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Chemioterapia : le statistiche ufficiali di
guarigione e di sopravvivenza -
Trieste, 21 aprile 2009
By Giuseppe Nacci
dal suo libro:
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clinici di terapia Metabolica +
Trentatre casi
FROM : “Thousand Plants against Cancer without
Chemo” free E-BOOK in INTERNET ; see:
http://www.mednat.org/cancro/nacci_english.pdf
Official statistics of
ChemoTherapy
We will now analyse survival times of patients with different
malignant tumours after undergoing Chemo-Therapy:
(IV degree Astrocytomas, Head and Neck Cancers, small cell and
non-small cell Cancer of the lung, small-cell Bronchial
Carcinoma, Breast Cancer, Cancer of the Stomach, Cancer of the
Pancreas, Kidney Cancer, Cancer of the Prostate, Ovarian Cancer,
Cancer of the Uterus, Colorectal Cancer, acute and chronic
myelogenous Leukemias, acute and chronic lymphatic Leukemias,
Multiple Myeloma, Hodgkin’s lymphoma/ NON-Hodgkin’s lymphoma)
Brain Tumours
Percentage of survival after five years, in the case of fourth
degree astrocytomas (multiform glioblastomas) is a mere 4-5%.
.(1035) [McLendon R: Cancer, 98 (8), pp.: 1745-1748, 2003 ;
Allegato 2_Lendon_Alperin.pdf ].
This latter scientific article states: “In 30 years, this rate
has by no means improved…).
Head and Neck Cancers
Much research work has shown that post-surgical Chemotherapy
does not prolong life in respect to patients that are not
treated with Chemotherapy, however on a free food regime and no
particular diet (60,435) [Stell P.M.: Br. J. Cancer, vol. 61,
pp. 779-787, 1990 ;
Allegato 3_Stell_Rawson.pdf ];[Chalmers T. in: De Vita:
"Cancro, principi e pratica dell'oncologia", Lippincott and Co,
Philadelphia, 4.a edizione, pp 235-241, 1993 ].
Some researches – out of twenty-three studies on pre-operatory
and post-operatory Chemotherapy – demonstrated that there is no
difference between groups treated with Chemotherapy and groups
not treated (without any particular diet to follow
(72,74,98,195,397, 449) [Tannock I.F.: J.Clin. Oncol. , Vol. 6,
pp.1337-1387, 1984];[Clark J.R.: Seminars in Oncology, vol. 15,
Suppl. 3, pp. 35-44, 1988];[Dodion P.: Raven Press, New York,
pp. 525-547, 1986];[Choski A.J.: Seminars in Oncology, vol. 15,
Suppl. 3, pp. 45-49, 1998];[Schantz S.P. : in : De Vita V.
"Cancro, principi e pratica dell'oncologia", Lippincott and Co,
Philadelphia, 4 a. edizione, pp. 574-630, 1993];[Jacobs C.: J.
Clin. Oncol., vol. 8 pp. 838-847, 1990 ;
Allegato 4_ Charlotte Jacobs.pdf
Finally, according to a recent study (2004) (1340), which
considered over 7,500 patients, only 2.5% were still alive 5
years after initiating Chemotherapy (this work is available in
PDF format at:
MORGAN.PDF
Non-small Cell Lung Cancer
There are no evident indications of an advanced stage being
influenced by Chemotherapy alone, concerning cases of advanced
stage non-small cell lung carcinoma (2) [Abel U.: Biomed and
Pharmacother, vol. 46, 1992, aggiorn. 1995, pp. 439-452] ;
(241)[Lad T.E.: Immediate versus postponed combination
chemotherapy (CAMP) for unresectable Non-Small Cell Lung Cancer:
a randomized trial, Cancer Treatment Reports, Vol. 65, No.11-12,
1981 ;
Allegato 5_Thomas E. Lad.pdf
In the case of non-small cell bronchial carcinoma, some studies
show an improvement in survival that is not, however,
statistically significant being so limited that they do not
justify the use of toxic therapies like Chemo.
Authors of extended research work all share the same view on
this statement: (16,39,158,259, 296, 361) [Bakowski M.T.: Cancer
Treatments Reviews, vol.10, pp. 159-172, 1983 ;
Allegato 6_Marie T. Bakowski.pdf
[Mitrou P.S.: Atemw.-Lungenkrhk., vol. 12, pp. 544-549, 1986];[Rankin
E.M.: Slevin and Staquet, Studi randomizzati del cancro: un
inventario critico per locazioni, Raven Press, New York, pp.
447-492, 1986];[Liu R.J.: Seminars in Oncol., vol. 20, pp.
