Cancer Radiation Therapy-4

Second cancers. Although long-term survival following treatment for primary cancer has increased significantly in recent years, one of the most serious side effects of cancer treatment is the induction of a new tumor (Fossa SD 2004). Second cancers account for up to 10 percent of all cancer diagnoses (Bhatia N et al. 2001). A study of patients with primary cancer in adulthood showed a 1.3-fold increased risk of developing a second cancer from radiation therapy (Curtis RE et al. 1985).

The increased risk of second malignancy usually, though not exclusively, occurs in the radiation field. The risk is dose dependent and appears to be higher when radiation exposure occurs at a younger age. The latency period is long; for example, secondary leukemia usually develops 1 to 10 years after radiotherapy, whereas an interval of more than 6 years and often decades is usual for solid tumors (Somerville HM 2003).

A large number of studies have evaluated the risk of solid tumors following radiotherapy for Hodgkin's disease (Bhatia S et al. 2002; Ng AK et al. 2002). Survivors of Hodgkin's disease appear to face a 2 percent to 4 percent greater risk of second malignancy per person per year (Somerville HM 2003).

Overall, it should be noted that the risk of second cancers is generally low, and the benefit of radiation therapy for patient survival outweighs the risk of developing a second tumor (Travis LB 2002).

Sexual dysfunction. Erectile dysfunction occurs in 7 percent to 84 percent of prostate cancer patients treated with radiation, even with the development of advanced radiation techniques such as proton beam therapy and 3D-CRT, which spare more normal tissue (Incrocci L et al. 2002).

Sixty patients presenting with erectile dysfunction 39 months after radiation treatment for prostate cancer were enrolled in a 12-week study to determine the efficacy of sildenafil citrate (Viagra®). Patients reported a significant increase in erectile function, with only mild side effects, at a dose of 100 mg taken one hour before sexual activity (Incrocci L et al. 2003).

Vaginal stenosis (narrowing) occurs in up to 88 percent of women undergoing brachytherapy for gynecological cancers (Hartman P et al. 1972). The time of onset of stenosis varies widely, from six weeks to several years after treatment (Lancaster L 2004). Stenosis leads to thinning of the vaginal mucosa, scarring, and eventually scar tissue (Abitbol MM et al. 1974). This results in shortening and narrowing of the vagina, leading to dyspareunia (pain during intercourse) and sexual dysfunction (Bergmark K et al. 1999).

Several treatment options have been suggested to manage radiation injuries of the vulva and vagina (Fraunholz IB et al. 1998). Proper personal hygiene is crucially important in managing acute vulva skin reactions (Grigsby PW et al. 1995). Dilatation of the vagina either through the use of vaginal dilators or regular sexual intercourse should be performed to help prevent stenosis. Use of dilators should start before or immediately on completion of treatment and continue indefinitely (Lancaster L 2004).

A Cancer “cure” that may be lethal:

Radiation Therapy Increases stroke risk
Although head and neck cancer is the fifth most common cancer, most people are not familiar with this type of cancer (Vermorken JB 2005). The mortality rate for those diagnosed with head and neck cancer (which does not include brain tumors) is high (Fortin A et al. 2001).

Radiation therapy is an important part of treating many different head and neck tumors, and is often used after surgery (Hunter SE et al. 2003). Lethal radiation necrosis to the brain is one potential side effect (Eisbruch A et al. 1999).

Another danger of radiation therapy to the head is increased risk of stroke (Abayomi OK 2004). A study of head and neck cancer patients who received radiation therapy found that stroke rates were five times greater than expected (Dorresteijn LD et al. 2002) This elevated stroke risk was found many years after administration of radiation. The average time between radiation treatment and stroke was 10.9 years, but the increased risk of stroke persisted for 15 years after radiation therapy.

For cancer patients treated with radiation therapy who later die from a stroke, the official cause of death is stroke, even though the cancer radiation therapy probably caused the stroke. This is an example of how cancer cure statistics are misleading. The government contends that radiation therapy is curing cancer patients, yet long-term radiation side effects cause many deaths that are not attributed to cancer.

The government claims that more cancer victims are living beyond five years, but ignores the fact that the toxic therapies often used to eradicate cancer can themselves cause premature death (Lassen UN et al. 1999).

(The authors of this study do not recommend that head and neck cancer patients refuse radiation therapy, as it often adds years to their lives. Patients who have received radiation therapy to the head or neck should take extra precautions to reduce their risk of stroke.)


Importance of Diet During Treatment
Radiation therapy can change nutritional needs and alter the body's absorption and use of food (Brown JK et al. 2003). Common cancer symptoms and toxic effects of radiation treatment include fatigue, anorexia, weight change, nausea, vomiting, pain, and changes in taste and bowel habits (Brown JK et al. 2003).

