Written by Ellen McDonell, Gabriele Dennert and the CAM-Cancer Consortium.
Updated September 11, 2018

Boswellia spp

Does it work?

Two prospective clinical studies, a retrospective and a prospective case series – all involving patients with brain tumours or metastases – as well as a case report of a female patient with brain metastases have been published. One controlled clinical trial of a topical 2% Boswellia cream for women receiving adjuvant breast radiation has been published.

Brain oedema

Clinical trials

Findings from a randomised clinical pilot trial with 44 patients suggest a positive effect of Boswellia serrata on brain oedema 29,30. Patients receiving irradiation of the brain for primary brain tumours or brain metastases of solid tumours were administered either 3 x 1400 mg/d Boswellia extracts during radiotherapy or placebo. In patients with brain metastases, a reduction of brain oedema (evaluated by MRI scans) of > 75% was seen in 60% in the Boswellia group and in 26% in the placebo group at the end of radiotherapy (p=0.023). Reevaluation at 4 weeks after radiotherapy showed no differences between Boswellia and placebo groups, which might be attributable to the termination of Boswellia intake at the end of radiotherapy. No differences could be seen in patients with primary brain tumours (small number of participants).

A prospective clinical study with 29 glioma patients was conducted by Heldt19 and Böker20. Participants were non-randomly allocated to receive three different doses of Boswellia extracts (3 x 1200 mg/d, 3 x 800 mg/d, 3 x 400 mg/d) prior to surgical intervention. After seven days of intervention, the size of perifocal oedema was reduced in the CT scans of participants receiving 3 x 1200 mg/d and – to a lower degree – in participants receiving 3 x 800 mg/d. Improvement in clinical symptoms was found only in the group receiving the highest daily dose. These participants also had a reduced urinary excretion of leukotrien E4 (LTE4) (as a measurement of leukotrien synthesis in the body). No effect on the tumour size was observed. Due to the study design, it is unclear whether changes in oedema size or clinical improvement can be attributed to olibanum intake.

Case studies/series

Janssen17 evaluated the use of H15 retrospectively in 17 female and male children (age 0.5 to 18 years) with different progressive or relapsed brain tumours. H15 was administered orally at 40 to 126 mg/kg body weight per day over 1 to 26 months with or without concomitant conventional therapy. Subjective improvement was reported by six patients, clinical regression of neurological symptoms was documented in four patients. In two patients, regression of the peritumoural oedema or reduction of a tumour cyst were documented by MRI. Four children remained in stable disease over 3 to 8 months and two showed tumour regression. However, these effects were more likely attributable to concomitant radio- and chemotherapy than to Boswellia extracts.

Streffer et al.18 published a prospective case series of 12 adult patients with progressive cerebral oedema with or without overt tumour progression (seven with glioblastoma and five with leukencephalopathy after conventional tumour therapy). All study participants had to be taken off steroids or on a stable dosage of steroids. H15 was administered orally at 3 x 1200 mg/d. Three participants with glioblastoma reported a clinical improvement, in two of these three cases a reduction in perifocal oedema could be seen in MRI scan. All five participants with leukencephalopathy reported a clinical benefit. No tumour response was seen in any patient.

Both case series suggest that there might be a beneficial effect for Boswellia extracts on brain oedema in study participants with brain tumours or leukencephalopathy. The applicability of these findings to other patients, however, is limited due to selection of participants and study design.

Flavin22 reported the favourable course of a 39-year old women with newly developed symptomatic multiple brain metastases of a mammacarcinoma, which were documented in a CT scan, one year after initial diagnosis. She received radiation therapy of the brain and capecitabine chemotherapy and also started with Boswellia serrata, 3 x 800 mg/d orally. After 10 weeks of treatment, brain metastases could no longer be seen in the CT scan. The patient was maintained on Boswellia serrata for another 4 years without signs of recurrent cerebral metastases, but newly developed bone metastases after that period.

However, it is not possible to attribute the long-term remission of her brain metastases to Boswellia extracts. Both radiotherapy and capecitabine treatment23 have reportedly induced remission of CNS metastases and may have been the active treatment in this case. Nevertheless, a long-term remission of multiple CNS metastases is rare and all involved possibly beneficial interventions, including Boswellia extracts, deserve consideration in future investigations.

Other outcomes

A randomized, placebo-controlled trial evaluated the effect of topical 2% Boswellic acid cream applied twice daily compared to a base cream onradiation dermatitisin 114 women receiving adjuvant breast radiotherapy (34). Erythema was evaluated after a total dose of 50 Gy was delivered, and was evaluated with a visual scale (slight, moderate, intense), and a computer-assisted analysis of photos. Secondary endpoints consisted of use of hydrocortisone cream, and adverse effects. There was a statistically significant difference in erythema on the visual scale; of note intense erythema was reported in 49% of placebo cream users versus 22% of Boswellia users, and more people using Boswellia cream had slight or moderate intensity erythema. More patients received hydrocortisone cream in the placebo group than in the Boswellia cream group (63% and 25% respectively, p < 0.0001). Treatment was well tolerated. Authors do not comment on whether the trial was double blinded, or whether unmasking could have occurred due to the smell of Boswellia, which may affect the methodological rigor of the trial.

Boswelliaessential oilalone or in combination with other oils has been used as aromatherapy (37-39). No clinical trials exist on the use of frankincense essential oil alone for cancer-related symptoms, however a retrospective audit in a cancer centre (37) and one case report (38) suggest a potential for quality of life improvements. Future clinical trials should evaluate this further.

Citation Ellen McDonell, Gabriele Dennert, CAM-Cancer Consortium. Boswellia spp [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Boswellia-spp. September 11, 2018.


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