Mikronährstoffsupplemente bei onkologischen Patienten

Zusammenfassung

Vitamine, Minerale, Spurenelemente insbesondere Antioxidanzien werden von bis zu 70 % der onkologischen Patienten in unterschiedlichsten Kombinationen und Konzentrationen eingenommen. Die Rationale für die Einnahme ist unterschiedlich und oft auch unbegründet. Während normal dosierte Mikronährstoffpräparate aufgrund der oft bestehenden Mangelernährung unkritisch sind, ist bei den vielfach empfohlenen hoch dosierten Präparaten, vor allem den Antioxidanzien, die Datenlage unklar und es ist nicht sicher inwieweit hier statt des positiven Effektes ein negativer eintreten kann. Die Radio- und Chemotherapie wirkt u. a. über die Bildung reaktiver Sauerstoffverbindungen (ROS), die wiederum durch Antioxidanzien abgefangen werden. ROS sind aber auch für Nebenwirkungen mitverantwortlich, sodass Antioxidanzien hier eher nützlich sein könnten. Dies gilt es bei der Beurteilung der wissenschaftlichen Evidenz für den Einsatz von Antioxidanzien abzuwägen.

Abstract

Vitamins, Minerals, trace elements and especially antioxidants are used from 70 % of oncological patients in different combinations and concentrations. The reason to consume these micronutrients differs and is in many cases not justified. Multivitamin supplements within a normal range (100 % DRI) are without any risk for cancer patients. Indeed, due to the frequently occurring malnutrition they might be rather beneficial. The frequently recommended antioxidants in high concentrations however, might be either beneficial or harmful. Radio- and chemotherapie exert some effects on cancer cells via generation of reactive oxygen species (ROS). Antioxidants may neutralise ROS and consequently have a harmful effect regarding the therapeutic efficacy. On the other hand ROS are in part also responsible for side effects of radio- and chemotherapy and antioxidants might be beneficial. If antioxidants are recommended, this has to be taken in mind and critically analysed.

Schlüsselwörter

Mangelernährung - Mikronährstoffe - Antioxidanzien - Krebs

Keywords

malnutrition - micronutrients - antioxidants - cancer

Literatur

• 1 Anthony H M, Schorah C J. Severe hypovitaminosis C in lung-cancer patients: the utilization of vitamin C in surgical repair and lymphocyte-related host resistance.  Br J Cancer. 1982;  46 354-367
• 2 Krasner N, Dymock I W. Ascorbic acid deficiency in malignant diseases: a clinical and biochemical study.  Br J Cancer. 1974;  30 142-145
• 3 Subapriya R, Kumaraguruparan C R, Ramachandran C. Oxidant-antioxidant status in patients with oral squamous cell carcinomas at different intraoral sites.  Clinical Biochemistry. 2002;  35 489-493
• 4 Leung S W, Mitchell J B, al-Nabulsi I et al. Effect of L-buthionine sulfoximine on the radiation response of human renal carcinoma cell lines.  Cancer. 1993;  71 2276-2285
• 5 Husbeck B, Peehl D M, Knox S J. Redox modulation of human prostate carcinoma cells by selenite increases radiation-induced cell killing.  Free Radic Biol Med. 2005;  38 50-57
• 6 Takada Y, Hachiya M, Park S H et al. Role of reactive oxygen species in cells overexpressing manganese superoxide dismutase: mechanism for induction of radioresistance.  Mol Cancer Res. 2002;  1 137-146
• 7 Schiff R, Reddy P, Ahotupa M et al. Oxidative stress and AP-1 activity in tamoxifen-resistant breast tumors in vivo.  J Natl Cancer Inst. 2000;  92 1926-1934
• 8 Gatenby R A, Kessler H B, Rosenblum J S et al. Oxygen distribution in squamous cell carcinoma metastases and its relationship to outcome of radiation therapy.  Int J Radiat Oncol Biol Phys. 1988;  14 831-838
• 9 Hockel M, Knoop C, Schlenger K et al. Intratumoral pO₂ predicts survival in advanced cancer of the uterine cervix.  Radiother Oncol. 1993;  26 45-50
• 10 Nordsmark M, Overgaard M, Overgaard J. Pretreatment oxygenation predicts radiation response in advanced squamous cell carcinoma of the head and neck.  Radiother Oncol. 1996;  41 31-39
• 11 Daniels J S, Gates K S, Tronche C et al. Direct evidence for bimodal DNA damage induced by tirapazamine.  Chem Res Toxicol. 1998;  11 1254-1257
• 12 Block K I, Koch A C, Mead M N et al. Impact of antioxidant supplementation on chemotherapeutic efficacy: a systematic review of the evidence from randomized controlled trials.  Cancer Treat Rev. 2007;  33 407-418
• 13 de Souza Fede A B, Bensi C G, Trufelli D C et al. Multivitamins do not improve radiation therapy-related fatigue: results of a double-blind randomized crossover trial.  Am J Clin Oncol. 2007;  30 432-436
• 14 Yeom C H, Jung G C, Song K J. Changes of terminal cancer patients’ health-related quality of life after high dose vitamin C administration.  J Korean Med Sci. 2007;  22 7-11
• 15 Mystakidou K, Tsilika E, Parpa E et al. Assessment of anxiety and depression in advanced cancer patients and their relationship with quality of life.  Qual Life Res. 2005;  14 1825-1833
• 16 Bryan J, Calvaresi E. Associations between dietary intake of folate and vitamins B-12 and B-6 and self-reported cognitive function and psychological well-being in Australian men and women in midlife.  J Nutr Health Aging. 2004;  8 226-232
• 17 Kamphuis M H, Geerlings M I, Grobbee D E et al. Dietary intake of B(6-9-12) vitamins, serum homocysteine levels and their association with depressive symptoms: the Zutphen Elderly Study.  Eur J Clin Nutr. 2008;  62 939-945
• 18 de Luca C, Deeva I, Mikhal’Chik E et al. Beneficial effects of pro-/antioxidant-based nutraceuticals in the skin rejuvenation techniques.  Cell Mol Biol (Noisy-le-grand). 2007;  53 94-101
• 19 Posthauer M E. The role of nutrition in wound care.  Adv Skin Wound Care. 2006;  19 43-52
• 20 Ucuncu H, Ertekin M V, Yoruk O et al. Vitamin E and L-carnitine, separately or in combination, in the prevention of radiation-induced oral mucositis and myelosuppression: a controlled study in a rat model.  J Radiat Res (Tokyo). 2006;  47 91-102
• 21 Jatoi A, Williams B, Nichols F et al. Is voluntary vitamin and mineral supplementation associated with better outcome in non-small cell lung cancer patients? Results from the Mayo Clinic lung cancer cohort.  Lung Cancer. 2005;  49 77-84
• 22 Jaakkola K, Lahteenmaki P, Laakso J et al. Treatment with antioxidant and other nutrients in combination with chemotherapy and irradiation in patients with small-cell lung cancer.  Anticancer Res. 1992;  12 599-606