Some researchers have suggested a low-fat (10 percent of calories from fat) and high-fiber (25 to 30 grams from vegetables and fruits) diet be consumed during and after cancer treatment (Boyd NF et al. 1997). Such a diet can interfere with tumor growth by reducing tumor-stimulating signals (Rao CV et al. 1993). Lifestyle changes that should be encouraged include quitting smoking, reducing consumption of caffeine and alcoholic beverages, exercising daily, and reducing stress levels (Prasad KN et al. 1999).

Nutritional Intervention During Radiotherapy
Dietary changes such as the use of low-residue and elemental diets are suggested for those patients undergoing pelvic radiotherapy, as they place less strain on the digestive system than do conventional diets (McGough C et al. 2004). Several studies have investigated dietary interventions in those undergoing pelvic radiotherapy (McGough C et al. 2004):

Dietary fat regimens, using 20 to 40 grams of fat per day, significantly reduced diarrhea and the frequency of bowel motions (Bye A et al. 1992). There was no difference in stool frequency or use of anti-diarrhea medication through dietary lactose restriction (Stryker JA et al. 1986).

Probiotics. The use of probiotics has a positive effect on gastrointestinal toxicity (Delia P et al. 2002). Probiotics refer to "friendly" bacteria that contribute to the health of the gastrointestinal tract. Twenty-four female patients suffering from gynecological malignancies all received dietary counseling recommending a low-fat, low-residue diet during their radiotherapy. Half the patients also received 150 ml of a fermented milk product supplying at least 2x109 Lactobacillus acidophilus bacteria daily and 6.5 percent lactulose as substrate for the bacteria. The results indicated significantly reduced diarrhea in the group receiving probiotics, though with increased flatulence (Salminen E et al. 1988).

Elemental diets are liquid diets consisting of essential amino acids, glucose, vitamins, and necessary minerals (Bounous G 1983). Nutrients are usually in digested form so they do not stress the digestive system. The use of an elemental diet during radiotherapy (Brown MS et al. 1980) resulted in a statistically significant decrease in the incidence and severity of acute diarrhea (Craighead PS et al. 1998; McArdle AH et al. 1986). In one favorable study, the elemental diet began three days before radiation therapy and was continued until completion. Patients were also placed on a modified diet that recommended low fiber, moderate fat intake, and adequate proteins and carbohydrates (Craighead PS et al. 1998).

Micronutrient supplementation in patients with proctitis (inflammation of the rectum) has been previously outlined (Levitsky J et al. 2003). A study of 19 patients treated with pelvic radiotherapy for more than six months examined whether vitamin A could reduce the resulting radiation-induced proctitis (Ehrenpreis ED et al. 2005). Ten patients received 10,000 IU of oral vitamin A for 90 days, after which seven reported a significant improvement in symptoms, compared to only two of nine placebo-treated patients who reported improvement.

In a pilot study, 20 patients with chronic radiation proctitis due to previous pelvic irradiation took vitamin E (400 IU, three times daily) and vitamin C (500 mg, three times daily) supplements for up to one year. Significant improvements were reported in the side effects of bleeding and diarrhea, but not pain (Kennedy M et al. 2001). However, in another study in which the same doses were administered, all symptoms subsided following 6 to 12 weeks of treatment (El Younis C et al. 2003).


For More Information
The complications related to radiation can be acute (such as low blood cell counts) and chronic (gastrointestinal, pulmonary, neuropathic, and cardiac). For more information on some of the topics outlined in this chapter, please consult the following chapters:

1)Blood Disorders

2)Catabolic Wasting

3)Complementary Adjuvant Cancer Therapies

4)Erectile Dysfunction

5)Neuropathy.

For general information on all aspects of radiation therapy, please visit: http://www.cancerlinksusa.com/radiation.htm.

Proton Therapy Centers in North America

The Loma Linda University Medical Center (LLUMC), California. LLUMC sponsors Prolit, a proton therapy literature database.

Northeast Proton Therapy Center at Massachusetts General Hospital in Boston.

Particle Therapy Co-operative Group (PTCOG) and the PTCOG publication Particles.

Midwest Proton Radiotherapy Institute, Bloomington, Indiana.

Proton Radiation Therapy at TRIUMF Vancouver, Canada. Pion Therapy is also available.

UC-Davis, California. The Berkeley Eye Program.


Life Extension Foundation Recommendations

For optimal results, the majority of these supplements or dietary changes should be introduced before starting radiation treatment. Refer to the text for a more detailed explanation of the dose and duration of the specific supplements.

