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Metabolic Response to a Personalized Multimodal Treatment Strategy in Advanced Pancreatic Adenocarcinoma
Curr Oncol. 2026 Aug 19;33(8):489.
Abstract
Background: Metastatic pancreatic adenocarcinoma carries a poor prognosis, and treatment options remain limited for patients who progress on standard chemotherapy. This report describes the metabolic response observed in a patient with drug-resistant disease following dose-reduced (“activated”) multi-agent chemotherapy combined with targeted agents and metabolic/microenvironmental support, alongside an unusually long overall survival.
Case Presentation: A 46-year-old man was diagnosed in June 2023 with inoperable, locally advanced/stage IV pancreatic adenocarcinoma. For approximately 2.5 years he maintained disease control on a combined multimodal protocol referred to here as metabolically controlled oncological treatment (MCOT): dose-reduced chemotherapy administered together with regional hyperthermia, hyperbaric oxygen therapy, and a carbohydrate-restricted diet. In February 2026 he developed local recurrence and extensive liver metastases; by May 2026 his condition had deteriorated rapidly, with a peak SUVmax of 18.2 on 18F-FDG PET/CT. The protocol was intensified to a low-dose, multi-agent “activated” chemotherapy regimen combined with lenvatinib, everolimus, hyperthermia, and hyperbaric oxygen therapy.
Treatment Methods: “Activated” chemotherapy refers to administration in a metronomic fashion: cytotoxic agents were given at no more than 50% of their conventional doses at frequent intervals (every 14 days). Treatment was delivered under metabolically optimized conditions: a dietitian-supervised carbohydrate-restricted ketogenic diet, regional hyperthermia (Oncotherm EHY-1030, 60 minutes, three consecutive days), and hyperbaric oxygen therapy (Quamvis 320, 1.5 ATA, 60–90 minutes, three consecutive days). These components were intended to improve tumor perfusion, oxygenation, drug distribution, and chemosensitivity while minimizing treatment-related toxicity.
Clinical Findings and Outcomes: After one month, the patient’s performance status improved from ECOG PS 2 to PS 0, and follow-up PET/CT showed a 63.7% reduction in SUVmax (from 18.2 to 6.6). Treatment-related adverse effects were limited to Grade 1 nausea, Grade 1 vomiting, and thrombocytopenia; no Grade 2 or higher non-hematologic toxicity was observed.
Conclusion: In selected patients considered to have exhausted standard treatment options, a combined multimodal protocol pairing dose-reduced chemotherapy with metabolic and microenvironmental support may produce a well-tolerated metabolic response. As this is a single, uncontrolled observation, these findings do not establish causality and require confirmation in prospective, controlled studies.
Clinical Research Framework Proposal for Ketogenic Metabolic Therapy in Glioblastoma
BMC Med. 2024 Dec 5;22(1):578.
Abstract
Glioblastoma (GBM) is the most aggressive primary brain tumor in adults, with a prognosis that remains almost universally lethal despite maximal standard therapies. This work presents a consensus treatment protocol based on the metabolic requirements of GBM cells for the two major fermentable fuels: glucose and glutamine. Glucose provides carbon and ATP for tumor growth through glycolysis, while glutamine supplies nitrogen, carbon, and ATP synthesis through glutaminolysis. Since no tumor can grow without anabolic substrates or energy, simultaneously targeting glycolysis and glutaminolysis is expected to reduce the proliferation of most, if not all, GBM cells. Ketogenic metabolic therapy (KMT) leverages diet-drug combinations that inhibit glycolysis, glutaminolysis, and growth signaling while shifting energy metabolism toward therapeutic ketosis. The glucose-ketone index (GKI) serves as a standardized biomarker for assessing biological compliance, ideally through real-time monitoring. KMT aims to increase substrate competition and normalize the tumor microenvironment through GKI-adjusted ketogenic diets, calorie restriction, and fasting, while targeting glycolytic and glutaminolytic flux with specific metabolic inhibitors. Non-fermentable fuels such as ketone bodies, fatty acids, and lactate are comparatively less able to meet the long-term bioenergetic and biosynthetic demands of cancer cell proliferation. The proposed strategy may be applied as a synergistic metabolic priming platform in other tumors driven by glycolysis and glutaminolysis, as in GBM, independent of their residual mitochondrial function. Best-practice recommendations are provided to guide future KMT research in metabolic oncology, offering a common, evidence-based framework for observational and interventional studies.
