Vitamins C and E fight side effect of pelvic radiation for cancer

Previous study found no reduction in effect against cancer cells

March 20, 2001. A small study of 20 men and women suffering from chronic radiation proctitis has shown that daily vitamins E and C substantially reduced or eliminated their symptoms. Proctitis has traditionally been treated with anti-inflammatory agents, without satisfactory results.

Radiation therapy is one treatment option for men with localized prostate cancer and for women with cervix and endometrial cancers. Radiation therapy is effective in killing cancer cells. But the therapy damages also any normal, non-cancerous cells within range of the beam.

Complications are especially common in patients who are treated with older equipment. New, 3D conformal, Intensity Modulated or Proton beam equipment (available in the USA and some other countries) targets the beam much more precisely. Higher doses can be given to tumor with less damage to bladder and rectum.

Most patients take vitamins - does this interfere with killing cancer cells?

Even under the best conditions patients want to do everything possible to protect themselves from radiotherapy side effects. Many patients who undergo cancer treatments take vitamins and supplements. Until recently, oncologists seldom asked patients about this.

Doctors still have almost no evidence on which to advice cancer patients about common supplements. But a previous, laboratory study by radiation oncologists at Rush-Presbyterian-St. Luke's Medical Center found that "Cancer patients who take vitamin E are probably not hindering the desired effects of radiation."

Dr. Keith Bruninga, gastroenterologist at Rush-Presbyterian-St. Luke's has now looked to see how much protection vitamins E and C actually offer patients irradiated for prostate, cervical or endometrial cancer. The effect of the vitamins in the treatment of chronic radiation proctitis had not been studied before, Dr. Bruninga said.

In normal bowel and rectal tissues exposed to radiation for cancer in the pelvis, oxygen radicals form and patients experience the symptoms of proctitis, he said. The condition starts with swollen, inflamed tissue, and it increases with dose. The symptoms, which may include diarrhea, pain, bleeding and incontinence, usually clear up within a few weeks of the last radiation treatment.

However, the symptoms do not clear up in 10 - 20 percent of patients. Some patients develop symptoms months or years after the initial radiation exposure.

“Our study showed that we can harness the potent antioxidant properties of the vitamins to repair cell damage and bring relief to many people who suffer from the persistent, lifestyle-altering symptoms of chronic radiation proctitis,” Dr. Bruninga says in a paper published in the April issue of The American Journal of Gastroenterology.

Oxygen free radicals form from cells that have been injured. Oxygen free radicals are highly active molecules that react with cells by changing or damaging their structure. The formation of the oxygen free radicals increases the amount of injury to the cells and results in a chronic condition as blood flow to the cells is decreased.

Vitamin E is a potent antioxidant that can react with damaging oxygen free radicals. Vitamin C in combination with E increases the effects of vitamin E. The researchers believe that the antioxidant treatment regimen using the vitamins counteracts and can prevent oxygen free radical injury and increase blood flow to the injured cells of patients with chronic radiation proctitis.

Patients in the study, ten men and ten women with chronic radiation proctitis, took one 400 IU vitamin E tablet along with one 500mg vitamin C tablet three times each day for eight consecutive weeks. Patients purchased the vitamins themselves at the store of their choice.

Each patient in the study rated their symptoms in terms of severity and frequency before and after treatment with the vitamins using a questionnaire developed by the researchers.

The impact of the symptoms on the lifestyle of the patients was also assessed using a questionnaire. Ten of the patients were assessed again after one year to determine if their initial responses were sustained.

The assessments showed a significant improvement in bleeding, diarrhea and urgency after taking the vitamins. Patients with rectal pain did not improve significantly. Thirteen patients reported an improvement in their lifestyle including seven whom reported a complete return to normal.

All of the ten patients who were assessed after one year reported a sustained improvement in their symptoms while continuing to take the vitamins.

The Rush physicians believe that the actual incidence of the ailment is greater than the estimated 10 – 20 percent of radiation patients. They feel that many patients, relieved and grateful that their cancers are remission, are embarrassed to tell their physicians about the symptoms of radiation proctitis.

Currently, the Rush physicians are seeking additional individuals with chronic radiation proctitis to conduct a larger, double-blinded study of the effectiveness of antioxidants in the treatment of the illness.

People who believe they may have radiation proctitis can call 312-942-5861 for more information.

