Ergänzende Maßnahmen in der Strahlentherapie: Nebenwirkungen und Spätfolgen vorbeugen und behandeln

Summary

Die Strahlentherapie ist eine wichtige Behandlungssäule in der Krebstherapie, jedoch auch mit Nebenwirkungen und Spätfolgen verbunden. Ergänzende Maßnahmen können diese effektiv vorbeugen und lindern. Dabei werden verschiedene pflanzliche Präparate, Vitamine, Spurenelemente oder weitere Nahrungsergänzungsmittel zur Behandlung der radiogenen Dermatitis (Aloe vera, Calendula), Mukositis (Honig, Sanddornfruchtfleischöl), Proktitis (Vitamin D, Probiotika, Selen) oder des Hirnödems (Boswelliaserrata) eingesetzt. Maßnahmen wie Sport und regelmäßige Entspannungsübungen können die allgemeine Leistungsfähigkeit und Befindlichkeit verbessern. Des Weiteren sind mögliche Wechselwirkungen zwischen komplementären Verfahren und der Strahlentherapie zu berücksichtigen.

Keywords

Krebs - Krebstherapie - Onkologie - Strahlentherapie - Hautpflege

Publikationsverlauf

Artikel online veröffentlicht:
12. Dezember 2023

• Literatur

• 1 World Health Organisation. New WHO/IAEA publication provides guidance on radiotherapy equipment to fight cancer (05.03.2021). Im Internet. https://www.who.int/news/item/05-03-2021-new-who-iaea-publication-provides-guidance-on-radiotherapy-equipment-to-fight-cancer Stand: 05.10.2023
• 2 Common Terminology Criteria for Adverse Event (CTCAE). Version 5.0. Published: 27.11.2017. Im Internet. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf Stand: 05.10.2023
• 3 Leitlinienprogramm Onkologie. S3-Leitlinie Supportive Therapie bei onkologischen PatientInnen. Langversion 1.3 (02/2020). Im Internet. https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Supportivtherapie/LL_Supportiv_Langversion_1.3.pdf Stand: 05.10.2023
• 4 Baharara H, Rahsepar S, Emami SA. et al The efficacy of medicinal plant preparations in the alleviation of radiodermatitis in patients with breast cancer: A systematic review of clinical trials. Phytotherapy Research 2023; 37 (08) 3275-3295
• 5 Pommier P, Gomez F, Sunyach MP. et al Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol 2004; 22 (08) 1447-145
• 6 Valls PB, Prieto CP, Rodríguez MF. et al Is calendula useful for radiation dermatitis in breast cancer? A single-centre clinical trial. Radiotherapy and Oncology 2021; 161: S924-S925
• 7 Siddiquee S, McGee MA, Vincent AD. et al Efficacy of topical Calendula officinalis on prevalence of radiation-induced dermatitis: A randomised controlled trial. Australasian Journal of Dermatology 2020; 62 (01) e35-e40
• 8 Sharp L, Finnila K, Johansson H. et al No differences between calendula cream and aqueous cream in the prevention of acute radiation skinreactions-results from a randomised blinded trial. European Journal of Oncology Nursing 2013; 17 (04) 429-435
• 9 Fotouhi M, Samee F, Amoozegar Hashemi F. et al Topical calendula and betamethasone valerate in the prevention of acute radiation dermatitis: A randomized prospective trial. Teheran University of Medical Sciences Journal, 2007; 65 (03) 23-29
• 10 Ahmadloo N, Kadkhodaei B, Omidvari S. et al Lack of prophylactic effects of aloe Vera gel on radiation induced dermatitis in breast cancer patients. Asian Pacific Journal of Cancer Prevention 2017; 18 (04) 1139-1143
• 11 Tungkasamit T, Chakrabandhu S, Samakgarn V. et al Reduction in severity of radiation-induced dermatitis in head and neck cancer patients treated with topical aloe vera gel: A randomized multicenter double-blind placebo-controlled trial. European Journal of Oncology Nursing 2022; 59: 102164
