11. SALIVA FLOW

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.

12. SENSITIZES CANCER CELLS TO RADIATION

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.

13. GENERAL PROTECTION FROM RADIATION 

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.

Cancer Side Effects

Updated 2024

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