Single -seam cancer: treatment with radiation, oral vitamin C, chemotherapy and the effects on inflammatory markers

This article is part of the ONCOLOGY SELLOUSE 2019 of magazine for naturopathy . Read the full edition here.

reference

Abdel-Latif MMM, Babar M., Kelleher D., Reynolds Jv. A pilot study on the effects of vitamin C supplementation with neoadjuvant radiochemotherapy on regulators of inflammation and carcinogenesis in patients with esophageal cancer. J Cancer Res Ther . 2019; 15 (1): 185-191.

Study goal

Assessment of the effects of an oral vitamin C supplement with neoadjuvant radiochemotherapy in adenocarcinoma of the esophagus on the core factor of Kappa B (NF-κB) and the associated cytokines

draft

randomized 4-week study with vitamin C, but the entire treatment protocol took 8 weeks to the operation

participant

Twenty patients with the diagnosis of esophageal carcinoma who underwent multimodal treatment

inclusion criteria

Patients with adenocarcinoma of the esophagus, which rehearsals were taken from both the tumor and their normal esophageal tissue and which an external radiation therapy (40 GY in 15 fractions over 3 weeks) as well as chemotherapy in weeks 1 and 6 (5-FU 50 mg/kg for 5 days and then cisplatin 75 m 2 7) and operation in week 8

exclusion criteria

Taking other nutritional supplements

instruments

Colorimetric NF-κB assay, cell extract and western blot analysis as well as cytokin analysis

treatment

orales vitamin C (1,000 mg/day) for 4 weeks

important knowledge

All 20 patients ended the study; 9 did not receive the oral vitamin C and 11. Of the 20 patients there were 4 female, the average age was 64.5 years, 6 were smokers, 17 drank alcohol, 12 had Krebs in the family and 13 had a Barrettadenocarcinoma.

NF-κB was activated in the cancer fabric of all patients before treatment. Dilutation of NF-κB > 10 % was found in 5 patients (25 %), including 2 from the vitamin C group, after treatment.

NF-κB binds to the inhibitory Iχbα and is broken down. In the 5 patients with > 10% change, their tumor tissue had a lower Iχbα compared to normal esophageal tissue. The trend went to a stronger NF-κB reduction in the vitamin C group, but was not significant.

Both treatment arms had a significant reduction in their cytokin profiles, whereby the effect in the vitamin C treatment arm was more pronounced ( p <0.05).

The NF-κBP50 and NF-κBP65 levels were increased in the cancer tissue of all patients before treatment. Nine had lower values ​​after treatment, but vitamin C had no influence on these values.

The zytokine vascular endothelial growth factor (vegf), interleukin (IL) 8, IL1α and IL1β were significantly increased in the tumor compared to normal tissue.

The cytokine levels were significantly reduced after treatment and this effect was larger in the vitamin C arm ( p <0.05).

practice implications

The authors chose a dose of 1,000 mg because they thought that this would be an appropriate dose. However, those who use intravenous vitamin C (IVC) know that oral treatment cannot be achieved or maintained in comparison to IV treatment. The dose used in this study was firstly based on the work of Levine et al. From 1999, in which it was calculated that 200 mg would maintain a reasonable vitamin C level in the body, and secondly on their former pilot study, in which 1,000 mg vitamin C per day for 4 weeks gave 8 (35 %) patients with the regulation of activated NF-KB and Cytokines.

The administration of IVC to oncological patients initially does not raise serum levels on those from healthy patients who receive IVC, which is why repeated administration is required.

In their overview article from 2018, Carr and Cook provided a comprehensive summary of the literature on IVC, including knowledge and gaps. ^{3 You find that a large part of the cancer patients suffer from hypovitaminosis C (<23 Umol/l) or open vitamin C deficiency (<11 Umol/l). 3 IVC of oncological patients initially does not raise serum mirrors to those from healthy patients who receive IVC, which is why repeated administration is required. 4 The work of Cieslak and Cullen showed that radiation plus IVC reduced tumor growth. 5 Schoenfeld et al. found that the additional chemotherapy increased the survival rates. 6 In the Schoenfeld et al-study with patients with glioblastoma multiforma and non-small-cell lung carcinoma (n = 11) there was a longer progression-free survival and a longer average overall survival, 4 (36 %) patients remained alive and 1 (9 %) of 4) the publication of the article in the MRI no evidence of cancer.}

The authors of the current study found in their discussion and conclusions that they did not achieve the hoped -for success and that future studies should evaluate the molecular profiles of the patients and contain the parenteral administration of vitamin C.

restrictions

It was not clear in which 4 weeks (5 weeks in another part of the work) of your 8-week protocol was given oral vitamin C. The oral dose may have been too low, especially since cancer patients generally have a low Ascorbate level at the time of diagnosis. The source of oral vitamin C and its review were not specified in this publication or earlier publication. ^{2 A study with IVC might have achieved a better result and provided us with additional information about the effects of IVC on the various inflammatory cytokines during Barrett-esophagus adoarcinoma.}

summary

In this small study with patients with Barrett-esophagus-ad-carcinoma, an oral daily dose of 1 g vitamin C over 4 weeks together with radiation and chemotherapy before the operation, but not all goods were reduced in the vitamin C group in 25 % of the patients, and there was a significant reduction in the cytokine Vitamin C group was more pronounced.