• 12 Hoopfer D, Holloway C, Gabos Z. et al Three-arm randomized phase III trial: Quality aloe and placebo cream versus powder as skin treatment during breast cancer radiation therapy. Clinical Breast Cancer 2015; 15 (03) 181-190
• 13 Mahtab T, Mahbobeh S, Ahmadreza A. et al Effect of aloe vera (L.) Burm.f. on the prevention of dermatitis in women with breast cancer under radiotherapy. Journal of Medicinal Plants 2020; 18 (72) 166-173
• 14 Becker-Schiebe M, Mengs U, Schaefer M. et al Topical use of a silymarin-based preparation to prevent radiodermatitis results of a prospective study in breast cancer patients. Strahlentherapie und Onkologie 2011; 187 (08) 485-491
• 15 Karbasforooshan H, Hosseini S, Elyasi S. et al Topical silymarin administration for prevention of acute radiodermatitis in breast cancer patients: A randomized, double-blind, placebo-controlled clinical trial. Phytotherapy Research 2019; 33 (02) 379-386
• 16 Hemati S, Saeedi A. Clinical evaluation of oral curcumin in prevention of acute dermatitis in breast cancer radiotherapy. Journal of Isfahan Medical School 2011; 29 (152) 1216-1223
• 17 Ryan JL, Heckler CE, Ling MN. et al Curcumin for radiation dermatitis: A randomized, double-blind, placebo-controlled clinical trial of 30 breast cancer patients. Journal of Clinical Oncology 2012; 30 (15) 9027
• 18 Ryan WJ, Heckler CE, Guido JJ. et al Oral curcumin for radiation dermatitis: A URCC NCORP study of 686 breast cancer patients. Support Care Cancer 2018; 26 (05) 1543-1552
• 19 Ansari M, Dehsara F, Mosalaei A. et al Efficacy of topical alpha ointment (containing natural henna) compared to topical hydrocortisone (1%) in the healing of radiation-induced dermatitis in patients with breast cancer: A randomized controlled clinical trial. Iranian Journal of Medical Sciences 2013; 38 (04) 293-300
• 20 Lesan M, Kamian S, Heidarirad G. et al Topical henna cream in prevention of radiation-induced dermatitis in breast cancer: A randomized double-blind clinical trial. Annals of Oncology, 2020; 31 (Suppl. 06) S1248
• 21 Rafati M, Ghasemi A, Saeedi M. et al Nigella sativa L. for prevention of acute radiation dermatitis in breast cancer: A randomized, double-blind, placebo-controlled, clinical trial. Complementary Therapies in Medicine, 2019: 47-102205
• 22 Zhu W, Zhao H. A randomized, double-blind, placebo-controlled phase 2 trial of epigallocatechin-gallate in the prevention of radiation-induced dermatitis. International Journal of Radiation Oncology Biology Physics 2020; 108 (03) S12
• 23 Togni S, Maramaldi G, Bonetta A. et al Clinical evaluation of safety and efficacy of Boswellia-based cream for prevention of adjuvant radiotherapy skin damage in mammary carcinoma: A randomized placebo controlled trial. European Review for Medical and Pharmacological Sciences 2015; 19 (08) 1338-1344
• 24 Layer K, Layer JP, Glasmacher AR. et al Risk assessment, surveillance, and nonpharmaceutical prevention of acute radiation dermatitis: Results of a multicentric survey among the German-speaking radiation oncology community. Strahlenther Onkol 2023; 199 (10) 891-900
• 25 Zimmermann E, Herber S. Aromatherapie – Begleitung bei Tumorerkrankungen. o. V. 2020
