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The term Traditional European Medicine (TEM) was coined analogous to Traditional Chinese Medicine (TCM). In the German-speaking areas, the so called Hildegard Medicine (HM) is very popular and acco ...

Das essenzielle Spurenelement Selen hat eine erhebliche Bedeutung fur die menschliche Gesundheit. Als Bestandteil selenabhangiger Proteine ist die Mitbeteiligung an Stoffwechselprozessen, v. a. im Rahmen der endogenen antioxidativen Ablaufe, essenziell und gut charakterisiert. Sowohl in vitro als auch in vivo liegen Daten fur eine positive Beeinflussung durch Supplementation von Selen im Rahmen der Krebspravention und bei der Reduktion von Nebenwirkungen durch Strahlen- und Chemotherapie vor. Weltweit erstmalig konnte nun die radioprotektive Wirkung von Selen ohne negative Beeinflussung des Gesamtuberlebens durch eine randomisierte radioonkologische Studie belegt werden. In einer kurzlich vorzeitig beendeten US-amerikanischen Studie zur Primarpravention des Prostatakarzinoms war der Einsatz von Selen eher wirkungslos. Wir geben eine Einschatzung dieser Ergebnisse und einen aktuellen Uberblick uber die neuen Erkenntnisse einschlieslich konkreter Empfehlungen fur den klinischen Einsatz.

Hintergrund und Ziel: Nach einer Patterns-of-Care-Studie (PCS) der AG Strahlentherapie gutartiger Erkrankungen der Deutschen Gesellschaft fur Radioonkologie (DEGRO) 2003/2004 ist eine Vielzahl von einzelnen PCS zu unterschiedlichen gutartigen Erkrankungen durchgefuhrt worden. Hier wird nun die PCS betreffend Radiotherapie (RT) bei schmerzhafter Gonarthrose (GNA) vorgestellt. Material und Methodik: Von 2006 bis 2008 wurden alle deutschen strahlentherapeutischen Institutionen mit Hilfe eines standardisierten Fragebogens hinsichtlich Patientenzuweisung und -anzahl, Anamnese, Vorbehandlungen, Bestrahlungsindikationen und -techniken, Zielvolumenkonzepten usw. sowie Behandlungsergebnissen betreffend RT bei schmerzhafter GNA befragt. Ergebnisse: Insgesamt beantworteten 238/248 (95,9%) der strahlentherapeutischen Einrichtungen in Deutschland den Fragebogen. 188/238 (79%) der strahlentherapeutischen Einrichtungen fuhren eine RT bei schmerzhafter GNA durch. Jahrlich wurden in Deutschland 4 544 Patienten (im Median 15 pro Institution; ein bis 846) mit schmerzhafter GNA bestrahlt. Indikationen waren akute Schmerzen in 18,9%, chronische Schmerzen in 95,3% sowie therapierefraktare Schmerzen in 81,1%. Die im Median applizierte Gesamtdosis betrug 6 Gy (3–12 Gy) bei einer medianen Einzeldosis von 1 Gy (0,25–3 Gy). 40,4% der Institutionen bestrahlten zweimal pro Woche, 51,4% dreimal pro Woche. Die RT wurde in 25% der Falle mit einem Orthovoltgerat, in 79,6% mit einem Linearbeschleuniger und in 8,3% mit einem Cobalt-60-Gerat durchgefuhrt. 42 Einrichtungen evaluierten die Resultate der RT von insgesamt 5 069 behandelten Patienten. Eine mediane Schmerzreduktion von mindestens 3 Monaten konnte in 60% (5–100%), eine mediane Schmerzreduktion von mindestens 12 Monaten in 40% (10–100%) und eine mediane dauerhafte Schmerzreduktion in 27,8% (10–85%) der bestrahlten Patienten erreicht werden. Im Median erhielten 30% (7–100%) der Patienten eine zweite Bestrahlungsserie. Es wurden keine radiogenen Akut- und Spatreaktionen angegeben. Schlussfolgerung: Die vorliegende PCS bestatigt mit der bisher weltweit grosten Fallzahl die traditionell weite Verbreitung der RT bei der schmerzhaften GNA in Deutschland sowie die damit verbundenen sehr guten Resultate. Die RT bei schmerzhafter GNA kann als effektive und nebenwirkungsfreie Option vor operativen Eingriffen durchgefuhrt werden.

