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| Selenium treatment of radiation-induced lymphedema - Literature Review & Commentary |
by Alan R. Gaby
Forty-eight patients (median age, 54 years) with lymphedema secondary to radiation therapy (12 with edema of the arm and 36 with edema of the head-and-neck region) were treated with selenium, as sodium selenite, for 4-6 weeks. The dose was 350 mcg/[m.sup.2] of body surface area, generally giving a dose of approximately 230 mcg/day of elemental selenium. The median interval between the end of radiation therapy and the beginning of selenium treatment was 10 months for arm edema and 4 months for head-and-neck edema. Quality-of-life assessment, using a visual analog scale (10 = worst, 0 = best), showed an improvement from a mean value of 7.3 to a mean of 3.0 (59% improvement; p < 0.05). Ten of 12 patients with arm edema showed a reduction in the circumference of the edematous limb.
Comment: Lymphedema is a relatively common complication of radiation treatment for cancer. Symptoms include swelling of the limb or other parts of the body, and decreased mobility and a sense of heaviness in the affected area. If untreated, lymphedema can lead to cellulitis, chronic ulceration, and tissue necrosis. Conventional therapy for lymphedema includes elevating the limb and using various physical modalities to promote the flow of lymphatic fluid. Certain flavonoids, such as coumarin, hydroxyethylrutosides, and Daflon (a mixture of 90% diosmin and 10% hesperidin), have also been reported to be of value in the treatment of lymphedema. Anecdotal evidence suggests that bilberry, another source of flavonoids, is also beneficial. The results of the present study indicate that a relatively low dose of selenium may be useful, although the possibility of a placebo effect cannot be ruled out. Because they are safe and potentially effective, a combination of selenium and an appropriate flavonoid should be considered for the prevention of lymphedema in patients undergoing radiation therapy, and for treatment, once lymphedema has developed.
Micke O, et al. Selenium in the treatment of radiation-associated secondary lymphedema. Int J Radiat Oncol Biol Phys 2003;56:40-49.
Alan R. Gaby, MD 301 Dorwood Drive * Carlisle, Pennsylvania 17013
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