1)R-lipoic acid—300 milligrams (mg) daily

2)Beta-carotene—25,000 international units (IU) or 75 mg daily

3)Coenzyme Q10—100 to 400 mg daily

4)Curcumin—up to 3.2 grams daily

5)Panax ginseng (Siberian)—200 to 1000 mg daily

6)Green tea extract—725 mg three times daily

7)Hydrolytic enzymes— papain (100 mg), trypsin (40 mg), and chymotrypsin (40 mg): three days before radiation therapy and continuing until five days after completion of treatment

8)Kamillosan—10 drops in 1 ounce of water, three times daily (http://www.smallflower.com/).

9)L-arginine—900 mg daily

10)L-glutamine—20 to 40 grams administered before starting radiation therapy

11)Melatonin—up to 20 mg daily

12)Multivitamin/multimineral supplement (without copper)

13)N-acetylcysteine—200 to 600 mg daily

14)Omega-3 fatty acids—1 to 2 grams (g) daily

15)Probiotics—2x109 Lactobacillus acidophilus daily

16)Pure honey—20 milliliters (ml), 15 minutes before, 15 minutes after, and 6 hours after radiotherapy

17)Selenium—200 to 1000 micrograms (mcg) daily

18)Silymarin—150 to 600 mg daily

19)Soy extract containing 50 mg of isoflavones—twice daily

20)Taurine—1000 mg daily

21)Vitamin A— 8000 to 30,000 IU daily

22)Vitamin C— 500 mg three times daily

23)Vitamin E—400 to 1200 IU daily

24)Whey protein isolate—20 grams daily.


Cancer Radiation Therapy Safety Caveats

An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:

All-trans retinoic acid (ATRA)

a)All-trans retinoic acid (ATRA) has been shown to exacerbate radiation nephropathy.

Beta-Carotene

1)Do not take beta-carotene if you smoke. Daily intake of 20 milligrams or more has been associated with a higher incidence of lung cancer in smokers.

2)Taking 30 milligrams or more daily for prolonged periods can cause carotenoderma, a yellowish skin discoloration (carotenoderma can be distinguished from jaundice because the whites of the eyes are not discolored in carotenoderma).

Coenzyme Q10

1)See your doctor and monitor your blood glucose level frequently if you take CoQ10 and have diabetes. Several clinical reports suggest that taking CoQ10 may improve glycemic control and the function of beta cells in people who have type 2 diabetes.

2)Statin drugs (such as lovastatin, simvastatin, and pravastatin) are known to decrease CoQ10 levels.

Curcumin

1)Do not take curcumin if you have a bile duct obstruction or a history of gallstones. Taking curcumin can stimulate bile production.

2)Consult your doctor before taking curcumin if you have gastroesophageal reflux disease (GERD) or a history of peptic ulcer disease.

3)Consult your doctor before taking curcumin if you take warfarin or antiplatelet drugs. Curcumin can have antithrombotic activity.

4)Always take curcumin with food. Curcumin may cause gastric irritation, ulceration, gastritis, and peptic ulcer disease if taken on an empty stomach.
Curcumin can cause gastrointestinal symptoms such as nausea and diarrhea.

EPA/DHA

1)Consult your doctor before taking EPA/DHA if you take warfarin (Coumadin). Taking
2)EPA/DHA with warfarin may increase the risk of bleeding.

3)Discontinue using EPA/DHA 2 weeks before any surgical procedure.

Ginseng

1)Consult your doctor before taking ginseng if you have high blood pressure. Overuse of ginseng can increase blood pressure.

2)Consult your doctor before taking ginseng if you take nonsteroidal anti-inflammatory drugs (NSAIDs) and/or warfarin (Coumadin). Taking NSAIDs or warfarin with ginseng can increase the risk of bleeding.

3)Consult your doctor before taking ginseng if you have diabetes. Taking ginseng can cause an extreme drop in your blood glucose level.

4)Ginseng can cause breast pain, vaginal bleeding after menopause, insomnia, headaches, and nosebleeds.

Green Tea

1)Consult your doctor before taking green tea extract if you take aspirin or warfarin (Coumadin). Taking green tea extract and aspirin or warfarin can increase the risk of bleeding.

2)Discontinue using green tea extract 2 weeks before any surgical procedure. Green tea extract may decrease platelet aggregation.

3)Green tea extract contains caffeine, which may produce a variety of symptoms including restlessness, nausea, headache, muscle tension, sleep disturbances, and rapid heartbeat.

L-Arginine

1)Do not take L-arginine if you have the rare genetic disorder argininemia.
Consult your doctor before taking L-arginine if you have cancer. L-arginine can stimulate growth hormone.

