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:
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.
Vitamin Depot Online.com 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.
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
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)
All-trans retinoic acid (ATRA) has been shown to exacerbate radiation nephropathy.
Beta-Carotene
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.
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
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.
Statin drugs (such as lovastatin, simvastatin, and pravastatin) are known to decrease CoQ10 levels.
Curcumin
Do not take curcumin if you have a bile duct obstruction or a
history of gallstones. Taking curcumin can stimulate bile production.
Consult your doctor before taking curcumin if you have
gastroesophageal reflux disease (GERD) or a history of peptic ulcer
disease.
Consult your doctor before taking curcumin if you take
warfarin or antiplatelet drugs. Curcumin can have antithrombotic
activity.
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
Consult your doctor before taking EPA/DHA if you take warfarin
(Coumadin). Taking EPA/DHA with warfarin may increase the risk of
bleeding.
Discontinue using EPA/DHA 2 weeks before any surgical procedure.
Ginseng
Consult your doctor before taking ginseng if you have high blood pressure. Overuse of ginseng can increase blood pressure.
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.
Consult your doctor before taking ginseng if you have
diabetes. Taking ginseng can cause an extreme drop in your blood
glucose level.
Ginseng can cause breast pain, vaginal bleeding after menopause, insomnia, headaches, and nosebleeds.
Green Tea
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.
Discontinue using green tea extract 2 weeks before any surgical procedure. Green tea extract may decrease platelet aggregation.
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
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.
Consult your doctor before taking L-arginine if you have kidney failure or liver failure.
Consult your doctor before taking L-arginine if you have herpes simplex. L-arginine may increase the possibility of recurrence.
L-Glutamine
Consult your doctor before taking L-glutamine if you have kidney failure or liver failure.
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
Do not take melatonin if you are depressed.
Do not take high doses of melatonin if you are trying to
conceive. High doses of melatonin have been shown to inhibit ovulation.
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
Consult your doctor before taking milk thistle with tranquilizers
such as Haldol, Serentil, Stelazine, and Thorazine. Milk thistle
combats the effect of tranquilizers.
Do not combine milk thistle with the blood pressure medication Regitine. Milk thistle combats the effect of Regitine.
NAC
NAC clearance is reduced in people who have chronic liver disease.
Do not take NAC if you have a history of kidney stones (particularly cystine stones).
NAC can produce a false-positive result in the nitroprusside test for ketone bodies used to detect diabetes.
Consult your doctor before taking NAC if you have a history of
peptic ulcer disease. Mucolytic agents may disrupt the gastric mucosal
barrier.
NAC can cause headache (especially when used along with nitrates) and gastrointestinal symptoms such as nausea and diarrhea.
Selenium
High doses of selenium (1000 micrograms or more daily) for prolonged periods may cause adverse reactions.
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.
Selenium can cause rash, breath that smells like garlic, fatigue, irritability, and nausea and vomiting.
Soy
Do not take soy if you have an estrogen receptor-positive tumor.
Soy has been associated with hypothyroidism.
Vitamin A
Do not take vitamin A if you have hypervitaminosis A.
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.
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
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.
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
Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
Consult your doctor before taking vitamin E if you have a
history of any bleeding disorder such as peptic ulcers, hemorrhagic
stroke, or hemophilia.
Discontinue using vitamin E 1 month before any surgical procedure.
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 Vitamin Depot Online.com/National Diagnostics, Inc. and may be
ordered by telephoning 1-800-544-4440 or by ordering online at http://www.lef.org/bloodtest/.
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