Evre II-IV rektum kanserinde metabolik destekli kemoterapinin ketojenik diyet, hipertermi ve hiperbarik oksijen tedavisi ile kombinasyonunun ön sonuçları

Öz

Amaç: Evre II-IV rektum kanserinde sistemik kemoterapi multimodalite tedavisinin bir parçasıdır. Özellikle, tanı sırasında küratif rezeksiyona uygun olmayan hastaların sonuçlarını iyileştirmek için daha etkili yaklaşımlara gerek vardır. Metabolik destekli kemoterapi (MDKT) tümör hücresinin bozulmuş enerji metabolizmasını hedef alan yeni bir yaklaşımdır. Bu çalışma, ketojenik diyet, hipertermi ve hiperbarik oksiyen tedavisi (HBOT) ile kombine edilmiş MDKT’nin başlangıçta cerrahi için uygun olmayan evre II-IV rektum kanseri hastalarındaki etkinliğini değerlendirmeyi amaçlamıştır.

Yöntemler: Metabolik destekli kemoterapi (MDKT) tedavisi ile ketojenik diyet, hipertermi ve HBOT kombinasyonu almış 21 evre II-IV rektum kanseri hastası çalışmaya dahil edilmiştir. Birinci basamak kemoterapi oksaliplatin bazlı, ikinci basamak kemoterapi ise irinotekan bazlıdır. Genel sağkalım ve progresyonsuz sağkalım hesaplanmıştır.

Bulgular: Ortalama takip süresi 33.3±22.0 aydır. Ortalama genel sağkalım 58.6 ay (95% CI, 43.3 - 73.9), ortalama progresyonsuz sağkalım 45.1 ay (95% CI, 28.9-61.2) olarak bulunmuştur. Metastatik hastalığı olanlarda ortalama genel sağkalım 35.7 ay olmuştur. Çok değişkenli analiz erkek cinsiyet ve evre IV hastalığın kötü progresyonsuz sağkalım için bağımsız belirteçler olduğunu göstermiştir. Başka hiçbir parametre sağkalım sonuçlarını etkilememiştir.

Sonuç: Bu çalışmanın bulguları, tümör hücresinin birçok zayıf noktasını hedef alan bu yeni kombinasyon protokolünün ilerlemiş rektum kanseri hastalarında, özellikle de metastatik hastalığı olanlarda, ek güvenilirlik endişesi oluşturmadan kullanılabileceği yönünde ümit vermektedir. Ancak, daha net çıkarımlara ulaşmak için uzun dönem sonuçlar gereklidir.

Anahtar Kelimeler

• rektum kanseri,metabolik destekli kemoterapi,ketojenik diyet,hipertermi,hiperbarik oksijen tedavisi,sağkalım

Preliminary results of metabolically supported chemotherapy combined with ketogenic diet, hyperthermia and hyperbaric oxygen therapy in stage II-IV rectal cancer

Abstract

Aim: Systemic chemotherapy is a part of multi-modality treatment in patients with stage II-IV rectal cancer. In particular, patients not eligible for curative resection at the time of diagnosis require more efficient approaches to improve outcomes. Metabolically supported chemotherapy (MSCT) is a novel approach targeting dysregulated energy mechanism of the tumor cell. This study aimed to examine the efficacy of MSCT combined with ketogenic diet, hyperthermia and hyperbaric oxygen therapy (HBOT) in patients with stage II-IV rectal cancer not eligible for surgery at baseline.

Methods: Twenty-one patients diagnosed with stage II-IV rectal carcinoma who received metabolically supported chemotherapy (MSCT) combined with ketogenic diet, hyperthermia and HBOT were included. First-line chemotherapy regimen was oxaliplatin-based, whereas second line regimen was irinotecan-based. Overall survival and progression-free survival were estimated.

Results: Mean duration of follow-up was 33.3±22.0 months. Mean overall survival was 58.6 months (95% CI, 43.3 - 73.9) and corresponding figure for progression-free survival was 45.1 months (95% CI, 28.9-61.2). Mean overall survival for patients with metastatic disease was 35.7 months. Multivariate analysis identified male gender and stage IV disease as independent predictors of worse progression free survival. No other parameter effected survival outcomes.

Conclusion: Findings of this study are promising for potential use of this novel combinatorial protocol targeting multiple vulnerabilities of tumor cells in patients with advanced rectal cancer, particularly for patients with metastatic disease, without additional safety concerns. However, long term results are warranted to draw firm conclusion. 

Keywords

• rectal cancer,metabolically supported chemotherapy,ketogenic diet,hyperthermia,hyperbaric oxygen therapy,survival

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