In recent years the demand and use of complementary and alternative medicine (CAM) in malignant diseases has increased noticeably. Since the general knowledge about CAM use is scant and CAM could potentially interact with standard therapies the German Working group “Trace Elements and Electrolytes in Oncology” performed a multi-centric study to comprehensively evaluate the use of CAM therapies in cancer patients treated with radiotherapy. Methods: 1,013 patients receiving consecutively radiotherapy for malignant diseases were interviewed using a standardized questionnaire including clinical and pathological tumor parameters as well as the type of CAM and reasons for CAM use. A self-assessment of patients’ personal conditions was performed in order to evaluate the subjective impact of CAM on quality of life. Results: A total of 59% of patients reported using CAM therapies. CAM use was more common in female patients, generally higher in advanced stages of disease and most common in breast cancer patients. Most frequently reported CAM therapies were vitamins (18%), mistletoe extracts (15%), selenium (10%), and other trace element preparations (7%). Multivariate logistic regression showed age, gender, tumor type and stage, and smoking behavior to be significant predictors for CAM use. A subjective improvement in quality of life due to the use of CAM was accounted for in 30% of patients. Conclusions: More than half of patients undergoing RT for cancer are using CAM therapies. Therefore, radiation oncologists should be asking for respective obtaining information about CAM use in order to avoid harmful interactions with conventional therapies. The value and potential hazards of such combined treatments have yet to be tested in further clinical studies.

Objective: To investigate the impact of selenium in the treatment of lymphedema of the head and neck region after radiotherapy alone or in combination with surgery. Subjects and Materials: Between June 1996 and June 2001 a total of 36 cancer patients (29 male, 7 female; median age 61 years) were treated with selenium for persistent, extensive or progressive lymphedema of the head and neck region. Twenty had interstitial endolaryngeal edema associated with stridor and dyspnea. All patients received 350 µg/m2 body surface sodium selenite medication p.o. daily (total dose 50 µg per day) for a period of 4–6 weeks after radiotherapy. The optimal effect of the selenium treatment was assessed after 4 weeks of therapy using the Miller score system. A visual analogue scale on a scale of 0–10 was used to assess the patient’s quality of life prior to and after selenium. Results: 75% of the patients had an improvement of the Miller score of one stage or more. The self-assessment of quality of life using the visual analogue scale improved significantly after selenium treatment with a reduction of 4.4 points (p < 0.05). Of the 20 patients with endolaryngeal edema tracheostomy was not necessary in 13 patients (65%), but 5 and 2 received a temporary or permanent tracheostomy, respectively. No episode of erysipelas was observed in all study patients. Conclusion: Our results suggest a short positive effect of sodium selenite on secondary head and neck lymphedema caused by radiotherapy alone or in combination with surgery.

Use of Complementary/Alternative Medicine by Patients with Breast Carcinoma Background: Complementary/alternative medicine (CAM) is gaining increasing importance especially in the treatment of patients with breast carcinoma. The purpose of this analysis was to investigate the prevalence of CAM in patients with breast carcinoma, to statistically describe the preparations and therapies used, and to determine the reasons for their use, the source of information and the individual perception. Patients and Methods: The statements of 203 patients with breast carcinoma who underwent radiotherapy were analyzed. The median age was 54 years (range 38–77 years). All patients underwent surgery as first therapy. 36 patients received a second-line radiotherapy because of metastases (27 patients) or local recurrence (9 patients). Results: 159 patients (78%) stated to carry out an additional treatment. 31 out of the 36 patients with metastases or local recurrence used CAM. Vitamin preparations (67%), mistletoe therapy (59%), and mineral preparations (33%) were used most frequently. 70% of the patients used a combination of two or more preparations/therapies. The most cited reason for using CAM was the aim of increasing quality of life (28%) and improving the immune system (27%). 72% stated an improvement of their individual perception. The main source of information was the general practitioner or the gynecologist. Conclusion: The radiotherapist has to take these complementary/alternative therapies into consideration; their importance should be evaluated in further studies.

