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The article presents abstracts on topics related to trace elements and electrolytes which include the reappraisal of an old and new problem on quakery, the sensitivity of magnesium to irradiation, and the complementary and alternative medicine in lung cancer.

The author reflects on the medical management of hot flushes in tumor patients with hormonal deprivation of magnesium, which is the second most abundant intracellular cation of the human body. The author states that vasomotor symptoms are most frequent in the menopausal transition in cancer patients. An overview of the seriousness of hot flushes in patients with hormone therapy is offered. The author suggests a healthy lifestyle in order to manage the side effects of hormone therapy.

Background: The trace element Selenium is an essential cofactor of the enzyme glutathioneperoxidase (GSH-Px), which is important for the endogenous detoxification of free radicals. A reduced activity of GSH-Px is related to increased toxicities due to radiation therapy during primary cancer treatment. Therefore, selenium substitution may be a new supportive strategy to diminish radiation-associated side effects. Two observation studies were conducted to get experiences in selenium substitution during ongoing irradiation. Material and methods: The selenium blood concentrations of 121 radiotherapy-patients were measured in two randomized observation studies (81 gynecological tumors, 40 head and neck tumors). Measurements (atom absorption spectrometry) were performed in serum and whole blood (WB) samples before, at the half, at the end, and 6 weeks after radiotherapy. In case of decreased selenium levels in WB, 63 patients (mean age 63.83 ± 9.23 y) received selenium substitution (500 μg sodium selenile at RT-days, 300 jig at weekend) and 64 patients (mean age 63.03 ± 10.47 y) were evaluated as control group without any selenium substitution. Both groups were well balanced according to tumor localization and stage. Reference values were 85 - 162 μg/l WB-selenium, and 65- 135 μg/l serum-selenium. Results: We measured the following WB selenium (Se) levels (Se-group vs. control group, U-test): beginning RT 64.17 ± 13.98 μg/l vs. 64.50± 14.47 μg/l (p=0.869); half RT 92.48 ± 26.68 μg/l vs. 65.80 ± 18.04 μg/l (p <0.001); end RT 93.78 ± 25.90 μg/l vs. 64.06 ± 17.54 μg/l (p <0.001); 6 weeks after RT 74.01 ± 20.06 μg/l vs. 69.66 ± 17.83 μg/l (p = 0.183). The serum levels were as follows: beginning RT 59.18 ± 13.49 μg/l vs. 61.99 ± 15.72 jig/I (p = 0.427); half RT 104.75 ± 31.41 μg/l vs. 62.37 ± 16.23 μg/l (p <0.001); end RT 100.63 ± 31.12 μg/l vs. 62.29 ± 16.11 μg/l (p <0.001); 6 weeks after RT 72.73 ± 26.53 μg/l vs. 64.17 ± 17.22 μg/l (p = 0.170). Conclusion: The used dosage of 500 jig sodium selenite per day is sufficient to treat the selenium deficiency during radio- therapy. After the end of substitution the patient returns to his individual selenium status. [ABSTRACT FROM AUTHOR]

Objective: The substitution of selenium effects in activation of the selenium dependent enzyme glutathione peroxidase which is important for scavenging free radicals. Until today only limited data was available about the clinical impact of selenium regarding the toxicities due to free radical producing therapies, e.g. irradiation or chemotherapy. Material and methods: 39 patients (8 female, 31 male) with advanced head neck cancer were included to a randomized Phase II study. The mean age was 63.52 ± 9.31 years. Tumor localizations: oral cancer 15 patients, oropharynx 19 patients, hypopharynx 5 patients, CUP 1 patient. Group A (n = 22) received 500 μg sodium selenite at the days of radiotherapy and 300 μg sodium selenite at holidays or weekend. Group B (17) was irradiated without any selenium substitution. Both groups were well balanced according age, gender, localization and stage of the tumor. We evaluated the RTOG grade of radiation-associated toxicities once per week. Results: We observed the following serious toxicities (Group A versus Group B): dysphagia 22.7% vs. 35.3%, loss of taste 22.7% vs. 47.1%, dry mouth 22.7% vs. 23.5%, and stomatitis 36.4% vs. 23.5%. A statistical trend (Fisher's exact-test) is only seen in the area of loss of taste (p = 0,172). The analysis per week (Student t-test) had shown a significant reduction of dysphagia in the selenium group at the last week of irradiation. Conclusion: The small randomized trial has shown limited effects of selenium in the prevention of ageusia (loss of taste) and dysphagia due to radiotherapy because of head and neck cancer. [ABSTRACT FROM AUTHOR]