296-301, 1993];[Hansen: J.Clin. Oncol., vol. 5, pp. 1711-1712,
1987];[Browen M.: in: Rosenthal S.: "Supporto medico del
paziente con cancro", W.B. Saunders Co, Philadelphia, pp.
200-215, 1987]
Even recently, survival percentages have not changed: a Japanese
work (2000) showed that 24% of 41 patients undergoing
Chemotherapy with Radiotherapy were still alive after 3 years
and 10% after 5 years (1326). [ Japan Clinical Oncology Group
Study 9306, Journal of Clinical Oncology, Vol. 20, No.3, 2002,
pages: 797-803].
Another Japanese study (2004) demonstrated that only 2 patients
out 70 patients treated with Chemotherapy and Radiotherapy
responded completely to the therapy. Two years after the
treatment 33% of patients were still alive (1327) [Yukito
Ichinose: Uracil/Tegafur plus Cisplatin with concurrent
Radioterapy for locally advanced Non-Small-Cell Lung Cancer: a
Multi-institutional Phase II Trial, Clinical Cancer Research,
Vol. 10, 2004, pp.: 4369-4373 ;
Yukito Ichinose.pdf
The same results were obtained by a Dutch study (2004), which
considered 57 patients undergoing Chemotherapy without
Radiotherapy: 50% of patients were still alive after about 4
months, but after one year only 32% were alive and in December
2002, i.e. 2 years and a half after the onset of the therapy,
all patients were dead (1328) [F.M. Wachters: Phase II Study of
docetaxel and carboplatin as second-line treatment in NSCLC,
Lung Cancer, 2004, Vol. 45, pp.255-262 ;
Wachters.pdf ].
Small-cell Bronchial Carcinoma
In 1986, George et al. wrote “…. with only a modest percentage
of remissions, the incapability of long-term palliatives (contained
action of symptoms), and a very modest number of survivors after
2-3 years, even in patients treated at the initial stage of the
illness, no treatment with Chemo can be considered a standard in
dealing with small-cell lung carcinoma …” (127) [George TK, in
: Cancer, vol. 58, pp. 1193-1198, 1986 ;
Allegato 7_T. K. George.pdf
During the following ten years, Klastersky (1995) summarized the
most important studies that had been carried out: “….. recently,
a number of different chemotherapy regimes have been tried, in
the hope of improving the results by increasing the intensity of
the dose. All of these efforts, from the extreme (Chemotherapy
with bone-marrow transplant) to the simplest (doubling of doses),
have failed. No significant result has been obtained by
increasing the chemotherapy doses in the treatment of small-cell
bronchial carcinoma, nor has any improvement been noted through
the combination of single agents…” (223) [Klastersky J., in
Seminars in Oncology, vol. 22, Suppl. 2, pp. 11-12, 1995].
Kokron (1982) observed: “…in the control group that was not
treated with Chemotherapy (however on a free food regime, with
no particular diet, n.d.t.) evident advantages were due to the
quality of life owing to the absence of side-effects tied to
chemo-therapy and to the briefness of the terminal phase of the
illness…” (232) [Kokron O., in : Onkologie , vol. 5, pp. 56-59,
1982].
According to a 2004 study (1340), which involved about 28,000
patients (some suffering from small cell cancer and others from
non-small cell cancer), only 2% of them were still alive 5 years
after starting Chemotherapy (the work is
available in PDF format:
MORGAN.PDF .
Breast cancer
There are many scientific works which demonstrate that
Chemotherapy is essentially useless in the treatment of the
breast cancer (71, 117, 183, 344, 373, 481).
[Chlebowski R.T.: A decade of breast cancer clinical
investigation: results as reported in the program/proceedings of
the American Society of Clinical Oncology, Journal of Clinical
Oncology, Vol. 12, No.9, 1994, pp.: 1789-1795 ;
Allegato 8_Chlebowski.pdf ].