Many patients receiving cancer treatment use micronutrient supplements, with the intention to complement their cancer treatment, or help them cope with the therapy- and disease-associated side-effects. Up to 90% of the cancer patients are adding antioxidants without the knowledge of the treating physician. There are many concerns that antioxidants might decrease the effectiveness of chemotherapy, but increasing evidence suggests a benefit when antioxidants and other micronutrients, such as selenium, L-carnitine and vitamin D are added to conventional cytotoxic therapies. It is imperative that physicians discuss the use ofantioxidant and other micronutrient supplements with their cancer patients and educate them about potentially negative, but also potentially beneficial effects.

As board members of the working group “Gutartige Erkrankungen [benign disorders]” within the German Society of Radiation Oncology (DEGRO, Deutsche Gesellschaft fur Radioonkologie), we read the original article by Holland et al. with great interest. The article shows that the risks associated with cortisone injections—a popular measure in the setting of painful skeletal disorders—are not as low as is commonly assumed (1). We are practicing radiation oncologists and would therefore unreservedly support the authors’ crucial conclusion—namely, that, concerning patient safety, the indication for invasive therapeutic options should always be critically defined and patients should be informed about associated risks. In view of the ageing population and the corresponding increase in painful degenerative disorders of joints and entheses, low dose radiotherapy offers a low-risk, genuinely conservative, non-invasive therapeutic alternative. This treatment is administered to many patients every day. A patterns of care study published in 2004 showed that 23 752 patients with degenerative disorders receive low-dose analgesic radiotherapy in Germany every year (2) and that the trend is upwards. Another patterns of care study showed that in Germany in 2007, 4544 patients with painful osteoarthritis of the knee received low-dose radiotherapy. In 25% of patients this treatment resulted in a complete resolution of pain, and a moderate to notable reduction in pain was achieved in 55% of patients (3). A current randomized study in patients with painful heel spur also showed a significant advantage for a total dose of 6 Gy compared to a very low total dose of 0.6 Gy, thus showing a clinical effect of the fractionation and dosage that is widely used in Germany (4). Finally it should be mentioned that low-dose analgesic radiotherapy is not named in the medical expert committees and mediation boards generally, and that it is a accredited service covered by the health insurers in Germany.

Giant cell tumor of the bone (GCTB) is a benign or sometimes semi-malignant neoplasm accounting for 5% of all primary bone tumors. This type of tumor has been historically considered as radioresistant, but nowadays radiotherapy (RT) is used in unresectable, recurrent or incompletely resected cases. Since the value of RT is not well defined, a national cohort study was conducted.Six German institutions collected data from 35 patients treated during the last 35 years and analyzed them.From 1975-2010 16 male and 19 female patients with 39 lesions were irradiated for GCTB. The median age was 30 years and the median follow-up 65 months. Nineteen patients had undergone RT for recurrent or unresectable disease and 16 patients for non-in-sano resection. The actuarial 5-year overall and disease-free survival rates were 90% and 59%, respectively.RT is an easy, safe and effective method for the treatment of GCTB. It may provide an attractive alternative to mutilating surgery.

