New options offer hope to prevent burns from breast cancer radiation treatment

   Though radiation treatment as an alternative to mastectomy is a popular choice, a high percentage –up to 80% or more – will experience some degree of skin burns, known as radiodermatitis. (This figure includes treatments for recurrent cancer as well.) According to studies, around 10% of women will experience what are known as “grade 3 lesions” which are open sores that are slow to heal. While there are other significant side-effects to radiation, radiodermatitis can be so severe that patients sometimes drop out of treatment. Clearly something is needed, and a skin cream containing a botanical antioxidant called silymarin seems to be effective in a preliminary study.
   The idea of antioxidants is not completely new for prevention and treatment of radiodermatitis, but there has been surprisingly little research on the subject. One big clue came from a study done in Italy in 2009, which found (to the surprise of many) that women who drank red wine regularly had significantly less radiodermatitis. In a cohort of nearly 350 women receiving radiation treatment for breast cancer, 38% of nondrinkers had skin effects of grade 2 or more, compared to 13% in women having a daily glass of wine. The protective effect dissipates with higher levels of drinking, but the implication for the benefits of antioxidants such as those in wine were clear. Previously available treatment consisted of expensive medications such as amifostine, which has its own potential toxicity.
   Wine’s antioxidants belong to a class of compounds called polyphenols, which are many times more potent than antioxidant vitamins. (Clinical trials of vitamin E for example have been inconclusive for preventing radiodermatitis.) Many plants contain antioxidant polyphenols, including the milk thistle plant from which silymarin is derived. It is the active ingredient in a skin cream called Leviaderm® which was tested to determine its effectiveness on radiodermatitis. In a study of 101 patients, half were given the cream and the other half the usually recommended cream containing panthenol (a vitamin B derivative.) The group using the silymarin cream took almost twice as long to show any skin toxicity (45 vs 29 days) and the incidence of grade 2 or higher skin lesions was about 10% compared to 1 in 2 of the panthenol group. Though this is only one study and the findings need to be confirmed, it supports the potential benefits of antioxidants for radiation therapy patients. Given the lack of toxicity of silymarin, there seems to be little reason not to encourage its use routinely.
There will doubtless be others found to be effective, a likely candidate being resveratrol (which comes from red wine.)