A novel lecithin-based delivery form of Boswellic acids as complementary treatment of radiochemotherapy-induced cerebral edema in patients with glioblastoma multiforme: a longitudinal pilot experience

J Neurosurg Sci. 2019 Jun;63(3):286-291. doi: 10.23736/S0390-5616.19.04662-9.


Background: Glioblastoma multiforme (GBM) is an extremely challenging neurological disease for which the development of more effective therapeutic options and of adjuvant/complementary treatment is needed. We investigated the effects of an innovative phytosome-based delivery form of boswellic acids extract (Monoselect AKBA™) on radiochemotherapy-induced cerebral edema in patients with primary GBM.

Methods: Patients with de novo GBM treated with surgery, radiotherapy and chemotherapy with temozolomide were enrolled in this longitudinal study and received boswellia-based product 4500 mg/die for a maximum of 34 weeks. Cerebral edema was assessed at 4, 12, 22 and 34 weeks post-surgery, together with steroids consumption and patients' psychological status.

Results: A total of 20 patients were included in the study. The percentage of patients with reduced edema was constant during the study, while the percentage of those with reduced or stable edema tended to increase over time. Of note, two patients achieved a considerable reduction in brain edema, which led to a more favorable and beneficial surgical resection. In addition, a good percentage of patients assumed a stable/reduced steroids dose or were dexamethasone free during the study. Lastly, patients' QoL and psychological state were maintained throughout the study.

Conclusions: Complementary treatment with Monoselect AKBA™ might exert a beneficial effect in reducing radiochemotherapy-induced cerebral edema, thanks to the anti-inflammatory properties of the boswellia serrata extract. The reduction in brain edema might diminish dexamethasone assumption, thus minimizing steroids-induced side effects, and in few cases may allow a complete surgical excision of the tumor mass.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Antineoplastic Agents, Alkylating / adverse effects
  • Brain Edema / drug therapy*
  • Brain Edema / etiology
  • Brain Neoplasms / therapy*
  • Chemoradiotherapy / adverse effects*
  • Dosage Forms
  • Female
  • Glioblastoma / therapy*
  • Humans
  • Lecithins
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Pilot Projects
  • Temozolomide / adverse effects
  • Triterpenes / administration & dosage*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antineoplastic Agents, Alkylating
  • Dosage Forms
  • Lecithins
  • Triterpenes
  • acetyl-11-ketoboswellic acid
  • Temozolomide