Dejonckheere Cas Stefaan, Scafa Davide, Käsmann Lukas, Zeyen Thomas, Potthoff Anna-Laura, Schäfer Niklas, Weller Johannes, Herrlinger Ulrich, Schneider Matthias, Vatter Hartmut, Grosu Anca-Ligia, Brehmer Stefanie, Giordano Frank Anton, Sarria Gustavo Renato, Gkika Eleni, Layer Julian Philipp
Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany.
Department of Radiation Oncology, University Hospital München, 80539 München, Germany.
Adv Radiat Oncol. 2025 Feb 1;10(4):101732. doi: 10.1016/j.adro.2025.101732. eCollection 2025 Apr.
Stereotactic radiosurgery (SRS) yields excellent local control in patients with a limited number of brain metastases (BMs), but radiation-induced cerebral edema and radiation necrosis (RN) in particular may cause dose-limiting late toxicity, with the same holding true after fractionated radiation therapy for glioma. In symptomatic patients, the first-line standard of care includes corticosteroids, which may, however, be counterproductive in the evolving era of immunotherapy. Boswellic acid (BA), available as an over-the-counter dietary supplement, has been suggested as a potential corticosteroid-sparing alternative because of its anti-inflammatory and antiangiogenic effects.
We performed a comprehensive literature search of the MEDLINE, Embase, Scopus, and Cochrane databases, identifying publications reporting on the use of BA during or after brain irradiation in humans. Using the Realist and Meta-Narrative Evidence Syntheses: Evolving Standards framework, relevant data are summarized using a meta-narrative approach.
Six records (3 for edema reduction in large irradiated volumes and 3 for RN after SRS) were identified, encompassing 130 patients. Roughly half of patients benefited from BA (radiographically or clinically) and about one third could successfully taper dexamethasone or prevent its long-term intake. Tolerability of BA was favorable, with mild gastrointestinal discomfort being reported most frequently. Current drawbacks include unknown optimal formulation as well as timing and dosing, a considerably large number of required daily capsules, and uncertain interactions with other drugs.
Overall, the clinical evidence on the use of BA for radiation-induced cerebral edema and RN is lacking and well-designed prospective trials are warranted to further investigate this potential low-cost corticosteroid-sparing option.
立体定向放射外科治疗（SRS）对脑转移瘤（BM）数量有限的患者能产生良好的局部控制效果，但辐射诱发的脑水肿，尤其是放射性坏死（RN）可能会导致剂量限制的晚期毒性，这在胶质瘤的分次放射治疗后也是如此。对于有症状的患者，一线标准治疗包括使用皮质类固醇，然而，在免疫治疗不断发展的时代，这可能会产生适得其反的效果。乳香酸（BA）作为一种非处方膳食补充剂，因其抗炎和抗血管生成作用，被认为是一种潜在的可替代皮质类固醇的药物。
我们对MEDLINE、Embase、Scopus和Cochrane数据库进行了全面的文献检索，确定了关于人类脑部放疗期间或之后使用BA的报道。使用现实主义和元叙事证据综合：不断发展的标准框架，采用元叙事方法总结相关数据。
共识别出6篇记录（3篇关于大照射体积时水肿减轻，3篇关于SRS后RN），涉及130例患者。大约一半的患者（在影像学或临床上）从BA中获益，约三分之一的患者能够成功减少地塞米松用量或避免长期服用。BA的耐受性良好，最常报告的是轻度胃肠道不适。目前的缺点包括最佳配方、给药时间和剂量未知，每天需要服用大量胶囊，以及与其他药物的相互作用不确定。
总体而言，关于使用BA治疗辐射诱发的脑水肿和RN的临床证据不足，需要进行精心设计的前瞻性试验，以进一步研究这种潜在的低成本替代皮质类固醇的选择。