[A prospective randomized trial comparing Epirubicin
monochemotherapy to two Fluorouracil, Cyclophosphamide, and
Epirubicin regimens differing in Epirubicin dose in advanced
breast cancer patients, Journal of Clinical Oncology, vol.9,
No.2, 1991, pp.: 305-312 ;
Allegato 9_French Epirubicin Study Group.pdf
[Hoogstraten B.: Combination chemotherapy and adriamycin in
patients with advanced breast cancer, a Southwest Oncology Group
Study, Cancer, 38, pp.. 13-20, 1976 ;
Allegato 10_Hoogstraten.pdf
[Petru E.: No relevant influence on overall survival time in
patients with metastatic breast cancer undergoing combination
chemotherapy, J.Cancer Res.Clin.Oncol., 1988, No: 114, pp.:
183-185 ;
Allegato 11_Petru.pdf
[Walters R.S.: Arandomized trial of two dosage schedules of
mitomycin C in advanced breast carcinoma, Cancer,1992, Vol. 69,
No.2, pp.:476-481;
Allegato 12_Walters.pdf
As far as far the use of different combinations of
Chemotherapies is concerned, a number of multicentric
experimental studies conducted on women affected by breast
cancer and published between 2003-2004 showed inconsistent
results: disease-free time of about 5 months and median survival
time of 15 months (1068) [Multicentre, phase II study evaluating
capecitabine monotherapy in patients with anthracycline and
taxane-pretreated metastatic breast cancer, Eur. J.Cancer, 2004;
40(4), PP:536-542 ;
Allegato 13_Fumoleau.pdf ; in case of the so-known “Salvage
chemotherapy”, the disease-free median survival time was only 8
months with an average response time of 4 months and a disease
progression within 5 months (1069); disease progression-free
survival time 3 years with median survival time of 2 years
(1071); disease progression-free survival time of 8-10 months
with median survival time of 18-19 months (1072). Finally, the
“compassionate” use of Chemotherapy given by mouth: “…An
open-label, non randomized, compassionate-use study was carried…”
(1073).
(1070)[Phase II study of docetaxel in combination with
epirubicin an protracted venous infusion 5-fluorouracil (ETF) in
patients with recurrent or metastatic breast cancer. A Yorkshire
breast cancer research group study, Br.J.Cancer, 2004,
90(11),pp.:2131-2134;
Allegato 14_Humphreys.pdf], According to doctor Ulich
Abel, there is no direct evidence that Chemotherapy prolongs
survival time; this should be noted because all women affected
by breast cancer undergo Chemotherapy before and after the
surgical intervention (1306).
In March 1996, Dr. Nelson Erlick, Director of the ECRI (Emergency
Care Research Institute), carried out an extended analysis of
the case studies published by the medical literature on breast
cancer in the years prior to 1994. 1.500 scientific research
works were studied.
On the basis of all the
available data, the following resulted:
1)In the initial phase Intensive Chemotherapy and Bone-marrow
transplant give a higher “Response Incidence” compared to the
standard Chemotherapy. In other words: the tumour mass
diminishes (“Incidence of Response”). But, this “Response” does
not last long and cancer soon after starts to advance one again;
2)Standard Chemo-therapy offers patients with breast cancer
metastasis a longer “Duration of Response” (i.e. the number of
months during which the reduction of tumour mass lasts longer),
and furthermore more patients survive for a year compared to
those treated with Intensive Chemotherapy and Bone-marrow
Transplant;
3)Scientific research on Intensive Chemotherapy and Bone-marrow
transplant has not yet identified any sub-group of population in
which this treatment can guarantee a period of non-progression
of cancer that is major to that referred to control groups.
Up until the present day, medical literature has never declared
that Intensive Chemotherapy and Bone-marrow Transplant may
actually heal/cure anyone from breast cancer. Intensive
Chemotherapy and Bone-marrow Transplant produce an income of
150-200 thousand Euro-Dollars for each bone-marrow transplant.
The latter without considering the high percentage of deceases
during the months that follow bone-marrow transplant, owing to
fatal infections caused by germs, that occur in patients that
are momentarily deprived of adequate immune defences after heavy
Chemotherapy and the lack of active bone marrow, that takes time
to engraft, notwithstanding the transplant performed in the
previous weeks.
As far as this is concerned, it is important to notice that in
the Wall Street Journal of 17 November 1994, in an article on
the front page about politic pressure on insurance companies, so
that they paid for bone marrow transplantation in case of
advanced stage breast cancer, the experts gave totally negative
reports about this sort of approach.
As far as early breast cancers are concerned, Philip Day in his
famous book “Cancer: Why We’re Still Dying to Know the Truth”
recounts (pages 20-21) the incredible discovery of Doctor Irwin
Bross of Roswell Memorial Park Institute in New York:
“… If a woman is diagnosed with early breast cancer, i.e.
without metastasis, a simple scientific datum should be known.
When a pathologist diagnoses a lesion such as “an early breast
cancer”, in the majority of cases the pathologist makes a
mistakes because actually it is not a breast cancer. Most women
are affected by a tumour similar to a cancer when seen under an
illuminated microscope. It is possible that this tumour will not
metastasize, which happens in case of a real cancer. The first
controlled clinical trial regarding adjuvant therapies in the
treatment of the breast cancer was conducted in my department.