During the last few years we have collected data showing a relation between status of the disease and the serum concentrations of different trace elements. Are they able to monitor the disease as tumor markers? In a first study 100 untreated head and neck cancer patients were characterized by decreased levels of selenium, zinc and iron. Copper was the only increased. During the radiotherapy no changes of serum concentrations were seen. A further analysis had shown the differences between resectable and non-resectable tumors. As larger primary tumors were examined, the concentration of selenium in the serum of our patients decreased. These findings are supported by new data of NMR-tumor volumetry and trace elements concentrations in 21 patients. The relation between serum-selenium and tumor volume is stronger than between classical tumor markers (SCC; CEA, CYFRA 2 1-1) and the tumor volume. A last investigation has suggested that a destroyed homeostasis of trace elements is a sign of a pre-terminal ill patient. When the destroyed homeostasis is observed, the patient has a window of 4-6 weeks of remaining life time. Conclusions: Trace element status offers a lot of information about the course of the disease and the individual. But environmental factors have more impact on this trace element status than on other classical tumor markers. [ABSTRACT FROM AUTHOR]

Background: The aim of this prospective observation study was to evaluate, whether sodium selenite is able to compensate a preexisting selenium deficiency in adjuvant radiotherapy (RT) for pelvic gynecologic malignancies. Further, we proved the use of sodium selenite in the prevention of radiation induced diarrhoea. Patients and methods: Whole blood selenium levels were measured in patients undergoing adjuvant RT after curative surgical resection of a pelvic gynecologic tumor before RT, after completing 50% of RT, at the end of RT and six weeks after RT depending on the supplementation of sodium selenite in the verum group till the end of RT. Data were calculated for the patients who completed the study protocol. From 12/2000 to 12/2005 77 patients (median age: 65 years) completed the protocol. Results: All patients with histologically proven squamous cell and adenocarcinoma of the uterine cervix or corpus had decreased whole blood selenium levels. There is a significant increase of the mean level of whole blood selenium in the supplementation group reaching the lower border of the normal range and a decrease after cessation of selenium intake. In the control group we could not see any change of investigated mean selenium levels. Concerning diarrhoea, there has been a statistically significant difference between the study groups towards a lower incidence of diarrhea CTC 1/2 in week 5 with selenium supplementation (u-test, p=0.03). With a median follow up of 24 months (1-60) the actuarial 4 year overall survival rate of patients with supplementation of selenium was 96% compared to the control group with 71.6% (p = 0.1102). Conclusion: Our first data may serve as evidence for a successful selenium supplementation during radiotherapy of gynecological tumors. Selenium does not diminish the cytotoxic effect of radiation treatment. [ABSTRACT FROM AUTHOR]

Objective: The supportive strategy of cytoprotection is based on the idea of scavanging free radicals in order to decrease side effects due to anticancer treatment. We have investigated amifostine and sodium selenite regarding its scavanging potential in head and neck cancer patients during radiochemotherapy. Material and methods: One hundred cancer patients received simultaneous radiochemotherapy. During irradiation, 31 patients (Group 1) got 500 µg sodium selenite per day, 29 patients (Group 2) got 500 mg amifostine, and 40 patients (Group 3) got 500 µg sodium selenite and 500 mg amifostine. Amifostine was given at days with chemotherapy only. We measured serum selenium concentration, activity of glutathione peroxidase and concentration of malondialdehyde at the beginning of radiotherapy, after three weeks and at the end of combined treatment. Results: We have seen differences in the serum selenium level of the patients regarding their tumor volume. Sodium selenite, in the amount of 500 µg, was able to correct decreased selenium concentrations within three weeks. The activity of glutathionperoxidase was increased when selenium was substituted. A reduction of malondialdehyde, e.g. aggressive free radicals, were seen in patients with selenium substitution and smaller tumors (Group 1) only. If the tumor volume was larger and the therapy more aggressive, the therapy-induced production of new free radicals was limited (Groups 2 and 3). The combination of sodium selenite and amifostine (Group 3) was more effective than the administration of amifostine alone (Group 2). Conclusion: The substitution of sodium selenite is able to reduce the endogenous level of aggressive free radicals in head and neck cancer patients. Further clinical studies are necessary to evaluate synergisms with other exogenous scavangers of free radicals (for example amifostine) and to evaluate the toxicity-limiting possibilities of this new supportive strategy. [ABSTRACT FROM AUTHOR]