Determination of the optimal nutritional parameter to provide useful information for the individual patient and assessing the impact of nutritional status have on the prognosis of head and neck cancer.Firstly a retrospective study analysed the outcome of 110 patients in relation to initial weight loss and weight loss at the end of radiotherapy. A second study investigated the changing bioimpedance (BIA) data of 27 survivors and 39 patients who died between their first and last measurement during nutritional therapy (at least four weeks).A critical initial weight loss is 10 kg or more at the point of diagnosis. At the end of radiotherapy the body mass reduction should be less than 15 kg. Raw data of BIA reflect the changing nutritional status at the end of life. We observed a stabilized phase angle in survivors (4.7° to 5.2°) whereas patients who died exhibited a significant lower phase angle (4.6° to 3.7°, p0.05).The prognosis of head and neck cancer patients is highly related to their nutritional status. Specific nutritional anamnesis (initial weight loss, total weight loss, body mass index) and additional biophysical measurements such as BIA are recommended to monitor the individual status during the follow-up.

Since the 20th century, radiotherapy (RT) has been used for treatment of symptomatic splenomegaly (SM). SM occurs in association with hematologic disorders. The purpose of this analysis was to determine the indication, treatment concepts, and efficiency of RT. Clinical features, treatment concepts, and outcome data during the past 20 years were analyzed. Endpoints were pain relief, symptomatic and hematological response, and treatment-related side effects. From 1989–2009, a total of 122 patients received 246 RT courses because of symptomatic SM. Overall 31 patients had chronic myelogenous leukemia (CML), 37 had chronic lymphocytic leukemia (CLL), 23 had osteomyelofibrosis (OMF), 17 had polycythemia vera (PV), 5 had acute myelogenous leukemia, 4 had idiopathic thrombocytopenic purpura (ITP), 3 had non-Hodgkin lymphoma (NHL), and 2 had multiple myeloma (MM). Patients were treated with 60Co gamma rays or 5–15MV photons. The fraction size ranged from 10–200 cGy and the total dose per treatment course from 30–1600 cGy. Significant pain relief was achieved for 74.8% of the RT courses given for splenic pain. At least 50% regression was attained for 77% of the RT courses given for SM. 36 patients died within 2 months due to the terminal nature of their disease. Of the RT courses applied for cytopenia, 73.6% achieved a significant improvement of hematological parameters and reduction of transfusion need. Notable hematologic toxicities were reported < EORTC/RTOG II°. The present analysis documents the efficacy of RT. In addition, RT as a palliative treatment option for symptomatic SM should not be forgotten.

As practicing radiooncologists, we missed a mention of low-dose radiotherapy in the context of conservative treatment in the article, since it has traditionally been much used in Germany and is recognized among orthopedic specialists. The so called x-ray stimulation radiotherapy is used everyday in many patients, including patients with osteoarthritis of the knee, and we would have appreciated at least a brief mention of this method. Even though randomized controlled studies for this special indication are thus far lacking, many publications of retrospective analyses, including patterns of care studies (PCS), are available.In 2004, investigators noted in the context of such a PCS that every year, 23 752 patients in Germany with degenerative joint disorders, including osteoarthritis of the knee, received x-ray stimulation radiotherapy (1).. In 2004, an orthopedic specialist published the results of a retrospective study with a success rate (pain reduction, absence of pain) of 63% after radiotherapy for osteoarthritis of the knee. A PCS published in 2010 showed that in Germany in 2007, 4544 patients with osteoarthritis of the knee received radiotherapy. Referrals for radiotherapy were made by orthopedic specialists (95.2%), general practitioners (84.6%), surgeons (28.8%), and other specialists (27.9%) (multiple mentions permitted). 25% of patients were free from pain, and a moderate to notable reduction in pain was achieved in 55% of patients who had received radiotherapy (3). From a radiotherapeutic perspective, low-dose radiotherapy for painful Kellgren stage 2–3 osteoarthritis of the knee at is an effective therapeutic option and can be recommended or undertaken even if surgical interventions are not possible or desirable.

