Sodium selenite as prophylaxis against erysipelas in secondary lymphedema. Reduction of postoperative lymphedema after oral tumor surgery with sodium selenite.
In a randomised, double-blind study, the efficacy of sodium selenite application in combination with physical therapy to relieve congestion was investigated in a cohort of 60 cancer patients with secondary lymphedema, with special reference to the development of the incidence of erysipelas. All of the patients investigated in this study had erysipelas infection of the skin. Selenium was administered in pharmacological doses. The duration of physical therapy was three weeks. Patients were under observation for a further three months. The incidence of erysipelas among our patients was 11%. During the three-week period of intensive treatment, there was not a single case of erysipelas in the treatment group, whereas there was one single case in the placebo group. In the follow-up period (3 months), once again there was not a single case of erysipelas in the treatment group, but 50% of the patients in the placebo group exhibited erysipelas. In spite of higher doses, the selenium level did not rise above normal values. Patients under long-term antibiotic therapy suffered no relapse when the antibiotic therapy was stopped and instead, selenium was administered. It could be shown, in addition, that by administration of a single high-dose of sodium selenite, inflammation could be immediately brought under control. The objective of this double-blind, randomized study was to establish whether sodium selenite administered orally or intravenously reduces postoperative lymphedema after oral tumor surgery and to study the effect of sodium selenite on glutathione peroxidase (GPX) activity and oxygen radical production. Twenty patients were enrolled in the study. Each of the participants received 1,000 microg sodium selenite intravenously or orally daily for 3 wk during the pre-, intra-, and postoperative period. The extent of lymphedema was measured for 2 wk and the plasma and whole-blood selenium concentration, GPX, reactive oxygen species (ROS), NO, and malonic dialdehyde were measured for 1 yr postoperatively. There was an inverse correlation between the severity of the lymphedema and the whole-blood/plasma selenium concentration and GPX activity. In addition, a positive correlation between the ROS concentration and the extent of lymphedema was observed. A significant reduction of lymphedema occurred in the sodium selenite-treated group. It is concluded that sodium selenite represents a suitable adjuvant treatment of secondary lymphedema in surgically treated patients with tumors in the oral and maxillofacial areas. Treatment with sodium selenite is especially advantageous as it can be instituted immediately after surgery prior to wound healing when manual lymphatic decongestion therapy cannot be applied.
There is insufficient evidence at present that selenium supplementation alleviates the side effects of tumour specific chemotherapy or radiotherapy treatments or that it improves the after-effects of surgery, or improves quality-of-life in cancer patients or reduces secondary lymphoedema. To date, research findings do not provide a basis for any recommendation in favour or against selenium supplementation in cancer patients. Potential hazards of supplementing a trace mineral should be kept in mind. Since the last version of this review, the one new additional study has not provided information to change the conclusions of the original review.