Metabolically Supported Chemotherapy for Managing End-Stage Breast Cancer: A Complete and Durable Response
Cureus. 2021 Apr 26;13(4).
Abstract
Breast cancer accounts for significant morbidity and mortality worldwide. Currently, treatment options in metastatic breast cancer consist of chemotherapy, along with endocrine, radiation, and/or biological therapies. Although advances in management have improved overall survival times, the treatment options for women with end-stage disease are mostly limited to supportive care.
Herein, we present a case report that highlights the response of a 47-year-old premenopausal woman with end-stage (T4N3M1) breast cancer treated with metabolically supported chemotherapy (MSCT), ketogenic diet (KD), hyperthermia (HT), and hyperbaric oxygen therapy (HBOT). The patient first noticed a right breast mass in late 2016, which was initially evaluated and ruled out as a cyst. Skin ulceration was observed in the region of the suspected cyst in May 2017. Subsequent bilateral breast ultrasound identified masses in both breasts and an enlarged right axillary lymph node. The diagnosis following biopsy was grade 3, estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), human epidermal growth factor receptor 2 negative (HER2-), invasive ductal carcinoma of the breast. Initially, the patient refused to receive conventional chemotherapy because of its potential for side effects and toxicity, but she sought medical treatment in August 2018 following extensive disease progression and deterioration of general health.
On re-evaluation, the patient was considered ineligible for conventional treatment due to her advanced end-stage disease, poor performance status (Eastern Cooperative Oncology Group score: 3), and advanced respiratory symptoms. Exploring other options, the patient was admitted to the ChemoThermia Oncology Center, Istanbul, Turkey in November 2018. At that time, the patient weighed 38 kg (body mass index: 18.1 kg/m2) and had extensive metastatic disease with lesions in the brain, lungs, mediastinum, liver, abdomen, and bones that were detected by magnetic resonance imaging of the brain (with contrast) and whole-body (18F)-fluorodeoxyglucose-positron emission tomography-computed tomography. The patient received a six-month treatment protocol comprised of MSCT, KD, HT, and HBOT, which eliminated all detectable lesions.
The therapeutic response was sustained for two years with maintenance treatment comprising KD, dietary supplements, and repurposed medications. This single case report presents evidence of a complete and durable response to a treatment protocol combining MSCT and a novel metabolic therapy in a patient with end-stage breast cancer.
Consideration of Ketogenic Metabolic Therapy as a Complementary or Alternative Approach for Managing Breast Cancer
Front Nutr. 2020 Mar 11;7:21.
Abstract
Breast cancer remains as a significant cause of morbidity and mortality in women. Ultrastructural and biochemical evidence from breast biopsy tissue and cancer cells shows mitochondrial abnormalities that are incompatible with energy production through oxidative phosphorylation (OxPhos). Consequently, breast cancer, like most cancers, will become more reliant on substrate level phosphorylation (fermentation) than on oxidative phosphorylation (OxPhos) for growth consistent with the mitochondrial metabolic theory of cancer. Glucose and glutamine are the prime fermentable fuels that underlie therapy resistance and drive breast cancer growth through substrate level phosphorylation (SLP) in both the cytoplasm (Warburg effect) and the mitochondria (Q-effect), respectively. Emerging evidence indicates that ketogenic metabolic therapy (KMT) can reduce glucose availability to tumor cells while simultaneously elevating ketone bodies, a non-fermentable metabolic fuel. It is suggested that KMT would be most effective when used together with glutamine targeting. Information is reviewed for suggesting how KMT could reduce systemic inflammation and target tumor cells without causing damage to normal cells. Implementation of KMT in the clinic could improve progression free and overall survival for patients with breast cancer.
Survival Outcomes of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy in Advanced Gastric Cancer
Niger J Clin Pract 2020;23:734-40.
Abstract
Background: Survival outcomes are still far from being satisfactory in patients with advanced gastric cancer, despite availability of novel chemotherapeutic regimens.
Aim: This study evaluated the outcomes of patients with advanced gastric cancer who received chemotherapy along with additional treatment modalities targeting multiple tumor cell vulnerabilities.
Materials and Methods: A total of 24 patients diagnosed with stage III–IV locally advanced or metastatic gastric adenocarcinoma that received metabolically supported chemotherapy (MSCT) combined with ketogenic diet, local hyperthermia, and hyperbaric oxygen therapy (HBOT) between April 2014 and October 2017 were included in this retrospective study. Survival outcomes were evaluated.
