Radiation Support Protocol

Coordinate with radiation oncologist: Discuss all interventions - some antioxidants during radiation controversial (may protect cancer, though evidence mixed)

During radiation - skin care: Gentle fragrance-free cleanser (Cetaphil), pat dry (don't rub), apply radiation burn cream (Calendula, Aquaphor, Miaderm, Biafine) 2-3x daily, wear loose cotton clothing, avoid sun exposure, no deodorant if underarm radiation (aluminum may increase dose - use cornstarch), avoid hot water, swimming pools (chlorine irritates), fragrances

Calendula cream: Apply topically 2x daily during radiation (RCT showed reduced radiation dermatitis vs placebo) - Boiron Calendula ointment

Aloe vera gel: Pure aloe gel (not lotion with additives) applied 2x daily (reduces radiation burns - use fresh aloe or pure gel)

Vitamin E cream: After radiation completed, apply vitamin E oil to skin (may reduce fibrosis, improves healing) - during radiation controversial

Glutamine: 10-20g 2x daily if radiation to head/neck or GI tract (prevents/treats mucositis, improves swallowing, reduces diarrhia from pelvic radiation)

Honey: Medical-grade honey (Manuka) for oral mucositis from head/neck radiation - swish and swallow before and after radiation (reduces severity of mucositis in RCTs)

Oral glutamine swish: 4-6g in water, swish for 2 minutes then swallow, 3x daily if mouth/throat radiation

NAC: 1200mg 2x daily (protects normal tissues from radiation damage, may reduce pneumonitis from chest radiation) - take away from radiation (12+ hours) per some protocols

Vitamin D: Optimize 50-80 ng/ml (immune support, tissue healing)

Probiotics: High-dose if pelvic radiation (reduces diarrhea)

Omega-3: 2-3g EPA/DHA (anti-inflammatory, reduces tissue damage)

Curcumin: 1-2g daily (anti-inflammatory, may reduce radiation side effects - controversial during radiation, coordinate timing)

Vitamin C: Low-dose 500-1000mg (antioxidant support) - high-dose IV vitamin C during radiation is controversial (may protect tumor, though some integrative oncologists use)

Vitamin E: 400 IU oral (protects against radiation-induced fibrosis - controversial during radiation, safer after completion)

CoQ10: 200-400mg (if chest radiation - protects heart and lungs)

Avoid: Antioxidants high-dose during radiation per mainstream (may protect tumor - controversial, discuss with RO), alcohol, smoking (worsens side effects, impairs healing), sun exposure on radiated skin (photosensitive for months-years)

Hydration: 3+ liters daily (flushes radiation byproducts, supports healing)

Nutrition: High protein 1.5-2g/kg (healing, prevent weight loss), adequate calories, soft foods if throat radiation (smoothies, soups, avoid spicy/acidic), avoid alcohol/tobacco

Hyperbaric oxygen: For late radiation tissue damage (osteoradionecrosis, radiation cystitis, proctitis) - typically 20-40 sessions at 2.0-2.4 ATA after radiation completed (improves tissue oxygenation, stimulates angiogenesis, healing) - covered by insurance for specific indications

Post-radiation fibrosis: Vitamin E + pentoxifylline protocol (400 IU vitamin E 2x daily + pentoxifylline 400mg 3x daily for 6-12 months reduces radiation fibrosis in studies - breast, head/neck radiation)

Lymphedema prevention: If radiation to lymph nodes (axilla, groin) - compression, manual lymphatic drainage, avoid blood draws/BP on that arm, exercise (prevent lymphedema)

Bowel/bladder symptoms: If pelvic radiation - probiotics, glutamine, avoid spicy foods, Metamucil for bulk, may need prescription for urgency (ditropan for bladder, lomotil for bowel)

Fatigue: Near-universal - pace activities, rest when needed, maintain light exercise (walking), nutrition, rule out anemia, thyroid (radiation to neck can cause hypothyroid)

Long-term surveillance: Radiation increases second cancer risk (5-20 years later), hypothyroidism (if neck radiation - check TSH annually), cardiac disease (if chest radiation - ECHO/stress test screening), monitor for late toxicities