“If our continued research shows that the antioxidant regimen is successful in treatment of this illness, we plan to investigate its use to prevent chronic radiation proctitis,” said Dr. Bruninga.

Results of the study appear in April issue of The American Journal of Gastroenterology.

Rush Presbyterian St. Luke's Medical Center

Background Links

Vitamin E does not protect cancer cells against radiation (15 January 2000, posted 20 march 2001) PSA Rising

Int J Cancer 2000 Apr 15;86(2):276-80 Anti-oxidant vitamins reduce normal tissue toxicity induced by radio-immunotherapy. Blumenthal RD, Lew W, Reising A, Soyne D, Osorio L, Ying Z, Goldenberg DM Garden State Cancer Center, Belleville, NJ 07109, USA.

Jpn Heart J 1996 May;37(3):353-9 Cardioprotection in patients undergoing chemo- and/or radiotherapy for neoplastic disease. A pilot study. Wagdi P, Fluri M, Aeschbacher B, Fikrle A, Meier B Department of Cardiology, University Hospital, Bern, Switzerland.

Free Radic Biol Med 1999 Apr;26(7-8):887-91 Modification of gene expression by dietary antioxidants in radiation-induced apoptosis of mice splenocytes. Ushakova T, Melkonyan H, Nikonova L, Afanasyev V, Gaziev AI, Mudrik N, Bradbury R, Gogvadze V Institute of Theoretical and Experimental Biophysics, Pushchino, Russia. This abstract says, mice that received 45 days of Vitamin E and C before radiation showed inhibition of TRPM-2 (a marker for programmed cell death) and increase of bcl-2 (which has been shown to prevent apoptosis). "The antioxidant administration decreased the radiation-induced apoptosis and delayed internucleosomal fragmentation of DNA." If so, this would indicate that the vitamins do interfere with radiotherapy.

Current treatment options in gastroenterology. 1999 Feb;2(1):20-26 Radiation-induced Proctitis. Ajlouni M Henry Ford Health Sciences Center, Department of Radiation Oncology--M2, 2799 West Grand Boulevard, Detroit, MI 48202.

Lancet 2000 Oct 7;356(9237):1232-5 Topical butyrate for acute radiation proctitis: randomised, crossover trial. Vernia P, Fracasso PL, Casale V, Villotti G, Marcheggiano A, Stigliano V, Pinnaro P, Bagnardi V, Caprilli R Cattedra di Gastroenterologia 1, Universita La Sapienza, Roma, Italy.

Conn Med 2000 Sep;64(9):523-6 Prostate brachytherapy--the community hospital experience. Percarpio B, Sanchez P, Kraus P, Corujo M, D'Addario P, Wolk J Department of Radiation Oncology, St. Mary's Hospital, Waterbury, USA. "The main side effects of brachytherapy included nocturia, daytime urinary frequency, dysuria, and proctitis. These side effects were transient and decreased to less than 10% by 12 to 24 months following implantation."

Cancer 2000 Feb 1;88(3):615-9 Use of complementary health practices by prostate carcinoma patients undergoing radiation therapy. Kao GD, Devine P Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. "There has been increasing interest in complementary health practices among patients, popular media, and even institutional health care providers. However, there is still surprisingly little information on the use of alternative medicine by patients undergoing treatment for prostate carcinoma... Patients undergoing radiation therapy for prostate carcinoma frequently rely on complementary health practices not prescribed by their treating physicians. Patients who do so tend to have higher education and income levels and continue their complementary practices during the conventional treatment. As the health implications of these practices are unclear, further research is clearly needed."

Acta Oncol 2000;39(2):173-80 Health-related quality of life and occurrence of intestinal side effects after pelvic radiotherapy--evaluation of long-term effects of diagnosis and treatment. Bye A, Trope C, Loge JH, Hjermstad M, Kaasa S Department of Gynaecology, Norwegian Radium Hospital, Oslo.

Eating to Beat Fatigue from Radiotherapy and Chemotherapy - U of Michigan comprehensive Cancer Center

Nutrition Advice for Cancer Patients (CanYA, Australia)

3-D Radiotherapy Helps To Combat Prostate Cancer The Independent, UK, March 30, 2000

Nutrition and radiotherapy Author: Sue Holmes, PhD, BSc.