Doctor Lesile Blumenson and I made a surprising discovery: more
than half patients had a tumour but it seemingly looked rather
like a benign lesion. Our discovery did not arouse much interest
among professional doctors. They would never accept the idea to
admit the scientific truth as at that time the therapy consisted
in the radical mastectomy.
Admitting the truth could have led some women – whose breast had
been removed because of a wrong diagnosis - to undertake legal
proceedings against those incompetent doctors. Doctors from
National Cancer Institute – furious – did not allow us to
continue the research. They probably succeeded in covering up
our discovery and stopping other publications. Breast cancer and
cancer of the prostate have the same statistical results: when
the functions of the two sexual organs decrease, cells often
become abnormal and look like tumour cells.
The Journal of the American Medical Association reported
surprisingly high survival times for patients affected from
cancer of the prostate which were not treated. This demonstrates
that 7 cancers out of 8 were NOT actually cancers.
Therefore, there is no reason for women to get into panic when
the word “cancer” is pronounced. It is the panic that makes them
easy victims…”
Finally, according to a recent study (2004) (1340), which
considered over 42,000 patients, only 1.5% were still alive
after 5 years from the first Chemotherapy cycle (this work is
available in PDF format at:
MORGAN.PDF
Cancer of the Stomach
Kingston evaluated the effectiveness of chemotherapy drugs
versus placebo (however on a free food regime, with no
particular diet), in patients presenting non-operable gastric
carcinoma. The group of 95 patients that underwent Chemotherapy
showed an average survival time more or less equal to survival
of patients on placebo (221) [Kingston R.D.: Clinical Oncology,
vol. 4, pp. 55-69, 1978].
The unanimous evaluation of many other authors is that medical
literature does not give any proof of prolonging life through
Chemotherapy in the case of stomach carcinoma (178,277,300,358)
[Moertel CG.: Cancer, vol. 36, pp. 675-682, 1975];[Queiber W.:
Onkologie, vol. 9, pp. 319-331, 1986];[Hockey M.S.: Slevin and
Staquet, Raven Press, New York, pp. 221-240, 1986];[Mc Donald:
Seminars in Oncology, vol. 15, Suppl. 3, pp. 42-49, 1988].
Twelve randomized studies, that compared post-surgical
Chemotherapy to control patients (on a free food regime, with no
particular diet) have demonstrated the more or less same time of
survival. (7,210,171,154).[Alexander H.L. .in:DeVita: Cancro,
principi e pratica dell'oncologia, Lippincott and Co.,
Philadelphia, 1993, 4.a ediz.];[Kelsen D.: Seminars in Oncol.,
vol. 18, pp. 543-559, 1991];[Hermans J.: J.Clin.Oncol. Vol. 11,
pp. 1441-1447, 1993];[Hallissey M.T.: The Lancet, vol. 343, pp.
1309-1312, 1994].
During the last 10 years the situation has not improved.
According to a Japanese study (2004) which considered about 500
patients from 1985 to 1997, 8% were still alive 2 years after
beginning Chemotherapy and only 2% after 5 years. (1317) [Yoshida
M., Jpn J. Clin. Oncol. 2004, 34, pages: 654-9, FREE full text
article at:
http://www.jjco.oupjournals.org ]
Other recent works demonstrate that Complete responses were
achieved only in few cases; an American research (2005)
involving 43 patients affected by Cancer of the stomach and the
esophagus showed only one Complete Response and 5 Partial
Responses; after 6 months 50% of the patients were alive, after
15 months 20% and after 2 years 12% (1318) [Enzinger PC. : A
phase II trial of irinotecan in patients with previously
untreated advanced esophageal and gastric adenocarcinoma, Dig.
Dis. Sci. 2005, 50, pp.: 2218-2223;
Enzinger.pdf
According to the results of an Italian study (2006) involving 52
patients, 50% were still alive one year after the first
Chemotherapy cycle but only 3 cases of Complete Response and 15
cases of Partial Response were observed. We are waiting to know
the percentage of patients alive after 2 and 5 years (1319)
[Felici A.: Bi-weekly chemotherapy with cisplatin, epirubicin,
folinic acid and 5-fluiorouracil continuous infusion plus g-csf
in advanced gastric cancer: a multicentric phase II study,
Cancer Chemother. Pharmacol., 2006, 57, pp.: 59-64 ;
Felici.pdf ].
According to a study conducted in Korea, only one Complete
Response and 13 Partial responses were observed out of 30
patients undergoing Chemotherapy; median survival time for all
patients was 11 months. (1320). [Lee SH: Br. J. Cancer, 2004,
91, pages: 18-22].