Results: In 22 patients (88.0%), complete response was achieved. Mean duration of follow-up was 23.9 ± 12.7 months. Mean overall survival was 39.5 months (95% confidence interval [CI]: 28.1–51.0) and mean progression free survival was 36.5 months (95% CI: 25.7–47.2). No problems were encountered due to fasting, hypoglycemia, ketogenic diet, hyperthermia or HBOT.
Conclusions: The combination treatment used in this study (MSCT together with a ketogenic diet, hyperthermia and HBOT) appears to be promising in the treatment of advanced gastric cancer. Further research and comparative clinical trials are warranted to support and standardize this novel treatment protocol.
Complete Response of Locally Advanced (Stage III) Rectal Cancer to Metabolically Supported Chemoradiotherapy with Hyperthermia
Int J Cancer Res Mol Mech. 2016;2(1).
Abstract
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 (T3N2Mx) low-lying 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.
Preliminary Results of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia and Hyperbaric Oxygen Therapy in Stage II-IV Rectal Cancer
Arch Clin Exp Med 2020;5(1):16-20.
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.
Long-Term Survival Outcomes of Metabolically Supported Chemotherapy with Gemcitabine-Based or FOLFIRINOX Regimen Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy in Metastatic Pancreatic Cancer
Complement Med Res. 2020;27(1):31-39.
Abstract
Background: Despite introduction of new chemotherapeutic agents, outcomes of patients with metastatic pancreatic cancer are still poor. Metabolically supported chemotherapy (MSCT) is a novel approach targeting dysregulated energy mechanism of the tumor cell.
Objectives: This study aimed to examine the efficacy of metabolically supported administration of chemotherapy combined with ketogenic diet, hyperthermia, and hyperbaric oxygen therapy (HBOT) in patients with metastatic pancreatic cancer.
Method: This retrospective observational study included 25 patients with metastatic pancreatic ductal carcinoma (stage IV) who received MSCT (either gemcitabine-based or FOLFIRINOX regimen administered concomitantly with induced hypoglycemia) plus ketogenic diet, hyperthermia, and HBOT combination. Survival outcomes were evaluated.
Results: During the mean follow-up duration of 25.4 ± 19.3 months, median overall survival and median progression-free survival were 15.8 months (95% CI, 10.5–21.1) and 12.9 months (95% CI, 11.2–14.6), respectively. Age and gender did not have any effect on overall survival (p > 0.05 for all).
Conclusions: MSCT administered together with ketogenic diet, hyperthermia, and HBOT appears to be a viable option with the potential to improve survival outcomes in patients diagnosed with metastatic pancreatic cancer. Further research, particularly with larger comparative clinical trials, is warranted.
Feasibility Study of Metabolically Supported Chemotherapy with Weekly Carboplatin/Paclitaxel Combined with Ketogenic Diet, Hyperthermia and Hyperbaric Oxygen Therapy in Metastatic Non-Small Cell Lung Cancer
Int J Hyperthermia. 2019;36(1):446-455.
Abstract
Background: Previous evidence suggests that metabolically supported chemotherapy (MSCT), ketogenic diet, hyperthermia and hyperbaric oxygen therapy (HBOT) could all target vulnerabilities of cancer cells. This study aimed to evaluate the efficacy and the tolerability of this combination therapy in the treatment of stage IV non-small cell lung cancer (NSCLC).
Methods: Forty-four NSCLC patients with distant metastasis that received MSCT (administration of chemotherapy regimen following induced hypoglycemia) plus ketogenic diet, hyperthermia and HBOT combination were included in this retrospective study. Survival and treatment response rates as well as toxicities were evaluated.
Results: Overall response rate (ORR, complete response plus partial response) was 61.4%; whereas, 15.9% and 22.7% of patients had stable disease (SD) and progressive disease (PD), respectively. Mean overall survival (OS) and progression-free survival (PFS) was 42.9 months (95% CI: 34.0-51.8) and 41.0 months (95% CI: 31.1-50.9), respectively. A higher Eastern Cooperative Oncology Group (ECOG) performance status (ECOG ≥2) was associated with worse OS and PFS. Patients received chemotherapy cycles with acceptable toxicity and adverse events. No problems were encountered due to fasting, hypoglycemia, ketogenic diet, hyperthermia or hyperbaric oxygen therapy.