• 26 Yang C, Gong G, Jin E. et al Topical application of honey in the management of chemo/radiotherapy-induced oral mucositis: A systematic review and network meta-analysis. Int J Nurs Stud 2019; 89: 80-87
• 27 Münstedt K, Momm F, Hübner J. Honey in the management of side effects of radiotherapy or radio/chemotherapy-induced oral mucositis. A systematic review. Complement Ther Clin Pract 2019; 34: 145-152
• 28 Yarom N, Hovan A, Bossi P. et al Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines—part 2 : Honey, herbal compounds, saliva stimulants, probi-otics, and miscellaneous agents. Support Care Cancer 2020; 28 (05) 2457-2472
• 29 Tian X, Xu L, Liu X. et al Impact of honey on radiotherapy-induced oral mucositis in patients with head and neck cancer: A systematic review and meta-analysis. Ann Palliat Med 2020; 09 (04) 1431-1441
• 30 An W, Li S, Qin L. Role of honey in preventing radiation-induced oral mucositis: A meta-analysis of randomized controlled trials. Food & Function 2021; 12 (08) 3365
• 31 Zhang L, Tang G, Wei Z. Prophylactic and therapeutic effects of curcumin on treatment-induced oral mucositis in patients with head and neck cancer: A meta-analysis of randomized controlled trials. Nutr Cancer 2021; 73 (05) 740-749
• 32 Dharman S, Maragathavalli G, Shanmugasundaram K. et al A systematic review and meta-analysis on the efficacy of curcumin/turmeric for the prevention and amelioration of radiotherapy/radiochemotherapy induced oral mucositis in head and neck cancer patients. Asian Pac J Cancer Prev 2021; 22 (06) 1671-1684
• 33 Memorial Sloan Klettering Cancer Center. Search about Herbs (o.D.). Im Internet. https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs/search Stand: 31.10.2023
• 34 Dastan F, Ameri A, Dodge S. et al Efficacy and safety of propolis mouthwash in management of radiotherapy induced oral mucositis: A randomized, double blind clinical trial. Rep Pract Oncol Radiother 2020; 25 (06) 969-973
• 35 Hamzah MH, Mohamad I, Musa MY. et al Propolis mouthwash for preventing radiotherapy-induced mucositis in patients with nasopharyngeal carcinoma: A randomized control trial. Med J Malaysia 2022; 77 (04) 462-467
• 36 Eslami H, Pouralibaba F, Falsafi P. et al Efficacy of Hypozalix spray and propolis mouthwash for prevention of chemotherapy-induced oral mucositis in leukemic patients: A double-blind randomized clinical trial. J Dent Res Dent Clin Dent Prospects 2016; 10 (04) 226-233
• 37 Bolouri AJ, Pakfetrat A, Tonkaboni A. et al Preventing and therapeutic effect of propolis in radiotherapy induced mucositis of head and neck cancers: A triple-blind, randomized, placebo-controlled trial. Iran J Cancer Prev 2015; 08 (05) e4019
• 38 Wang C, Wang P, Ouyang H. et al Efficacy of traditional Chinese medicine in treatment and prophylaxis of radiation-induced oral mucositis in patients receiving radiotherapy: A randomized controlled trial. Integr Cancer Ther 2018; 17 (02) 444-450
• 39 Doğan MD, Can G, Meral R. Effectiveness of black mulberry molasses in prevention of radiotherapy-induced oral mucositis: A randomized controlled study in head and neck cancer patients. The Journal of Alternative and Complementary Medicine 2017; 23 (12) 971-979
• 40 Aghamohammadi A, Moslemi D, Akbar J. et al The effectiveness of zataria extract mouthwash for the management of radiation-induced oral mucositis in patients: A randomized placebo-controlled double-blind study. Clin Oral Invest 2018; 22: 2263-2272