Another Korean study (2005) considered 43 patients undergoing
Chemotherapy from January 2002 to November 2002. Also the
results of this study showed the slow decrease of surviving
patients: about 40% of them 9 months after the beginning of the
therapy, 20% after 14 months, then about 18% after about 20
months and following less than 5% 2 years and a half after the
first Chemotherapy (1324)[Do-Youn: Docetaxel + 5-Fluorouracil +
Cisplatin 3 day combination chemotherapy as a first-line
treatment in patients with unresectable Gastric Cancer, Japanes
Journal Clin. Oncol., 2005, 35, pp.: 380-385;
Do-Youn Oh.pdf ] .
Another Swiss study (2004) showed that only one Complete
Response wasachieved out of 52 patients; 50% were still alive
after 9 months, about 24% after 18 months, 20% after 20 months,
18% after 24-30 months and about 10% after 2 years. Survival
percentages after 4 years are not known yet (1323) [Roth AD:
5-Fluorouracil as protracted continuous intravenous infusion can
be added to full-dose docetaxel (Taxotere)-cisplatin in advanced
gastric carcinoma: a phase I-II trial, Ann. Oncol. 2004, 15,
pp.: 759-764;
Roth.pdf
Another Korean research conducted in 2002 showed that only one
Complete Response and no less than 19 Partial Reponses were
achieved out of 35 patients receiving Chemotherapy from 1999 to
2001; but the percentage of alive patients was 50% after 10
months, going down then to 20% after 18 months. Survival
percentages after 5 years were not published (1325) [Eun Kyung
Cho: Epirubicin, Cisplatin, and Protractedvenous infusion of
5-Fluorouracil for advanced gastric carcinoma, Journal Korean
Med. Sci., 2002, 17, pp.. 348-52 ;
Eun Kyung.pdf
Finally, according to a recent study (2004) (1340), which
considered over 5,000 patients with cancer of the stomach, only
0.7% were still alive 5 years after initiating Chemotherapy. On
the contrary, out of 2,500 patients suffering from cancer of the
esophagus, about 5% of them were still alive 5 years after the
first Chemotherapy cycle (work available in PDF format at:
MORGAN.PDF
Cancer of the Pancreas
The average time of survival is 3 months in patients that
undergo Chemotherapy, whereas in control patients (on a free
food regime however, and no particular diet), that have not
undergone Chemotherapy, the average time of survival is approx.
4 months (118) [Frey C., Cancer, vol. 47, pp. 27-31, 1981].
With Chemotherapy response results of over 30% have been reached
(reduction of the tumour mass) (38,285,321,401) [Scheithauer W.:
Tumor Diagnostik and Therapie, vol. 5, pp. 44-48, 1984; O’Connel:
Seminars in Oncol., vol. 3, pp. 1032-1039, 1985;Meyer: Tumor
Diagnostic and Therapie, vol. 8, pp. 54-58, 1987;Brennan: .in:DeVita
"Cancro, principi e pratica dell'oncologia", Lippincott and Co,
Philadelphia, 4 a. edizione, pp. 849-882, 1993], but the
survival period of time, compared to patients NOT treated with
Chemotherapy (likewise on a free food regime and no particular
diet) does not change.
Even considering more recent studies, the results do not change;
for example, in 2006, using new chemotherapeutic agents such as
Gemcitabine in association with Docetaxel, only 3 out of 43
German patients demonstrated a Complete
Remission; only 6 patients in all were still alive just one year
after starting the therapy…but it is also known that the
survival time after 2 and 5 years decreases further (1309). [Ridwelski
K.: Eur. Pharmacol., 2006, 32, pages: 297-302].
Another study, which was conducted in 2005, considered 46
patients receiving Gemcitabine in association with 5
Fluorine-Uracile (5 F-U); the median disease-free survival time
was only 3 months and a half. About 75 patients died already one
year after initiating the therapy. Also in this case data on
survival time at 2-5 years are not available (1310). [Santasusana
JM: Clin. Transl. Oncol. 2005, 7, 493-498]
According to a research carried out by the European Organisation
for Research and Treatment of Cancer Gastrointestinal Group, at
one year the survival rate is about 30% but with percentages of
10% at 16 months and about 1-2% at 2 years (1311); [Lutz MP.: J.
Clin. Oncol., 2005, 23, pages: 9250-6, Full text article at
http://www.jco.org ]
Rates of a further research are: 30% one year after initiating
the therapy, 10% at about 18 months and about 2% at more than 2
years (1312). [Ko A:, J. Clin. Oncol. 2006, 24, pages 379-385].