Conclusions: Findings of this study suggest that MSCT combined with other modalities targeting multiple pathways and cellular vulnerabilities may bring about remarkable improvements in survival outcomes and treatment response rates in metastatic NSCLC without additional safety concerns. Large comparative studies are warranted to draw firm conclusions.
Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer
Cureus. 2017 Jul 7;9(7):e1445.
Abstract
Triple-negative breast cancer (TNBC) is more aggressive and metastatic than other breast cancer types. Cytotoxic chemotherapy is presently the predominant systemic therapy for TNBC patients. This case report highlights the influence of metabolically supported chemotherapy (MSCT), ketogenic diet (KD), hyperthermia (HT), and hyperbaric oxygen therapy (HBOT) in an overweight 29-year-old woman with stage IV (T4N3M1) triple-negative invasive ductal carcinoma of the breast. The patient presented with an observable mass in her left breast detected during a physical examination in December 2015. Magnetic resonance imaging revealed a Breast Imaging Reporting and Data System Category 5 tumor and multiple lymphadenomegaly in the left axilla. A Tru-Cut biopsy led to the diagnosis of a triple-negative nuclear grade 2 invasive ductal carcinoma. The patient was admitted to ChemoThermia Oncology Center, Istanbul, Turkey in October 2016, and a whole body (18F)-fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET-CT) scan revealed a 77 mm x 55 mm primary tumor in her left breast, multiple left pectoral and axillary lymph nodes, multiple widespread liver masses, and an upper left nodular abdominal lesion. The patient received a treatment protocol consisting of MSCT, KD, HT, and HBOT. A follow-up whole body 18F-FDG PET-CT scan in February 2017 showed a complete therapeutic response with no evidence of abnormal FDG uptake. The patient continued to receive this treatment protocol and in April 2017 underwent a mastectomy, which revealed a complete pathological response consistent with the response indicated by her PET-CT imaging. This single case study presents evidence of a complete clinical, radiological, and pathological response following a six-month treatment period using a combination of MSCT and a novel metabolic therapy in a patient with stage IV TNBC.
Complete Response of Locally Advanced (Stage III) Rectal Cancer to Metabolically Supported Chemoradiotherapy with Hyperthermia
Int J Cancer Res Mol Mech. 2016;2(1).
Abstract
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 (T3N2Mx) low-lying 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.
Long-Term Outcomes of the Treatment of Unresectable (Stage III-IV) Ductal Pancreatic Adenocarcinoma Using Metabolically Supported Chemotherapy (MSCT): A Retrospective Study
J Pancreas (Online). 2016 Jan 08;17(1):36-41.
Abstract
Introduction: Metabolically supported chemotherapy (MSCT), is defined as the application of standard chemotherapy protocols concomitant to the administration of pharmacological doses of regular insulin and the development of hypoglycemia, and following fasting starting the previous day. This study aims to present the effects of MSCT on the overall survival of locally advanced and metastatic (stage III and stage IV, respectively), or simply unresectable pancreatic adenocarcinoma patients.
Material and methods: This study is a retrospective analysis of a prospectively maintained database of patients. It includes all patients that applied to our clinic between July 2012 and December 2014 that were diagnosed with unresectable (stage III-IV) pancreatic adenocarcinoma. The demographic data of all the patients as well as the chemotherapy regimen received, date of treatment initiation, date of disease remission, mortality and overall survival of all patients were analyzed using SPSS 20.0. Patient follow-up was performed by means of CT and PET-CT scans.
Results: 33 patients, 24(73%) males and 9(27%) females, were included in our study. The majority, 27(81%) patients, had metastatic disease at the time of diagnosis and were stage IV. While 11(33%) of the patients were treated using a gemcitabine-based protocol, 13(39%) received FOLFIRINOX. 9(27%) of the patients were initially treated using gemcitabine, but began receiving FOLFIRINOX following progression as second-line chemotherapy. Statistical analysis revealed a median survival of 19.5 months and a 1-year survival rate of 82.5%. Presently, 18(54%) of the patients remain healthy and alive, free of disease progression with ECOG performance statuses ranging between Grade 0-1. 4(22%) of these patients ultimately underwent radical pancreatic surgery: 3(17%) having undergone pancreaticoduodenectomies (Whipple procedures) and 1(5%) having undergone a distal pancreatectomy.
Conclusion: This study demonstrates that a metabolically supported form of applying standard chemotherapy regimens may enhance the overall survival rates of unresectable (stage III-IV) pancreatic adenocarcinoma patients.
