The Role of Integrative Therapies in Radiotherapy: Evidence and Practice
Integrate nutrition, anti-inflammatory, and lifestyle strategies to reduce side effects and improve quality of life
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Introduction
Over the past two decades, cancer treatment has made tremendous progress. With the continuous development of surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy, the overall five-year survival rate for cancer has risen from 40% to over 60% (American Cancer Society, 2023). However, standard therapies alone often eliminate only 90–95% of tumor cells, leaving behind “minimal residual disease (MRD)” or “circulating tumor cells (CTCs)” (Alix-Panabières & Pantel, 2014). These residual cancer cells may lead to recurrence or metastasis after treatment. Therefore, clinical research increasingly focuses on how nutritional support, anti-inflammatory strategies, and immune modulation can improve overall treatment outcomes.
Integrative Oncology (IO) has emerged as a response, combining conventional medical treatments with evidence-based complementary therapies. These include nutrition, exercise, stress management, and supplemental approaches, with the goals of reducing side effects, improving quality of life, and ultimately enhancing treatment outcomes (Society for Integrative Oncology, 2022). This article focuses on “how radiotherapy can be combined with nutritional and supportive integrative medicine,” highlighting the latest research and clinical practice cases to show how nutrition and anti-inflammatory strategies can be integrated to optimize cancer treatment.
Challenges and Side Effects of Radiotherapy
Radiotherapy is a cornerstone treatment for many solid tumors. However, its side effects vary depending on tumor location and dose, including:
- Head and Neck Cancer: Oral mucositis, taste changes, swallowing difficulties (Zenda et al., 2021)
- Esophageal and Gastrointestinal Cancer: Appetite loss, weight loss, malnutrition (Silva et al., 2020)
- Breast and Lung Cancer: Fatigue, radiation dermatitis (Hymes et al., 2006)
- Systemic Effects: Immunosuppression, chronic inflammation, reduced quality of life
These side effects often lead to treatment interruptions or suboptimal dosing, compromising tumor control. Nutritional support and anti-inflammatory strategies are therefore critical not only for quality of life but also for treatment completion and survival outcomes.
International Trends in Integrative Oncology
Major U.S. cancer centers (e.g., MD Anderson Cancer Center and Memorial Sloan Kettering Cancer Center) have established integrative medicine departments providing nutritional counseling, exercise programs, and mind-body interventions, grounded in scientific evidence to improve side effects and enhance efficacy (MD Anderson, 2021).
According to the Society for Integrative Oncology (SIO) Clinical Practice Guidelines (Greenlee et al., 2022), integrative oncology has strong evidence in the following areas:
- Nutrition: Protein and immune-nutrition support reduce weight loss during treatment
- Exercise: Improves cancer-related fatigue and treatment tolerance
- Stress Management: Mindfulness and yoga reduce anxiety and pain
- Natural Compounds: Vitamin D, fish oil, and curcumin show anti-inflammatory and immune-supportive benefits
Nutritional Support Strategies During Radiotherapy
High-Protein, High-Calorie Diet
Patients undergoing radiotherapy require 20–50% more calories than usual, with protein intake ≥ 1.2–1.5 g/kg/day to maintain muscle mass and tissue repair (Silva et al., 2020).
Practical tips:
- At least two palm-sized portions of protein daily (fish, meat, eggs, legumes)
- Use medical-grade nutritional supplements to ensure adequate intake
Immunonutrients
Randomized trials show specific immunonutrients improve radiotherapy tolerance:
- Omega-3 fatty acids: Anti-inflammatory, reduce cachexia (Bougnoux et al., 2009)
- Vitamin D3: Deficiency impairs immune function and tolerance (Fedirko et al., 2019)
- Polysaccharides (e.g., Reishi, Turkey Tail): Support white blood cell recovery and immunity (Jiang et al., 2017)
High-Dose Vitamin C
Intravenous high-dose vitamin C (serum ≥ 20 mM) has shown potential in reducing chemo-radiotherapy side effects, fatigue, and improving quality of life (Ma et al., 2014). Some studies report delayed disease progression in breast, colorectal, and pancreatic cancer (Monti et al., 2012).
Curcumin
Curcumin regulates NF-κB and IL-6 pathways, showing anti-inflammatory and anti-tumor effects. It reduces radiation-induced dermatitis and mucositis (Lopresti, 2018).
Gut Health and Probiotics
Radiotherapy disrupts gut microbiota diversity, leading to diarrhea and immune decline. Probiotics, glutamine, and digestive enzymes help maintain gut barrier integrity and mitigate side effects (Redman et al., 2021).
Lifestyle and Anti-Inflammatory Strategies
- Anti-inflammatory diet: The Mediterranean diet lowers CRP and NLR, improving survival (Schwingshackl & Hoffmann, 2015).
- Exercise & stress management: Regular exercise (150 min/week) accelerates immune recovery (Courneya et al., 2015). Stress reduction practices lower cortisol, improving prognosis (Carlson et al., 2013).
- Intermittent fasting: Short-term fasting enhances cancer cell sensitivity to treatment while protecting normal cells (de Groot et al., 2020).
Clinical Case Snapshots
- Advanced urothelial cancer: Combined chemotherapy, immunotherapy, and high-dose vitamin C; complete remission after one year.
- Recurrent endometrial cancer: Not eligible for chemotherapy; concurrent radiotherapy and high-dose vitamin C achieved disease stabilization.
- Nasopharyngeal cancer: Radiotherapy with immune-nutrition and gut microbiome support significantly reduced mucositis and enabled treatment completion.
These cases highlight the value of integrative oncology in reducing side effects, supporting immunity, and improving treatment adherence.
Conclusion
Radiotherapy remains a cornerstone of cancer treatment, but its side effects limit efficacy. Integrative oncology strategies—including high-protein nutrition, immunonutrients (Vitamin D, Omega-3, polysaccharides), curcumin, probiotics, anti-inflammatory lifestyle measures, and intravenous vitamin C—can significantly improve quality of life and potentially enhance survival outcomes. As more randomized controlled trials emerge, integrative nutritional strategies will likely become indispensable in comprehensive cancer care
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參考文獻
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