Study on the use of complementary and alternative medicine (CAM) in lung cancer patients has been widely neglected. Therefore, we initiated a study on the use of CAM in lung cancer patients in addition to radiation treatment. Overall, 120 patients from 3 institutions were interviewed by a standardized questionnaire. Besides the tumor parameters and the use of CAM, the reason for the use, patient information of the medication, the information sources and the subjective condition of the patient. Altogether, 54% of the patients reported using CAM (66% of female patients, 52% of male patients). The most frequently used CAM measures were vitamin combinations (17%), mistletoe (15%), and selenium (12%). A total of 52% reported the wish to support the tumor treatment as a reason for using CAM and 27% had a 'better feeling' using CAM. 50% of CAM was bought by the patients themselves and 50% were prescribed by their family physicians. The use of CAM is frequent in lung cancer patients. Our results suggest that it is very important to obtain information on the CAM use of patients and, particularly in controlled clinical trials, to prospectively document it.

After a patterns-of-care study (PCS) in 2003/2004 addressing benign disorders in general, the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) conducted several multicenter cohort studies including the use of radiotherapy (RT) in painful gonarthrosis (GNA).From 2006 to 2008, a PCS for GNA was conducted in all German RT institutions using a standardized structured questionnaire. Patient accrual, patient number, pretreatment, pain record, treatment indications, RT technique, and target volume concepts for painful GNA were assessed. In addition, the long-term functional and subjective outcomes were evaluated.238/248 institutions (95.9%) returned the questionnaire: 50 (21%) reported no clinical experience with RT in GNA, while 188 (79%) institutions treated 4,544 patients annually (median 15; range one to 846 cases per institution). Indications for treatment were acute pain symptoms in 18.9%, chronic pain in 95.3%, and treatment-refractory pain in 81.1%. The median total dose was 6 Gy (range 3-12 Gy), with a median single dose of 1 Gy (0.25-3 Gy). 40.4% of the institutions applied two fractions and 51.4% three fractions weekly. RT was delivered with orthovoltage units (25%), linear accelerators (79.6%), and cobalt-60 units (8.3%). 42 institutions evaluated the long-term clinical outcome in a total of 5,069 cases. Median pain reduction for at least 3 months was reported in 60% (5-100%), median pain reduction for at least 12 months in 40% (10-100%), and median persistent pain reduction in 27.8% (10-85%) of the treated patients. In 30% of patients (7-100%), a second RT series was applied for inadequate pain response or early pain recurrence. No radiogenic acute or chronic side effects were observed.This PCS comprises the largest number of cases reported for RT in painful and refractory GNA. Despite variations in daily RT practice, high response and low toxicity for this treatment in a very large number of painful and refractory GNA cases renders low-dose RT an effective conservative therapy which can be applied prior to surgical procedures.

Painful heel spur (plantar fasciitis) is a major part of the heel spur syndrome. It is reportedly the most common cause of pain in the inferior heel and is estimated to account for 11% to 15% of all foot symptoms requiring professional care among adults [17]. The first description of the clinical picture in the literature came from Wood in 1812, but he incorrectly attributed it to tuberculosis [11, 68]. During the Civil War, another early citing by Zacharie in 1860 discussed a condition affecting the heel in which patients had “greater pain in the morning than after standing and walking one or two hours” [153].

The late toxicities due to multimodal therapy of advanced head and neck cancers were analysed. The impact of cytoprotection with amifostine is the specific objective of this report.A total of 851 patients (717 men, 134 women) with head and neck cancer were included in this prospective study. Of these patients, 519/851 had received amifostine before radio(chemo)therapy, while 332 control patients had not received any kind of cytoprotection before irradiation. Primary radiochemotherapy was performed in 282 patients and adjuvant radiation was administered in 569. The follow-up examination was carried out at our outpatient department 21.4 months (median, range 2.3 to 149 months) after the primary therapy.Late xerostomia was seen in 765/851 patients (89.9%). Altered taste was reported by 284/851 (33.5%). These symptoms were reduced significantly by amifostine. No influence was seen on interstitial lymph edema (48.4%), or stenosis of the cervical esophagus (20.4%). Secondary symptoms such as dysphagia (78.8%) also had a trend for reduction.The administration of amifostine offers an opportunity to reduce selected long-term toxicities for survivors of head and neck cancer.

