Manuka Honey Shows Potential For Radiation-Induced Dermatitis
The results, from a phase 2 study reported at the 2011 European Multidisciplinary Cancer Congress (EMCC), show that the product may also decrease the duration of dermatitis episodes.
Nichola Naidoo, MD, Waikato District Health Board, Hamilton, New Zealand, and colleagues randomised 81 patients to either standard aqueous cream or manuka honey in a non-blinded fashion using a range of radiation schedules.
The study included women with invasive breast cancer or ductal carcinoma in situ who were undergoing adjuvant external beam radiation therapy.
Treatments were applied twice daily from the 1st day of radiation therapy until 10 days after the completion of radiation therapy. The honey formulation used was a pure sterilised product with active manuka honey as the only ingredient (1g/g), unique manuka factor of 18.
Toxicity was scored by visual inspection using the Radiation Therapy Oncology Group (RTOG) acute toxicity scale and digital photography. Independent assessment of the photographs was performed by a clinician blinded to treatment allocation.
Radiation dermatitis is a common side effect in patients undergoing irradiation of the breast and/or chest wall, with the incidence of early grade 2 reactions reported in 30 to 50% of patients.
Dermatitis is due, in part, to an acute inflammatory response, with the release of cytokines, serotonin, and histamine as well as elevated levels of reactive oxidative species.
Many topical agents are used in clinical practice however no single agent has been proven to prevent radiation dermatitis.
Manuka honey, which is a monofloral honey made by bees in New Zealand that frequent the manuka bush known as Leptospermum scoparium, has demonstrated wound healing and anti-inflammatory properties, possibly related to its significant levels of antioxidants. The product has also been shown to be useful for healing moist desquamation and for radiation-induced mucositis.
The primary study endpoint was the incidence of radiation dermatitis ≥ grade 2.
Results revealed a lower incidence of grade ≥ 2 dermatitis in the honey-treated group compared to the group using aqueous cream (37.2% versus 57.8%, P=0.08). There was a trend towards a lower incidence of grade ≥ 2 dermatitis lasting longer than 1 week in patients treated with honey compared to aqueous cream (14.0% versus 28.9%, P=0.1).
Ratings on a scale of 1 to 10 for the ease of application (9.3 versus 7.1; p<0.05), comfort (9.0 versus 6.1; p<0.05) and overall acceptability (9.2 versus 8.6; p=0.04) were significant, in favour of the aqueous cream over honey.
There was no difference noted with the stratifying factors of type of surgery and dose per fraction. However, in the case of boost versus no boost, there was a suggestion that the benefit of honey was "more clearly observable" in patients who received a boost.
Dr. Naidoo said that while the results are promising, a larger phase 3 trial is needed to further examine the potential for honey in this setting.
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The 2011 European Multidisciplinary Cancer Congress (EMCC)
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