Better results were not reached even using microembolization and
infusion of Cisplatin, Mitoxantrone and Mitomycin. Out of 265
cases treated in Germany between 1995 and 2005, 42-85% of
patients were still alive one year after initiating the therapy,
but the survival rate fell down to 20% after about 2 years and
10% after 4 years and settled at 5% after 5-6 years (1313) [K.
Aigner: Celiac axis infusion and microembolization for advanced
stage III/IV pancreatic cancer – a phase II study on 265 cases,
Anticancer Research, 25, pp.: 4407-4412, 2005 ;
Allegato 16_Karl R. Aigner.pdf .
Another research showed only one case of Complete Response and 2
of Partial Responses out of 68 treated patients; the median
survival time was 8 months, in particular the median survival
time was about 6 months in patients with hepatic metastasis and
about 9 months in patients without. In case of peritoneal
carcinomatosis, the median survival time was 7 months and a half,
as against 9 months in patients without peritoneal carcinosis.
Percentages of patients alive after 2 and 5 years are not
available. But the study revealed that only one
Complete Response and 3 Partial Responses were achieved 54
months (4 years and a half) after initiating the therapy (1314)
[Oman M.: Phase I/II trial of intraperitoneal 5-Fluorouracil
with and without intravenous vasopressin in non-resectable
pancreas cancer, Cancer Chemother. Pharmacol., 2005, 56, pp.
603-609;
Oman.pdf
According to the results of another study involving 565 patients,
the average disease-free survival time following Chemotherapy
was only 4 months (1315). [Oettle H.: Ann. Oncol., 2005, 16,
pages: 1639-1645, full text article at:
http://www.annonc.oupjournals.org
Chemotherapy given by mouth did not produce better results: a
study conducted in 2005 on 58 patients treated with Rubitecan by
mouth showed a survival time of 17% after 6 months but this
percentage falls to 9% already after one year (1321).
Finally, another study conducted in 2004 demonstrated that only
20% of 48 patients treated by the North Central Cancer Treatment
Group, USA, were still alive 9 months after starting the therapy.
This percentage settled in the following months but it slowly
decreased reaching 10% at the end of the study, i.e. after 2
years. We are waiting to know the percentage of patients alive
after 5 years. (1322).
Instead, according to the results of a 2004 study (1340)
involving over 5,000 patients, none of them was alive 5 years
after the first Chemotherapy (work available in PDF format at:
MORGAN.PDF ).
(1737) [F. Di Costanzo : Gemcitabine with or without continuous
infusion 5-FU in advanced pancreatic cancer: a randomised phase
II trial of the Italian oncology group for clinical research (GOIRC),
British Journal of Cancer, No. 93, pp. 185-189, 2005 ;
Allegato 17_F Di Costanzo.pdf .
Kidney cancer
Survival after two years from diagnosis is notoriously
considered an anedoctal case, or with very low survival
percentages two years after the diagnosis (10-20%), if underwent
chemotherapy (1174,1175) [Gattinoni L.: Renal cancer treatment:
a review of the literature, Tumori, 2003, 89(5), pp.: 476-484;
Flaningan RC.: Metastatic renal cell carcinoma, Curr. Treat.
Options Oncol. 2003, 4(5), pp.: 385-390].
According to the results of a 2004 study (1340) involving about
6,000 patients, none of them was alive 5 years after the first
Chemotherapy (work available in PDF format at:
MORGAN.PDF ).
Cancer of the Prostate
On the 4th November 1995, the scientific magazine The Lancet
announces “…. 90% of cases of prostate cancer never become
clinically significant. The percentage of survival at 10 years
among patients that had never received any treatment (either
Surgery, or Radiotherapy, or Chemotherapy, or Hormonetherapy)
was 91,5% against 77% of patients that underwent Radiotherapy…”.
Comment of the author on the latter work published: Radiotherapy,
as is known, destroys even the local defences, first of all the
lymph nodes near the tumour, that abound in Natural-Killer
Lymphocytes, unfortunately extremely sensitive to radiations.
Once again The Lancet, on 9th December 1995, comes down heavily
with the shock announcement: “…. radical surgery in the
treatment of prostate cancer, manages only to spread the illness:
monitoring 14 consecutive surgical operations, tumour cells that
came from the prostate after the operation were discovered in
the blood stream of 12 patients. In those same patients no
tumour cells were revealed in their blood stream before the
operation took place….”
