How do you use Boswellia for radiation necrosis?

I reached out to my colleague, naturopath Lise Alschuler, Associate Director of the University of Arizona Fellowship Program in Integrative Medicine program, for her thoughts on this question. Here is her answer:

This study by Upadhyay et al. is a well-designed study which builds upon earlier studies showing that Boswellia may reduce steroid use in patients receiving brain radiotherapy. One earlier study by Di Pierro et al., PMID 31096725 studied the effects of 4500 mg Boswellia (as a phytosome-b...

Our current practice is to begin Boswellia 4200-4800 mg per day if the first post-SRS/SRT MRI shows worsening edema. And if any patients subsequently develop grade 1 radionecrosis later in their follow-up. If a patient has mild symptoms, we also begin Boswellia and use steroids only for refractory cases. We have several patient handouts with examples we like to use from Amazon. I have also had patients take boswellia and turmeric, or take with a fatty meal.

I have started using it given the cited data, favoring it primarily in those who have radiographic edema without overt symptomology. I'm not personally at a point where I would skip steroids in the hopes that Frankincense would fix the problem.

Even if it does happen to do nothing, the downsides are relatively minimal. I don't know that there is a 'right' answer in regards to which supplement brand to trust given the lack of regulation in this space.