We investigated the hypothesis that patients with advanced head and neck cancer exhibit a decreased serum concentration of magnesium compared to the normal population. In July 2013 we measured the magnesium serum concentration of 18 patients with squamous cell carcinoma of the head and neck region. The control group consisted of 17 patients received tonsillectomy during the same period. Overall 14/18 patients with cancer have had Magnesium serum concentrations < 0.80 mmol/l (78%). The control group showed only two patients (12%) with serum levels below the cut off. This small controlled study supports the hypothesis that decreased Magnesium serum concentrations are typical for patients with advanced head and neck cancer. We could not show, that hypomagnesaemia is prognostic biomarker in head and neck cancer treatment.

The purpose of this work was to investigate the relationship between the tumor volume and the endogenous selenium levels in untreated head and neck cancer patients.One hundred consecutive patients were included in this study. We measured the endogenous levels of selenium in the serum and the whole blood of all patients by atomic absorption spectrometry. Additionally, the activity of glutathione peroxidase and the concentration of malonedialdehyde were observed. The resectability of the tumor was used as an independent marker of the tumor volume.Thirty-one out of 100 patients had resectable tumors, while 69 patients were characterized as unresectable. The following median results were obtained (resectable versus unresectable): Serum Se 0.90 micromol/l versus 0.78 micromol/l (p=0.024); whole blood Se 1.00 micromol/l versus 0.93 micromol/l (p=0.139); glutathione peroxidase 145 U/l versus 148 U/l (p=0.93); and malonedialdehyde 2.21 mmol/l versus 2.6 mmol/l (p=0.84).The concentration of serum selenium shows a significant relationship with tumor resectability in patients with advanced head and neck cancer.

From the Department of Radiotherapy, Klinikum Weiden, Germany (Ralph Mucke, Berthold Reichl, Rainer Heyder), Department of Radiotherapy, Wiesbaden, Germany (Ralph Mucke), Department of Radiotherapy, University of Munster, Germany (Oliver Micke), Department of Otolaryngology, Sudharzklinikum Nordhausen, Germany (Jens Buntzel), Department of Pathology, University of Wurzburg, Germany (Alexander Marx, Hans Konrad Muller-Hermelink, German Ott)

The aim of this explorative study was to evaluate the impact of selenium in the treatment of lymphedema after radiotherapy.Between June 1996 and June 2001, 12 patients with edema of the arm and 36 patients with edema of the head-and-neck region were treated with selenium for therapy-related lymphedema. Of these 36 patients, 20 had interstitial endolaryngeal edema associated with stridor and dyspnea. All patients received sodium selenite over 4 to 6 weeks.Self-assessment using a visual analog scale (n = 48) showed a reduction of 4.3 points when comparing pre- and posttreatment values (p0.05). Of 20 patients with endolaryngeal edema, 13 underwent no tracheostomy, 5 underwent a temporary tracheostomy, and only 2 underwent a permanent tracheostomy. Ten of 12 patients with arm edema showed a circumference reduction of the edematous limb and improvement in the Skin-Fold Index by 23.3 points. An improvement of one stage or more was shown by the Földi or the Miller score (n = 28) in 22 (Földi score) and in 24 (Miller score) patients.Treatment with sodium selenite is well tolerated and easy to deliver. Additionally, our results suggest that sodium selenite has a positive effect on secondary-developing lymphedema caused by radiation therapy alone or by irradiation after surgery.

