International Journal of Cancer Research and Molecular Mechanisms

5

Authors: Michael K Gibson

Background: The treatment of resectable stages of esophageal cancer often involves pre-operative concurrent chemoradiotherapy. This study aims to evaluate the effect of cisplatin/paclitaxel-based neoadjuvant chemoradiotherapy on pathologic stage and survival in patients with locally advanced esophageal cancer. Methods: Patients (n=67) received cisplatin/paclitaxel-based induction chemoradiotherapy followed by esophagectomy. Survival calculated from time of surgery was stratified by pathologic stage and controlled for clinical factors. Results: Clinical factors included: age (range 40 to 76 years); gender (64 male; 3 female); and histology (59 adeno; 8 squamous cell). Pretreatment stages were: IIA (n=2); IIB (n=8); III (n=49) and IVa (n=8). Treatment led to downstaging in 54 patients, and 19 patients achieved a pathologic complete response (pCR). Post-treatment (pathologic) stages were: 0 (n=19); I (n=6); IIA (n=26); IIB (n=7); III (n=6); IV (n=3). Median survival was 47.5 months with minimum follow up of 5 months for surviving patients. Number of stage reductions did not correlate with survival (p=0.83 by chi2 ), and 6/13 patients with no downstaging are alive at the time of analysis. Median survivals for each pathologic stage were: 0 (not reached); I (31 months); IIA (35 months); IIB (17 months); III (11 months); and IV (4 months)—[p <0.01 by logrank test]. In a Cox multivariate model adjusted for age, gender and histology, higher pathologic stage correlated with worse survival (HR 1.44; 95% CI 1.12-1.86). Conclusions: Cisplatin/paclitaxel-based neoadjuvant chemoradiotherapy for resectable esophageal cancer leads to pathologic downstaging in most patients, and lower pathologic stage correlates with better survival.

6

Authors: Colleen Huber

Background: Correlation between blood glucose or glycemic load and neoplastic growth has been established for a number of types of cancer. Previous studies involved mice and/or fewer than 20 human subjects and/or were retrospective. This is a 7-year interventional study of 317 consecutive human cancer patients at one clinic, who were treated naturopathically, with cancer-disrupting nutrients and herbs, plus the abstention from sweetened foods as the dietary intervention. Methods: Mortality vs survival was recorded of sweetened food eaters among cancer patients at one clinic over a seven-year period. Since 2006, this clinic has recorded data on consumption of sugar and other sweeteners in cancer patients, and has consistently recommended, but never mandated, avoidance of sweetened foods, except with extracts of the plant Stevia rebaudiana, which does not contain saccharides or sugar alcohol. In this controlled interventional study, the diets and outcomes are reported for all 317 patients with a diagnosis of cancer who were treated at the clinic, and who stayed at least two weeks in treatment. All results are reported in this paper. Results: Achievement of remission was quite different for the following two categories: all patients: 151/317=48% and those who ate sweetened foods: 9/29=31%. The difference between these two groups was much stronger for the cohort of patients who continued treatments until either remission or death. Comparing all patients who were steadfast in the recommended treatments with the sweetened food eaters who were steadfast in all but dietary recommendations, 151/183=83% of all completely steadfast patients achieved remission, but only 9/25=36% of the steadfast sweetened food eaters achieved remission. Remission was defined as no visibly active tumor on MRI imaging of the same area that had previously active tumor growth. Of all patients who were steadfast in the treatments (including the sweetened food eaters), 32/183=17% died while still under the care of the clinic, but considering only the sweetened food eaters who otherwise consistently pursued the recommended treatments, 16/25=64% died. Conclusions: In this first ever, long-term interventional study of glycemic restriction in hundreds of cancer patients, we found that sweetened foods (other than stevia-sweetened foods) were highly correlated with patient mortality across all types and all stages of cancer. Stevia is therefore recommended as the only sweetener to be used by cancer patients.

4

Authors: Akdemir O

Background: Locally advanced rectal cancer is defined as a rectal mass that cannot be resected without a high probability of leaving residual disease at the tumor site. While the standard treatment for locally advanced rectal cancer is chemoradiotherapy followed by surgery, this study reports a locally invasive rectal adenocarcinoma patient who achieved complete pathological and clinical remission after receiving a combination of metabolically supported chemotherapy (MSCT), radiotherapy (RT) and hyperthermia (HT). Case presentation: An 81-year-old female underwent a rectosigmoidoscopy at a referring hospital following a complaint of bloody stools for a period of 20 days. The rectosigmoidoscopy revealed an ulcerated tumor beginning at the level of the anal sphincter. A pathological examination of biopsy material revealed moderately differentiated invasive adenocarcinoma and the patient received a diagnosis of stage III (T3N2M0) lowlying rectal cancer. When further follow-up revealed colonic obstruction, the patient was recommended an abdominoperineal resection (APR) and was referred after refusing surgical treatment. The patient received a metabolically supported combination of oxaliplatin, 5-florouracil (5-FU) and calcium folinate (FOLFOX6) concomitant to RT and local HT and, ultimately, never underwent surgery. 27 months since her disease-free PET-CT scan, the patient remains with no sign of disease recurrence. Conclusion: According to the findings of the present study, the non-surgical treatment and achievement of complete clinical and pathological remission of locally advanced rectal adenocarcinoma may be possible by means of a combination of MSCT, RT and HT.

4

Authors: Uy AB

Lymphoma and tuberculosis (TB) share common features, thus misdiagnoses are commonly encountered. The Philippines is ninth out of the 22 countries in the world with the highest TB-burden, while lymphoma has age-standardized rates of 4.6/100,000 population in all ages in Manila. This study reports a case of a 24-year-old HIV-negative male presenting with a six-month course of anorexia, weight loss, fever, night sweats, and hepatosplenomegaly. Heamatologic studies revealed anemia. Bilirubins, alkaline phosphatase, and lactate dehydrogenase were elevated, while transaminases were normal. Initial chest X-ray showed nodular infiltrates on both lung apices and a negative sputum acid-fast bacilli smear. Contrast-enhanced computed tomography (CT) scan of the chest and abdomen revealed multiple tiny, non-calcified pulmonary parenchymal nodules on both lung fields, marked hepatomegaly with multiple nodules in the portahepatic, retroperitoneal and mesenteric region consistent with lymphadenopathies; and splenomegaly with intraparenchymal cystic nodules. Primary considerations were gastrointestinal lymphoma versus TB. The patient was diagnosed late with severe disseminated TB affecting the lungs, liver, spleen, genitourinary tract and intestines. No anti-TB treatment was started within the patient’s six-month course because of uncertainty in the diagnosis, especially in light of the negative sputum acid-fast bacilli smears. Malnutrition, anemia, hypoalbuminemia, and an overall immune compromised state contributed to the demise of the patient while undergoing surgery for a ruptured viscus from ileocecal TB invasion. TB is a disease that can be easily controlled and treated. The decision to start empiric treatment with anti-TB medications has a higher benefit versus risk of complications, especially in a patient with a high index of suspicion for the disease.