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

Year 2020, Volume: 5 Issue: 1, 16 - 20, 20.03.2020

Mehmet Salih İyikesici

https://doi.org/10.25000/acem.650341

Cited By: 4

Abstract

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.

Keywords

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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