Using Leptospermum Honey to Manage Wounds Impaired by Radiotherapy: A Case Series
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Radiation-induced tissue injury and wounds with radiation-impaired healing are traumatic for patients and challenging for their caregivers. Standardized management approaches do not exist. The effect of Leptospermum honey as a primary dressing for managing these wounds was assessed in four patients (age range 63 to 93 years) who had previously undergone radiotherapy that left them with fragile friable areas of damaged skin that did not respond to conventional treatment. Compromised areas involved the neck, cheek, groin/perineum, and chest. In patients 1 and 2, after topical application of honey via hydrofiber rope and nonadhesive foam, respectively, improvements in the size and condition of wound/periwound area and a reduction in pain were noted before death or loss to follow-up. After including honey in the treatment regimen of patients 3 and 4, complete healing was noted in 2.5 weeks (with honey and paraffin) and 6 weeks (with honey-soaked hydrofiber rope), respectively. No adverse events were reported. Honey as an adjunct to conventional wound/skin care post radiation therapy shows promise for less painful healing in these chronic wounds. Prospective, randomized, controlled clinical studies are needed to confirm these observations.
Radiation therapy is an effective treatment for various types of cancer. Overall estimates of the worldwide incidence (absolute number of cases per year) of 26 types of cancers in 2002 include 10.9 million new cases, 6.7 million deaths, and 24.6 million persons living with the disease within 5 years of diagnosis.1 Although geographical variations exist, a fair estimate for both the United States and the European Union is that 50% of long-term cancer survivors will have had radiotherapy as a primary treatment or in combination with surgery and/or chemotherapy. 2
Radiotherapy is used to limit the growth of neoplastic cells. Because radiotherapy exposes healthy cells within the vicinity of tumors and between the tumor site and the radiation source to radiation, undesirable sequelae often are unavoidable.2 Damage is usually most prominent in tissues with rapid rates of proliferation, such as skin, mucosa, and bone marrow. Often, multiple adverse cellular effects are induced by radiotherapy because free radicals and peroxides are generated in tissues, which cause changes in DNA, proteins, and cellular membranes. Although cells possess scavenging mechanisms to remove potentially destructive free radicals, these protective mechanisms are overcome by episodes of extensive or repeated radiation. Where repair is successful, normal cell function resumes but incomplete repair can lead to mutations that cause cellular dysfunction, altered proliferation, or carcinogenesis.3
Nineteenth century scientists who pioneered development of radiation for medical use recognized its adverse effects. Complex changes normally manifest in patients as either immediate (short-term or early) side effects or delayed (late) injury4-7; a subacute (intermediate) stage also has been recognized.8 It is estimated that a moderate to severe skin radiation reaction can be expected in 87% of patients. 9 Among the most serious side effects in cancer patients receiving radiotherapy are delayed wound healing and the development of new wounds following treatment.3 A retrospective study of pressure ulcers and chronic wounds (N = 36) in patients with cancer and patients without cancer indicated that patients with cancer were more likely than patients without cancer to have nonhealing wounds.
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