Objective: The use of complementary and alternative methods is common in oncology, but nothing is known about the rote of CAM in the last days of a patient's life. Material and methods: Between 1-2007 and 10-2008 the palliative care team treated 85 patients (50 male, 35 female, median age 62 years) on out-door basis. All families were asked to complete a structured questionnaire regarding the use of CAM during the last period of the patient's life. Patients suffered from cancer in 83/85 patients (98%), 2 patients had neurologic disorders. Results: Only 20 families (3 1%) have not used any CAM. Spiritual support (praying, hospice services) was asked for by 60/85 families (71%). 25/85 families (29%) reported drug use. Favorite methods were vitamins (n = 11, 13%), trace elements (n = 9, 11%), and mistletoe (n = 8, 9%). 30 patients (35%) were treated by physiotherapy (28 oncology patients, 2 neurology patients). Logopedy and ergotherapy were used in 10 patients (12%). 12 families (14%) reported use of aroma-therapy in patient's care. The main information source was the GP (house physician) (45/85, 53%)), followed by the palliative care team (30/85, 35%) and pharmacies (27/85, 32%). Internet, journals or self-service information were only used by 25/85 families (29%). The effectivity of the categorized methods was estimated between 1 and 5 (very good worthy) by the patients or their families. The following ranking was registered: spiritual support 2.4; physical therapy 2.7, logopedy/ergotherapy.3.1, drugs 3.3. 65/85 families (76%) were satisfied with the information received from the health care practitioners. Conclusion: Complementary methods are often practiced during the last days of a patients life. Families and friends are looking for valid information and need help from the professionals. The different methods have been evaluated regarding effectivity as well as acceptance by the patients. [ABSTRACT FROM AUTHOR]

Objective: A majority of radiotherapy patients is using complementary and alternative methods during anti-cancer treatment in order to improve the quality of life during this period. We investigate the influence of selenium substitution on the treatment toxicity (radiochemotherapy) in the group of head and neck cancer patients. Material and methods: 31 patients received concomittant radiochemotherapy (2 Gy Single dose, 60 Gy total dose, Week 1 and 5 with daily carboplatin 70 mg/m² about 5 days) because of their squamous cell carcinoma of the ENT region. All patients had performed primary surgery of the basic tumor and the regional lymph nodes. Additionally the patients got sodium selenite orally (1,000 µg on the days of radiochemotherapy and 500 µg an the days of radiotherapy alone). Results: We observed severe mucositis in 7/31 (22%), severe xerostomia in 8/31 (26%), and resulting severe dysphagia in 2/31(6%) of all patients. The Karnofsky performance status decreased from mean 85.5% to 30.4% at the end of radiochemotherapy. The median survival time was 21 month (range 2-62 month) after primary treatment. Conclusion: This first pilot investigation has shown decreased incidences and grades of typical toxicities as mucositis and xerostomia if selenium was substituted during the anticancer therapy. Further investigations are necessary to support this hypothesis. [ABSTRACT FROM AUTHOR]

An abstract of the article "Lymphedema in head and neck cancer patients: Modern aspects of diagnosis and treatment" by J. Büntzel and colleagues at the 14th Workshop on Trace Elements and Electrolytes in Oncology held in Chur, Switzerland in 2013 is presented.

An abstract of the article "Malnutrition in head and neck cancer patients - diagnostic standards and nutritional therapy" by J. Büntzel and colleagues at the 14th Workshop on Trace Elements and Electrolytes in Oncology held in Chur, Switzerland in 2013, is presented.