Effect of pomegranate extract (PFE) in human radiodermatitis patients with squamous cell carcinoma (SCC) after radiotherapy
Studies carried out by the authors and other research groups have shown that pomegranate extract and other naturally occurring antioxidants, such as centella aciatica and green tea are effective in reducing the adverse effects of UVA/UVB or linear accelerator-mediated cutaneous damage. In addition pomegranate extract protects the skin by inhibiting UVB- and UVA-induced modulations of NF-kB and MAP kinase pathways. Our data suggest that the mechanism of the photochemopreventive effect of pomegranate extract against X-ray mediated damage is possibly similar to that demonstrated with UVB, UVA ionizing radiation
Introduction Radiodermatitis caused by radiotherapy is characterized by erythema and/or necrosis of the skin. This sometimes requires therapeutic protocols to be suspended, thus increasing the overall length of treatment time. Currently, there is no standard treatment for radiodermatitis but emollients or topical drugs such as steroids are commonly used. The development of effective photochemopreventive agents capable of ameliorating the effects of UV-induced damage is an area of ongoing research. One such agent is extracted from the pomegranate derived from the Punica granatum tree, a fruit recognized since antiquity for its healing properties. Recent studies have suggested that pomegranate extract (PFE) is an effective agent for ameliorating UVA and UVB-mediated damage by modulating cellular pathways and merits further evaluation as a photochemopreventive agent. In order to study the photochemopreventive potential of pomegranate extract (Biotrek, Greece) in an in vivo situation, its effect was studied in radiotherapy induced erythema.
Methods Two groups of 10 patients diagnosed with SCC were evaluated by different investigators who were asked to apply a emulsion containing 0.2% PFE twice a day, once in the morning and once in the evening in one group, while in the other group the same emulsion was applied without PFE (control group). The efficacy of the pomegranate extract emulsion was evaluated by determining the erythema index (EI) at time 0 and after 20 days of radiotherapy (Roentgen 150 kV, 16 mA, 55 Gy/22 fractions) using a Mexameter MX 18 instrument (Courage Khazaka Electronic). The statistical analysis of the results was carried out using the unpaired t-test, values of P<0.05 were considered statistically significant.
Results The subjects in the group in which pomegranate extract-emulsion was applied, did not show a significant increase in the intensity of cutaneous erythema (P=0.0775), while in contrast the results obtained in the control group indicated that there was a significant increase in the erythema after 22 days (P<0.0001).
Conclusion Studies carried out by the authors and other research groups have shown that pomegranate extract and other naturally occurring antioxidants, such as centella aciatica and green tea are effective in reducing the adverse effects of UVA/UVB or linear accelerator-mediated cutaneous damage. In addition pomegranate extract protects the skin by inhibiting UVB- and UVA-induced modulations of NF-kB and MAP kinase pathways. Our data suggest that the mechanism of the photochemopreventive effect of pomegranate extract against X-ray mediated damage is possibly similar to that demonstrated with UVB, UVA ionizing radiation.