2)Consult your doctor before taking L-arginine if you have kidney failure or liver failure.

3)Consult your doctor before taking L-arginine if you have herpes simplex. L-arginine may increase the possibility of recurrence.

L-Glutamine

1)Consult your doctor before taking L-glutamine if you have kidney failure or liver failure.

2)L-glutamine can cause gastrointestinal symptoms such as nausea and diarrhea.

NOTE: Glutamine and Arginine

Many clinical trials utilizing glutamine and arginine resulted in beneficial outcomes for cancer patients, and four clinical trials are ongoing. However, some doctors are concerned that supplemental arginine and glutamine may promote tumor cell proliferation in patients, though this has not been clinically observed and is based solely on laboratory studies.

Lipoic Acid

Consult your doctor before taking lipoic acid if you have diabetes and glucose intolerance. Monitor your blood glucose level frequently. Lipoic acid may lower blood glucose levels.

Melatonin

1)Do not take melatonin if you are depressed.

2)Do not take high doses of melatonin if you are trying to conceive. High doses of melatonin have been shown to inhibit ovulation.

3)Melatonin can cause morning grogginess, a feeling of having a hangover or a “heavy head,” or gastrointestinal symptoms such as nausea and diarrhea.

Milk Thistle

1)Consult your doctor before taking milk thistle with tranquilizers such as Haldol, Serentil, Stelazine, and Thorazine. Milk thistle combats the effect of tranquilizers.

2)Do not combine milk thistle with the blood pressure medication Regitine. Milk thistle combats the effect of Regitine.

NAC

1)NAC clearance is reduced in people who have chronic liver disease.

2)Do not take NAC if you have a history of kidney stones (particularly cystine stones).

3)NAC can produce a false-positive result in the nitroprusside test for ketone bodies used to detect diabetes.

4)Consult your doctor before taking NAC if you have a history of peptic ulcer disease. Mucolytic agents may disrupt the gastric mucosal barrier.

5)NAC can cause headache (especially when used along with nitrates) and gastrointestinal symptoms such as nausea and diarrhea.

Selenium

1)High doses of selenium (1000 micrograms or more daily) for prolonged periods may cause adverse reactions.

2)High doses of selenium taken for prolonged periods may cause chronic selenium poisoning. Symptoms include loss of hair and nails or brittle hair and nails.

3)Selenium can cause rash, breath that smells like garlic, fatigue, irritability, and nausea and vomiting.

Soy

1)Do not take soy if you have an estrogen receptor-positive tumor.

2)Soy has been associated with hypothyroidism.

Vitamin A

1)Do not take vitamin A if you have hypervitaminosis A.

2)Do not take vitamin A if you take retinoids or retinoid analogues (such as acitretin, all-trans-retinoic acid, bexarotene, etretinate, and isotretinoin). Vitamin A can add to the toxicity of these drugs.

3)Do not take large amounts of vitamin A. Taking large amounts of vitamin A may cause acute or chronic toxicity. Early signs and symptoms of chronic toxicity include dry, rough skin; cracked lips; sparse, coarse hair; and loss of hair from the eyebrows. Later signs and symptoms of toxicity include irritability, headache, pseudotumor cerebri (benign intracranial hypertension), elevated serum liver enzymes, reversible noncirrhotic portal high blood pressure, fibrosis and cirrhosis of the liver, and death from liver failure.

Vitamin C

1)Do not take vitamin C if you have a history of kidney stones or of kidney insufficiency (defined as having a serum creatine level greater than 2 milligrams per deciliter and/or a creatinine clearance less than 30 milliliters per minute.

2)Consult your doctor before taking large amounts of vitamin C if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD) deficiency. You can experience iron overload if you have one of these conditions and use large amounts of vitamin C.

Vitamin E

1)Consult your doctor before taking vitamin E if you take warfarin (Coumadin).

2)Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.

3)Consult your doctor before taking vitamin E if you have a history of any bleeding disorder such as peptic ulcers, hemorrhagic stroke, or hemophilia.

4)Discontinue using vitamin E 1 month before any surgical procedure.

For more information see the Safety Appendix


Blood Test Availability
Cancer cell markers (tumor antigen profile) can be determined via Genzyme Genetics (http://www.genzymeimpath.com/lymphoma_leukemia.html) and may be ordered by a physician by telephoning 1-800-966-4440.

Tests for angiogenesis markers (e.g., VEGF) are available at UCLA’s Jonsson Comprehensive Cancer Center (http://www.cancer.mednet.ucla.edu/).

Hemoglobin levels (part of a Chemistry Panel/Complete Blood Count) may be tested via Life Extension/National Diagnostics, Inc. and may be ordered on line