1. Susman, Ed

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Radiation-induced oral side effects can be ameliorated with the topical application of aloe vera before treatment, researchers suggested at the first European Society of Medical Oncology Asia Cancer Conference.

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In a study of patients undergoing radiation treatment for head and neck cancer, the incidence of patients complaining of dry mouth was reduced from 90 percent in controls (45 of 50 patients) to 33 percent of 100 patients treated with aloe vera, reported Jitendra Acharya, BDS, a senior demonstrator in the Department of Dentistry at Sardar Patel Medical College in Bikaner, Rajasthan, India (Abstract 324P).


Noteworthy Findings

Acharya also stated that in the study:


* Burning sensation in the mouth was reported by 80 percent of the controls, but just 39 percent of the patients pre-treated with aloe vera;


* Altered taste sensations was experienced by 84 percent of the controls, but just 28 percent of the patients on aloe vera; and


* Difficulty with mouth opening was experienced by 46 percent of controls and by 27 percent of the patients on aloe vera.



"We had very good results using aloe vera to prevent oral cavity sores in these patients undergoing radiation treatment," Acharya told OT at his poster presentation. Aloe vera is very easy to obtain in India, he noted.


"The oral cavity is highly susceptible to direct and indirect toxic effects of ionizing radiation in cancer patients," he continued. "New treatment modalities to prevent cancer therapy-induced complications, especially xerostomia and oral fibrosis-are needed.

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"Oral complications from radiation to the head and neck can compromise patients' health and quality of life. Recently, herbal medicine have been used to treat radiation induced xerostomia and oral fibrosis," he said.


"When severe oral morbidity occurs, the patient may no longer be able to continue cancer treatment, and therapy is then usually discontinued. These dosing disruptions due to oral complications can thus directly affect patient survivorship."


Hence, he and his colleagues tested aloe vera as a possible treatment to prevent these complications of treatment.


Study Details

The patients in his study included men and women ages 20 to 50 years who were planned to undergo radiation therapy for head and neck cancer. Patients were excluded if they had restricted mouth opening. The aloe vera experimental group received a topical application at the target area and oral mucosa before radiotherapy. After radiotherapy, the experimental group completed the same oral screening and questionnaire as the irradiated control group.


The oral screening included an examination of the oral cavity, assessment of the mouth opening, consistency of saliva, and measurement of oral discomfort using a visual analog scale. The questionnaire asked about dryness of mouth, burning sensation, altered taste sensation, oral discomfort, and difficulty swallowing.


Every Little Bit Helps

In commenting on the study, Kenneth Niermann, MD, Assistant Professor of Radiation Oncology at Vanderbilt-Ingram Cancer Center, said the results of the small Indian trial support his anecdotal experience in encouraging his patients undergoing head and neck radiation to use aloe water products as possible protection from radiation-induced injury.


"Overall, aloe vera seems to be a safe substance," Niermann told OT. He said that people might want to test aloe water or gel for allergic type reactions, noting that none of the patients who use aloe water have reported such reactions. "It is always a good thing to monitor this treatment to make sure there are no reactions," he said.


"Radiation to the throat and neck are among the most difficult types of treatments to go through when we offer radiation therapy," Niermann said. "One of the hardest things I ask my patients to do is to go through head and neck radiation, so if you can find anything that helps, even if it only helps a little bit, it is quite meaningful. Anything that can help with the acute and the long-term side effects of radiation or head and neck cancer radiation is really significant."


Aloe Vera's History

Aloe vera has been used for centuries for its health, beauty, medicinal, and skin care properties, Acharya said.


"About 2,000 years ago medical scientists regarded aloe vera as the universal panacea," he said. "The Egyptians called aloe 'the plant of immortals.' It has been used for various purposes in dermatology. Egyptian queens Nefertiti and Cleopatra used it as part of their regular beauty regimes. Alexander the Great and Christopher Columbus used it to treat soldiers' wounds."


He and his colleagues decided to use aloe vera gel with patients undergoing head and neck radiation.


"There is no established efficient treatment for radiation-induced fibrosis that either stabilizes or gradually worsens with acute inflammatory periods," Acharya explained. "Several drugs, including corticosteroids and non-steroidal anti-inflammatory agents, hemorheologic, and vasodilator drugs zinc and interferon, have proven to be effective when administered prophylactically or during early stages of fibrosis.


"A combination of pentoxifylline and tocopherol has proven to be effective in reversing radiation-induced fibronecrosis," he said. "While supplementation with high doses of alpha tocopherol and beta-carotene may reduce the severity of adverse effects induced by radiation therapy, high doses of such antioxidants as adjuvant therapy might also reduce the efficacy of radiation treatment."


Acharya suggests the reason why aloe vera is helpful in his head and neck radiation patients may be due to its chemical composition; aloe vera includes 20 of 22 body-required amino acids. Aloe vera also provides antibacterials, enzymes, hormones, and minerals essential for healthy body functions. It is also known to have anti-inflammatory and anti-oxidant properties and can improve wound healing.