Top Line: Does boswellia serrata treat radionecrosis following radiosurgery for brain metastases?
The Study: Boswellia serrata is an over the counter supplement derived from Indian frankincense. Some small studies have suggested that the anti-inflammatory properties of boswellia serrata may help reduce inflammation edema in patients with radionecrosis. In this retrospective cohort study, 100 patients were identified who developed radionecrosis after SRS and received boswellia serrata. Patients were treated with 1 (18-20 Gy, 38%), 3 (24-27 Gy, 50%), or 5 fractions (25-30 Gy, 12%). Most had grade 1 (44%) or grade 2 (47%) radionecrosis with a small subset having grade 3 radionecrosis, and 44% were symptomatic. The median duration of boswellia was 7.8 months, and the median dose was 4200 mg (4050-4500 mg). This dose is pretty high, so it was usually given in divided doses over the day. Boswellia can cause GI symptoms, but only 14% had grade 2 GI toxicity and 2% had grade 2 GI toxicity. The overall response rate was 59.6% with complete response in 12% and a partial response (>30% decrease in edema) in 48%. Most patients (73%) never required steroids during treatment with boswellia.
TBL: This study adds to the data suggesting that boswellia serrata is a safe and effective over the counter treatment for radionecrosis. | Upadhyay, Int J Radiat Oncol Biol Phys 2025
The Study: Boswellia serrata is an over the counter supplement derived from Indian frankincense. Some small studies have suggested that the anti-inflammatory properties of boswellia serrata may help reduce inflammation edema in patients with radionecrosis. In this retrospective cohort study, 100 patients were identified who developed radionecrosis after SRS and received boswellia serrata. Patients were treated with 1 (18-20 Gy, 38%), 3 (24-27 Gy, 50%), or 5 fractions (25-30 Gy, 12%). Most had grade 1 (44%) or grade 2 (47%) radionecrosis with a small subset having grade 3 radionecrosis, and 44% were symptomatic. The median duration of boswellia was 7.8 months, and the median dose was 4200 mg (4050-4500 mg). This dose is pretty high, so it was usually given in divided doses over the day. Boswellia can cause GI symptoms, but only 14% had grade 2 GI toxicity and 2% had grade 2 GI toxicity. The overall response rate was 59.6% with complete response in 12% and a partial response (>30% decrease in edema) in 48%. Most patients (73%) never required steroids during treatment with boswellia.
TBL: This study adds to the data suggesting that boswellia serrata is a safe and effective over the counter treatment for radionecrosis. | Upadhyay, Int J Radiat Oncol Biol Phys 2025