Associations Between Clinicopathological Prognostic Factors and pAkt, pMAPK and Topoisomerase II Expression in Breast Cancer
Int J Clin Exp Med. 2014 May 15;7(5):1459-1464.
Abstract
This study aimed to examine the associations between mitogen activated protein kinase (MAPK), Akt, and topoisomerase II expression and other well established clinical and pathological prognostic factors in patients with breast cancer. A total of 42 women with breast cancer who underwent anthracycline based chemotherapy were included in this retrospective study. Immunohistochemical methods were used to examine the expression of phosphorylated MAPK (pMAPK), phosphorylated Akt (pAkt), HER-2/neu and topoisomerase IIα (topo IIα) in tissue blocks. Subsequently, the associations between pMAPK, pAkt, and topo IIα expression characteristics and disease stage (T and N), tumor grade, estrogen/progesterone receptor status and HER-2/neu expression were investigated. Median age of the patients was 63 years (range, 37-82). A significant association was found between N stage and topoisomerase IIα expression (P = 0.021), with positivity rates increasing in higher stages: N0, 22.7%; N1, 11.1%; N2, 42.9%; N3, 100%. In addition, topo IIα expression was higher in estrogen receptor positive tumors compared to estrogen receptor negative tumors (50% vs. 0%, P = 0.0004), and MAPK expression was more frequent in progesterone receptor positive tumors compared to negative ones (64.0% vs. 20.0%, P = 0.027). Our results indicate that tissue expression of topo IIα and MAPK, which play roles in intracellular signaling pathways, is associated with certain established prognostic factors in breast cancer.
Prolonged Interval in Prophylactic Heparin Flushing for Maintenance of Subcutaneous Implanted Port Care in Patients with Cancer
Eur J Cancer Care (Engl). 2009 Mar;18(2):191-194.
Abstract
The long-term use of subcutaneous implanted ports for chemotherapy in cancer patients has been associated with the occurrence of thrombosis and infection. In this study, we compared the safety and efficacy of administration of 1000 U of heparin flushes in prolonged interval (every 6 weeks) with standard dose and schedule (500 U every 4 weeks) for port-related infections and thrombosis during periods of non-use. Data were collected retrospectively from patients treated for various cancer types (matched as 2:1 for age, gender, stage of the disease). Patients who had diseases that could cause thrombosis or bleeding in their past medical history, or were taking oral anticoagulants, or had contraindications for heparin usage were excluded. After completing their chemotherapy, 59 patients received prolonged interval, while 30 patients received standard schedule. All patients were followed for at least 1 year. No clinically documented port-related infection or thrombosis has been found in both groups. Also, none of the devices was removed during this time. Prophylactic flushing of central venous ports with 1000 U of heparin in every 6 weeks might be a safe, easy, cheaper, comfortable and effective alternative to standard dose and schedule for preventing thrombosis and infections.
The Effect of Body Mass Index on Cancer Development
J BUON. 2008 Jan-Mar;13(1):55-59.
Abstract
Purpose: To determine the impact of body mass index (BMI) on cancer in a hospital-based Turkish population.
Patients and methods: The study group consisted of 2015 patients with histologically proven cancer who applied to Marmara University Medical School, Medical Oncology Clinic (1172 females: 423 pre- and 749 postmenopausal; and 843 males). The control group included 305 healthy caregivers (192 females: 110 pre- and 82 postmenopausal; and 113 males).
Results: Mean BMI of the patients with breast, ovarian and cervical carcinoma was significantly higher than that of the healthy female controls (p<0.001, 0.003, <0.001, respectively). Postmenopausal breast cancer patients had significantly higher BMI than postmenopausal female controls (odds ratio [OR] 1.3; 95% confidence interval [CI], 1.06-1.6; p=0.012), which was not observed in premenopausal patients. The risk of breast cancer was increased 3.26-fold (95% CI 1.54-6.90) in obese postmenopausal female patients compared with controls (p=0.002). Mean BMI of patients with lung, gastric, esophageal, pancreatic and head and neck carcinoma was significantly lower than that of healthy controls. BMI of female patients with lung and colorectal carcinoma was higher than that of female controls.
Conclusion: High BMI may be a risk factor for breast cancer in postmenopausal women. Case-control studies may not demonstrate the true relationship between BMI and cancer in malignancies presenting with prediagnostic weight loss and advanced stage.
