Nutraceutical therapies for radiation-induced injury: A systematic review and meta-analysis.

Abstract

e24196 Background: Radiation-induced edema and necrosis are common, dose-limiting toxicities. Corticosteroids remain first-line therapy but are associated with significant morbidity and limited long-term tolerability. Dietary and herbal agents with antioxidant, anti-inflammatory, and neurovascular protective properties are suggested as adjunct or steroid-sparing agents, yet systematic analysis of their overall efficacy is unclear. Methods: A systematic search of PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was conducted from inception through December 2025. Eligible studies included randomized trials and observational studies evaluating non-traditional dietary or herbal interventions for radiation-induced cerebral edema or injury. The primary outcome was radiographic improvement of cerebral edema on MRI, harmonized as any MRI-documented reduction or resolution of edema or necrosis. A random-effects comparative meta-analysis was performed for controlled studies with extractable binary outcomes, excluding case reports. A secondary random-effects, single-arm meta-analysis of proportions was conducted for Boswellia serrata , including observational cohorts and case series. Studies without MRI-based cerebral toxicity endpoints were synthesized qualitatively. Results: Eleven studies encompassing more than 400 patients met the inclusion criteria. Boswellia serrata was the most frequently evaluated intervention, followed by dl-3-n-butylphthalide, vitamin E, omega-3 fatty acids, melatonin, multi-herbal formulations, and integrative multi-compound regimens. In a comparative meta-analysis of two controlled studies, dietary and herbal interventions were associated with a significantly higher likelihood of radiographic improvement in cerebral edema compared with standard therapy or placebo (pooled risk ratio 1.60, 95% CI 1.12–2.30; I² = 0%). In a secondary, single-arm, meta-analysis of five Boswellia serrata studies, the pooled radiographic response rate was 56.2% (95% CI 45.0%–67.1%). Across other studies, neurologic and cognitive improvement and steroid-sparing effects were commonly reported, while serious treatment-related adverse events were uncommon. Integrative oncology approaches combining Boswellia serrata with other natural compounds were also associated with improved survival and reduced steroid dependence in longitudinal observational studies. Conclusions: Dietary and herbal interventions, particularly Boswellia serrata , are associated with meaningful radiographic and clinical improvement in radiation-induced cerebral edema and brain injury, with favorable safety profiles. These findings support further prospective randomized trials and suggest a potential adjunctive role for non-pharmacologic therapies in managing radiation-related neurotoxicity.