According to the results of a 2004 study (1340) involving about
32,000 patients, none of them was alive 5 years after initiating
Chemotherapy (work available in PDF format at:
MORGAN.PDF ).
Ovarian Cancer
101 women treated with a standard dose of “Cisplatine” showed
the same period of survival as other 306 women treated instead
with higher doses of “Cisplatine” (22,78)[Bella M.: Abstract No.
706, in: Proc. Amer. Soc. Clin. Oncol., vol.11, pp.223, 1992]
[Colombo N.: Abstract No. 614, in: Proc. Amer. Soc. Clin.
Oncology, vol. 12, pp 255, 1993].
Other studies confirm these results (81,329,330) [Conte P.F.:
Abstract No. 880, in: Proc. Amer. Soc. Clin. Oncol. 12, pp 273,
1993];[Ozols R.F, “Journal of Clinical Oncology”, Vol. 5, pp
641-647, 1987.];[ Ozols R.F.: Seminars in Oncol., vol. 21,
Suppl. 2, pp. 1-9, 1994].
According to the results of a 2004 study (1340) involving about
4,200 patients, only 9% of patients were still alive 5 years
after initiating Chemotherapy (work available in PDF format at:
MORGAN.PDF ).
Cancer of the Uterus and Endometrium
In the case of metastasis cured with different combinations of
chemotherapy drugs it is possible to have a partial response
percentage of the tumour of over 40%, but according to
randomized studies this does not result in any prolonging of
survival time. (31,186,327,455,492,) [Williams, C.J.: Raven
Press, New York, pp. 417-446, 1986];[ Thigpen J.T.: Cancer, Vol.
60, pp. 2104-2116, 1987];[Hoskins WJ.in:DeVita:Cancro, principi
e pratica dell'oncologia, Lippincott and Co, Philadelphia, 4.a
edizione, pp. 1125-1152, 1993]; [Omura G.A.: Seminars in Oncol.
Vol. 21,pp. 54-62, 1994];[Bonomi P.: J.Clin.Oncol., vol.3, pp.
1079-1085, 1985].
In actual fact, in an extended study on 260 women in class IIb
and IV, the combination of Chemotherapy and Radiotherapy proved
to be even worse that Radiotherapy alone (450) [Tattersall
M.H.: J.Clin. Oncol., Vol. 13, pp. 444-451, 1995 ;
Allegato 19_M.H.N. Tattersall.pdf .
According to the results of a 2004 study (1340) involving about
6,000 patients, none of them was alive 5 years after the first
Chemotherapy cycle. On the contrary, out of 2,500 patients
suffering from cancer of the cervix, about 12% of them were
still alive 5 years after the first Chemotherapy cycle (work
available in PDF format at:
MORGAN.PDF ).
Colonrectal Cancer
According to Nicholls (317) [Nicholls J.: in : Slevin and
Staquet, Studi randomizzati del cancro: un inventario critico
per locazioni, Raven Press, New York, pp. 241-271, 1986] and
Kane (204) [Kane M.J.: Seminars in Oncology, vol. 18, pp.
421-442, 1991], the groups of patients not treated with
Chemotherapy (but however on a free food regime, with no
particular dietary restrictions), showed a major survival time
compared to those patients that had undergone Chemotherapy.
Even results obtained on 1523 patients, through hepatic arterial
infusion chemotherapy, do not show an advantage in survival and,
in contrast with the actual aim of these studies, even present
an increase in liver metastasis. (301,429, 485) [Soybel D.L.:
Current Problems in Cancer, vol. 11, pp. 257-356, 1987];[Weber
W.: SAKK Anticancer Research, Vol. 13, pp. 1839-1840, 1993];[Moertel
CG.: The New Engl. J. Med., vol. 330, pp. 1136-1142, 1994].(175)
[Hine K.R.: Prospective randomised trial of early cytotoxic
therapy for recurrent colorectal carcinoma detected by serum
CEA, Gut 25, pp.: 682-688, 1984 ;
Allegato 20_Hine.pdf ].
Today the situation is not better. According to the results of
an American study (2005) considering 110 patients, only a
Partial remission was achieved.
The average survival time for all patients was 6 months. More
impressing was the drop in the number of disease
progression-free patients (20%), which settled at 15% after 4
months and fell down to less than 5% 7-8 after initiating the
therapy; the reported graph shows the slow but inexorable
decrease of alive patients at 5, 10, 15 and 20 months, with a
final survival percentage of 10% after 18 months (1316).
Finally, according to a recent study (2004) (1340), which
considered over 30,000 patients affected by colorectal cancer,
only 1-3% of them were still alive 5 years after initiating
Chemotherapy (this work is available in PDF format at:
MORGAN.PDF ).
