Selenium in the Treatment of Radiation-Associated Lymphedemas

Heather Jones, MD
UPCC
Last Modified: November 5, 2001

Presenter: F. Bruns
Presenter's Affiliation: Department of Radiotherapy and Radiation Oncology, University Hospital, Muenster, Germany
Type of Session: Reporting

Background
: Lymphedema is a relatively common side effect after surgical and/or radiotherapeutic treatment of lymph node areas. It can also be seen due to tumor compression of the lymphatic channels. There are some preliminary studies that selenium, a popular antioxidant, may have an antiedematous effect. This study was designed to evaluate the impact of oral selenium in the treatment of lymphedema of the trunk, the extremities, and the head and neck region in the radiation oncology setting.

Materials and Methods

48 patients were treated for acute or chronic lymphedema. 8 had an edema of upper extremities and 4 of the lower extremities; 36 patient suffered from lymphedema in the head and neck region.

20 of Head and Neck patients showed signs of an endolaryngeal edema associated with stridor and dyspnea

Patients received sodium selenite (350 µg/kg m2 body surface daily p.o.) over four to eight weeks.

The treatment effect was evaluated at the end of therapy and two months later: The circumference of the extremity was measured by standardized equipment. Additionally the skin folds index and a five-items score adopted from Miller et al. and the RTOG was used. According to this scale all patients had a grade II to IV lymphedema.

Results

In patients with edemas of the extremities, we found a significant reduction of the circumference compared to the unaffected side as well as an improvement of skin folds index.

Clinically 32/48 patients had a marked reduction of lymphedema. According to the five-items score 14/18 evaluated patients had an improvement of more than one grade.

14 patients received additional proteolytic enzymes. These drugs were effective only in 2.

No tracheostomy was necessary in 13/20 patients with endolaryngeal edema, further 5 patients received a temporary tracheostomy, and only 2 patients got a permanent tracheostomy.

Author's Conclusions
The results suggest that sodium selenite has a positive effect on acute and chronic lymphedemas in different body sites. The treatment is well tolerated by the patients and easy to deliver. Overall, the treatment was well tolerated by all patients. It is very inexpensive and has a high cost-effectiveness ratio.

Clinical/Scientific Implications
Many cancer patients attempt to alleviate the sequelae of cancer therapy with the use of unconventional medical therapies. One popular intervention is the use of the antioxidant selenium. This small, yet interesting study indicates that selenium my benefit a subset of patients with chronic lymphedema. This is a small study and it is not clear if the resolution acute edema in the head and neck patients was simply due to natural recovery from therapy or drug effect. Nonetheless, the use of selenium appears feasible and cost effective and should be studied in a prospective randomized fashion.