Use of Boswellia Serrata for Cerebral Radiation Necrosis – a Case Report

Radiation necrosis is a dose-limiting side effect of radiation therapy for brain lesions. Several treatment options are available. However, they offer limited symptomatic relief and have important side effects. Boswellia serrata extract shows promising results in reducing the associated cerebral edema and neurological symptoms. We present the case of a 44-year-old male, diagnosed with an unspecified glioma, who received surgery, followed by concurrent Temozolomide and radiation therapy on the tumor bed (60 Gy/30 fr), followed by adjuvant Temozolomide (6 cycles). Two years later, the patient became symptomatic again and an MRI confirmed two recurrent lesions, that were treated with fSRS and 6 cycles of Temozolomide. Two months later, the patient developed headaches and balance impairment and was diagnosed by MRI spectroscopy with radiation necrosis. He started treatment with corticosteroids, which he inconsistently used due to side effects. After three months he was advised to add Bevacizumab, Hyperbaric Oxygen, and Boswellia serrata. At 2 months he showed impressive symptomatic benefit, concurrent with improvement on MRI imaging, despite the suboptimal use of corticosteroids and hyperbaric oxygen.