• 41 Ebert N, Kensche A, Löck S. et al Results of a randomized controlled phase III trial: Efficacy of polyphenol-containing cystus® tea mouthwash solution for the reduction of mucositis in head and neck cancer patients undergoing external beam radiotherapy. Strahlenther Onkol 2021; 197 (01) 63-73
• 42 Yayla EM, Izgu N, Ozdemir L. et al Sage tea-thyme-peppermint hydrosol oral rinse reduces chemotherapy-induced oral mucositis: A randomized controlled pilot study. Complement Ther Med 2016; 27: 58-64
• 43 Steinmann D, Babadağ Savaş B, Felber S. et al Nursing procedures for the prevention and treatment of mucositis induced by cancer therapies: Clinical practice guideline based on an interdisciplinary consensus process and a systematic literature search. Integr Cancer Ther 2021; 20: 1534735420940412
• 44 Guedes da Silva Lima IC, de Fátima Souto Maior L, Monteiro Gueiros LA. Clinical applicability of natural products for prevention and treatment of oral mucositis: A systematic review and meta-analysis. Clin Oral Investig 2021; 25 (06) 4115-4124
• 45 Bagot J. Krebs und Homöopathie: Natürliche Hilfe bei den häufigsten Nebenwirkungen von Chemo-, Strahlentherapie und Operation. Kandern: Narayana; 2013
• 46 Sahebnasagh A, Ghasemi A, Akbari J. et al Prevention of acute radiation-induced proctitis by aloe vera: A prospective randomized, double-blind, placebo controlled clinical trial in pelvic cancer patients. BMC Complement Med Ther 2020; 20 (01) 146
• 47 Sahebnasagh A, Ghasemi A, Akbari J. et al Successful treatment of acute radiation proctitis with aloe vera: A preliminary randomized controlled clinical trial. J Altern Complement Med 2017; Nov 23 (11) 858-865
• 48 Ghorbanzadeh-Moghaddam A, Gholamrezaei A, Hemati S. Vitamin D deficiency is associated with the severity of radiation-induced proctitis in cancer patients. Int J Radiat Oncol Biol Phys 2015; 92 (03) 613-8
• 49 Dobos G, Kümmel S. Gemeinsam gegen Krebs: Naturheilkunde und Onkologie – zwei Ärzte für eine menschliche Medizin. Hamburg: ZS; 2011
• 50 Muecke R, Schomburg L, Glatzel M. et al Multicenter, phase 3 trial comparing selenium supplementation with observation in gynecologic radiation oncology. Int J Radiat Oncol Biol Phys 2010; 78 (03) 828-835
• 51 Kirste S, Treier M, Wehrle SJ. et al Boswellia serrata acts on cerebral edema in patients irradiated for brain tumors: A prospective, randomized, placebo-controlled, double-blind pilot trial. Cancer, 2011; 117 (16) 3788-3795
• 52 Ziemann J, Lendeckel A, Müller S. et al Herb-drug interactions: A novel algorithm-assisted information system for pharmacokinetic drug interactions with herbal supplements in cancer treatment. Eur J Clin Pharmacol 2019; 75 (09) 1237-1248
• 53 Universität Greifswald. Interaktionsmatrix (o.D.). Im Internet. https://pharmazie.uni-greifswald.de/institut/abteilungen/klinische-pharmazie/forschung/interaktionsmatrix/ Stand: 31.10.2023
• 54 Deutsche Gesellschaft für Radioonkologie. Pressemitteilung: Antioxidantien können die Wirksamkeit der Brustkrebstherapie vermindern (04/2019). Im Internet. https://www.degro.org/antioxidantien-koennen-die-wirksamkeit-der-brustkrebstherapie-vermindern/ Stand: 05.10.2023
• 55 Jung AY, Cai X, Thoene K. et al Antioxidant supplementation and breast cancer prognosis in postmenopausal women undergoing chemotherapy and radiation therapy. The American Journal of Clinical Nutrition 2019; 109 (01) 69-78