Vascular Endothelial Growth Factor, Hypoxia-Inducible Factor 1 Alpha and CD34 Expressions in Early-Stage Gastric Tumors: Relationship with Pathological Factors and Prognostic Impact on Survival
Oncology. 2007;72(1-2):111-117.
Abstract
Background: Angiogenesis is one of the key steps in solid tumor growth and metastasis. We planned to investigate the prognostic significance of vascular endothelial growth factor (VEGF), hypoxia-inducible factor 1alpha (HIF-1alpha) and CD34 expressions as markers of angiogenesis in gastric cancer.
Patients and methods: We retrospectively reviewed the medical records of 51 gastric cancer patients who had total or subtotal gastrectomy at Marmara University Hospital from 1990 to 2004 and evaluated the expression of VEGF, HIF-1alpha and CD34 by immunohistochemistry in their archival tumor tissues.
Results: The median age was 63 years (range 34-81). The median follow-up was 17 months. Thirty-six patients had node-positive disease. The majority of patients (n = 43) had T2 and T3 disease. Vascular and lymphatic invasions were present in 57 and 77% of tumors, respectively. VEGF and HIF-1alpha were positive in 65 and 71% of tumors. The median CD34 staining score was 19 (3-68). VEGF, HIF-1alpha and CD34 expressions were more common in tumors without serosal invasion. However, VEGF, HIF-1alpha, CD34 expressions and other pathological features had no impact on survival.
Conclusion: VEGF, HIF-1alpha and CD34 expressions were more common in tumors without serosal invasion. As a future perspective, biological agents targeting VEGF and HIF-1alpha might be more effective at earlier stages of gastric cancer.
Outcome of Locally Advanced and Metastatic Non-Small Cell Lung Cancer Patients — Marmara University Experience
Turkish Journal of Oncology. 2004;19(3):106-111.
Abstract
Treatment outcomes of the 175 advanced and metastatic NSCLC patients who were given chemotherapy since April 1997 were retrospectively evaluated. In 138 patients, a platinum analogue was used in combination with etoposide, vinorelbine, paclitaxel, docetaxel or gemcitabine. The thoracic radiotherapy was given to stage IIIB patients after completion of first line chemotherapy and to symptomatic stage IV patients with palliative intent. Eligible stage IIIA patients (8.6%) were operated. Median age was 60 and 132 patients were male. Performance status was 0 in 77.5% and stage was IIIA/IIIB/IV in 16/39/120 patients. Forty-eight patients received local RT. At a median follow-up of 11 months, median overall survival (OS) was 13 months, 1-year OS ratio was 51%. Women, patients with good performance status, having resectable tumors and who received local radiotherapy lived significantly longer (p=0.005, p=0.0001, p=0.044 and p=0.0002, respectively). The independent factors influencing the OS were identical. Our results are consistent with the world literature.
Stage I (T1N0M0) Breast Cancer: Pathological Features and Clinical Outcomes
Turkish Journal of Oncology. 2004;19(2):53-57.
Abstract
Thanks to greater patient awareness and screening programs, breast cancer is increasingly being diagnosed at earlier stages worldwide. Among early-stage breast cancer patients, the pT1N0 group has been reported to have an excellent prognosis. This study retrospectively reviewed the clinical course of 66 breast cancer patients with pT1N0 disease who were followed at our department between 1997 and 2003 and had at least 10 months of follow-up after diagnosis. Median age was 48 years (33-83) and median follow-up was 40 months (10-78). Thirty-four patients (52%) were postmenopausal and 63 patients (96%) were over 35 years of age. Breast-conserving surgery had been performed in 50% of patients, and 48 patients (73%) had histological grade 2-3 disease. Tumor histology was invasive ductal carcinoma in 84% of patients, and both hormone receptors (estrogen and progesterone) were immunohistochemically negative in a total of 15 patients (23%). The median number of axillary lymph nodes (ALN) removed was 14 (1-41), and 10 patients (16%) underwent dissection of fewer than 10 ALNs. Tumor size was T1a in 2 patients (3%), T1b in 13 patients (20%) and T1c in 51 patients (77%). All patients received systemic adjuvant therapy (chemotherapy, endocrine therapy, or chemotherapy plus endocrine therapy). Five-year disease-free survival (DFS) was 97%. Because of the small number of recurrences (n=2) and the fact that all patients were alive, an analysis of prognostic factors affecting disease-free and overall survival could not be performed. Consistent with the literature, the prognosis of our patients with pT1N0 breast cancer appears to be quite favorable.