Retrospective analysis of 117 patients treated between 1996 and 2000 with low-dose radiotherapy (RT) for painful heel spurs. 71 women and 46 men were irradiated on 136 painful heel spurs in one (n = 104) or two radiation series (n = 13). The painful spurs were located either at the plantar (n = 94), dorsal (n = 5) or bilateral heel (n = 18). 82 patients had prior treatments, in 35 patients RT was the primary treatment. Low-dose RT was performed twice a week with one 6-MV photon field. Ten fractions of 0.5 Gy were applied to a total dose of 5 Gy. Evaluation was done on completion and during follow-up using the four-scale von Pannewitz score. On completion of RT, 27 patients were free of pain, 40 were much improved, 31 reported slight improvement, and 19 experienced no change. After a mean follow-up of 20 months, 75 out of 100 patients were free of pain, twelve had marked and three some improvement. Ten patients reported no change of symptoms. Mean duration of pain before RT was 6 months. RT applied ≤ 6 months after the onset of clinical symptoms resulted in improvement in 94%. By contrast, an interval of > 6 months until the initiation of RT resulted in only 73% of patients with clinical improvement. Low-dose RT reveals a benefit in > 80% of the patients. RT should start during the first 6 months of symptoms. Prospective clinical studies with validated symptom scores should be conducted to assess optimal dose and fractionation scheme of RT.

There is only little preliminary information about combined-modality treatment with radiotherapy and temozolamide. The purpose of this analysis was to document the feasibility of such combined-modality treatment.We treated 25 patients with recurrent high grade gliomas after standard therapy (surgery and radiation) with the following schedule: 400 mg temozolomide orally for five days repeated every 28 days, and radiotherapy at a dose of 20-30 Gy (2 x 1.2 Gy per day). Four of these patients underwent a second operation without complete tumor resection.After 125 courses of temozolomide, grade 1 (NCI-CTC) thrombocytopenia was found in four patients and grade 2 in two patients. Two patients developed grade 1 leukocytopenia and two others grade 2. CTC grade 1-2 nausea was observed in eight patients. For one patient we reduced the dose of temozolomide to 300 mg/day because of thrombocytopenia. One patient discontinued therapy after the first course because of leukocytopenia and nausea. CTC grade 3-4 side effects did not occur. Combined-modality treatment showed no more side effects than treatment with temozolomide alone. The median duration of response was seven months.The observed side effects were tolerable. Combined treatment with radiotherapy and temozolomide is feasible. Further investigation of this agent is necessary.

Auteur(s) : Oliver Micke1, Robert Hunger2, Jens Buntzel3, Ralph Mucke4, Klaus Kisters5 1Franziskus Hospital, Department of Radiotherapy and Radiation Oncology, Bielefeld, Germany 2Lurlibadstr. 80, Chur, Switzerland 3Sudharz Hospital, Department of Otolaryngology, Nordhausen, Germany 4Lippe Hospital, Department of Radiotherapy, Lemgo, Germany 5St. Anna Hospital, Department of Internal Medicine, Herne, Germany Dear Editor, We recently read with great interest the notable [...]

Introduction The use of complementary and alternative medicine (CAM) is the norm in tumor patients (Burstein, JCO 2000). CAM is most frequently used in breast and prostate cancer patients. The CAM use in lung cancer patients is widely neglected, and systematic studies are scarce in this field. Therefore, the German Working Group Trace Elements and Electrolytes in Radiation Oncology, AKTE, initiated a study on the use of CAM in lung cancer patients in addition to radiation treatment. Methods A total of 120 patients (38 f, 72 m) of 3 institutions were interviewed by a standardized questionnaire. Besides the tumor parameters and the use of CAM, the reason for the use, information on the receipt of the medication, the information sources and the subjective condition of the patient. Results Altogether, 54% of the patients reported to use CAM (66% of female patients, 52% of male patients). The CAM measures, most frequent used, were: vitamin combinations (17%), mistletoe (15%), selenium (12%), other trace element combinations (8%), prayer (6%), thymus preparations (5%), homeopathy (3%) and other physical treatment (3%). A total of 52% reported the wish to support the tumor treatment as a reason to use CAM and 27% better feeling using CAM. 50% of CAM was bought by patients themselves and 50% were prescribed by their family physicians. Sources of CAM supply predominantly were pharmacies and drugstores. Information sources mostly were the family physician and other patients. 55% of patients described an improvement of their subjective condition. Conclusions The use of CAM is a frequent phenomenon in lung cancer patients. Our results suggest that it is very important to obtain information on the CAM use in lung cancer patients and, particularly in controlled clinical trials, to prospectively document it.