• 56 Schoenfeld JD, Alexander MS, Waldron TJ. et al Pharmacological ascorbate as a means of sensitizing cancer cells to radio-chemotherapy while protecting normal tissue. Semin Radiat Oncol 2019; 29 (01) 25-32
• 57 Günes-Bayir A, Kiziltan HS. Palliative Vitamin C application in patients with radiotherapy-resistant bone metastases: A retrospective study. Nutr Cancer 2015; 67 (06) 921-925
• 58 Vollbracht C, Schneider B, Leendert V. et al Intravenous vitamin C administration improves quality of life in breast cancer patients during chemo-/radiotherapy and aftercare: Results of a retrospective, multicentre, epidemiological cohort study in Germany. In Vivo 2011; 25 (06) 983-990
• 59 Park H, Kang J, Choi J. et al The effect of high dose intravenous vitamin C during radiotherapy on breast cancer patients' neutrophil-lymphocyte ratio. J Altern Complement Med 2020; 26 (11) 1039-1046
• 60 Schad F, Steinmann D, Oei SL. et al Evaluation of quality of life in lung cancer patients receiving radiation and Viscum album L.: A real-world data study. Radiat Oncol 2023; 18 (01) 47
• 61 Baek JH, Jeon Y, Han KW. et al Effect of mistletoe extract on tumor response in neoadjuvant chemoradiotherapy for rectal cancer: A cohort study. World J Surg Oncol 2021; 19 (01) 178
• 62 Arbeitsgemeinschaft Gynäkologische Onkologie. Guidelines Breast Version 2023.1D. Im Internet. https://www.ago-online.de/fileadmin/ago-online/downloads/_leitlinien/kommission_mamma/2023/Einzeldateien/AGO_2023D_23_Komplementaermedizin.pdf Stand: 05.10.2023
• 63 Schnur JB, David D, Kangas M. et al A randomized trial of a cognitive-behavioral therapy and hypnosis intervention on positive and negative affect during breast cancer radiotherapy. J Clin Psychol 2009; 65 (04) 443-455
• 64 Montgomery GH, Sucala M, Dillon MJ. et al Cognitive-behavioral therapy plus hypnosis for distress during breast radiotherapy: A randomized trial. Am J Clin Hyp 2017; 60 (02) 109-122
• 65 Deutsche Krebsgesellschaft, Deutsche Krebshilf, AWMF. S3-Leitlinie Komplementärmedizin in der Behandlung von onkologischen PatientInnen, Langversion 1.1. AWMF Registernummer: 032/055OL (09/2021). Im Internet. https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Komplement%C3%A4r/Version_1/LL_Komplement%C3%A4r_Langversion_1.1.pdf Stand: 05.10.2023
• 66 Malik Y, Sen J, Mishra A. et al Effects of physical exercise on rehabilitation of cancer patients undergoing radiotherapy. J Cancer Res Ther 2023; 19 (03) 585-589
• 67 Song J, Wu Z, Fang Y. et al Effects of multimodal exercise on health-related physical fitness and quality of life in patients with nasopharyngeal carcinoma during radiotherapy. Pain Manag Nurs 2023; 15: 1524 9042(23)00092-9. DOI: 10.1016/j.pmn.2023.04.007
• 68 Mavropalias G, Cormie P, Peddle-McIntyre CJ. et al The effects of home-based exercise therapy for breast cancer-related fatigue induced by radical radiotherapy. Breast Cancer 2022; 30 (01) 139-150
• 69 Zhou Z, Luo Y, Pang L. et al Effect of the hospital-community-family (HCF) nutritional management on patients with esophageal and head and neck cancers undergoing radiotherapy: A randomized control trial. Transl Cancer Res 2023; 12 (02) 375-386
• 70 Micke O, Büntzel J. Nutrition in the context of radiotherapy. Der Onkologe 2021; 27: 139-147
• 71 Langius JA, Zandbergen MC, Eerenstein SE. et al Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: A systematic review. Clin Nutr 2013; 32 (05) 671-678