Chronic Lymphocytic Leukaemia
In a recent Polish study carried out on 229 patients who
underwent chemotherapy, median survival (50%) for this disease
is about 3-4 years, with the survival curve becoming slightly
more stable in the following years, with 8-9 year survival
values of 30% for patients older than 65, and of 15-20% for
adult patients younger than 65.(1176) [T. Robak: The effect of
subsequent therapies in patients with chronic lymphocytic
leukaemia previously treated with prednisone and either
cladribine or chlorambucil, Haematologica, 90, pp.: 994-996,
2005].
In another recent, 10-year long work, 78 patients out of a total
of 134 initial patients were subsequently brought to the second
stage of therapy, as they were still considered to be able to
continue chemotherapy. Progression-free survival turned out to
be lower than 3-4 years for more than 75% of the 78 patients.
Most of the 56 patients that were thought not to be able to
continue clinical trials with the other 78 patients were
excluded for the following reasons: hepatitis B virus infection,
Listeria monocytogenes infection, Zoster virus infection,
persistent cytopenia, autoimmune hemolytic anemia,
non-hematologic neoplasia, cerebral hemorrhage, persistently
high transaminase levels.(1177) [F.R.Mauro: Fludarabine +
prednisone + alfa-interferon followed or not by alfa-interferon
maintenance therapy for previously untreated patients with
chronic lymphocytic leucemia: long term results of a randomized
study, Haematologica 88(12), pp.1348-1355, 2003]
Note: according to the author of this work, dr. Giuseppe Nacci,
this sort of exclusions from chemotherapy treatment protocols
are very common and tend to alter the final results.
Acute Lymphoblastic Leukaemia in Adults
Recent works regarding life-saving chemotherapy for patients
with primarily refractory or relapsed Acute Lymphoblastic
Leukaemia carried out on 135 adults show that survival
percentages tend to linearize only after the first year from
chemotherapy, with survival percentages lower than 20%. After 24
months, the percentage of patients still alive is lower than
10%.(1178) [Camera A.: GIMELA ALL –Rescue 97: a salvage
strategy for primary refractory or relapsed adult acute
lymphoblastic leucemia, Haematologica, 89(2), pp.145-155, 2004.
http:
//www.haematologica.org ]
Acute Lymphoblastic Leukaemia in Children
If treated with chemotherapy, Acute Lymphoblastic Leukaemia in
Children has a less dramatic prognosis compared to adults.
Indeed, recent studies carried out in 1998 on 2038 children (a
very wide sample) show variable survival percentages between 42%
and 66.8%, 10-12 years after chemotherapy, with a stabilization
of the mortality curve around the fifth-sixth year after
treatment with chemotherapy.(1179) [R. Consolini: Clinical
relevance of CD10 expression in childhood ALL, Haematologica 83,
pp.: 967-973, 1998]
Note: as chemotherapy is notoriously ineffective for most
tumours, we wonder why it seems to be so effective in Acute
Lymphoblastic Leukaemia. You should keep in mind that many drugs
can erroneously give haematological values similar to Acute
Lymphocytic Leukaemia, Hodgkin’s Lymphoma or Non-Hodgkin’s
Lymphoma.
The patient’s immune response to germs or viruses (e.g.
Mononucleosis) can also erroneously lead to a diagnosis of
tumour. (SEE further).
Chronic Myelogenous Leukaemia
The following reported data have been obtained from 1084
patients who underwent chemotherapy; almost all of them had bone
marrow stem cell transplant. In comparison with Acute
Myelogenous Leukaemia, the median survival is better: about 60%
of patients are still alive after 24 months and the survival
curve tends to stabilize on slightly lower values in the
following years. The situation for patients with Chronic
Myelogenous Leukaemia in the progressive phase is different:
only 50% of patients are still alive after 12 months. The
percentage drops to 35% after 24 months and then stabilizes
around 30%. (1180) [De Souza: Validation of the EBMT risk score
in chronic myeloid leucemia in Brazil and allogeneic transplant
outcome, Haematologica, 90, pp.: 232-237, 2005.
De Souza.pdf]
Acute Myelogenous Leukaemia
A recent study of 2004 carried out on 621 elderly patients (older
than 60) who underwent chemotherapy shows that the median
survival (50%) is just 5-7 months. With an aggressive
chemotherapy, less than 10% were still alive after 20 months; on
the contrary, with a conservative approach (low-dose
chemotherapy), about 20% of patients were still alive after 20
months. This figure dropped to 10% after another 20 months. Both
curves drop to less than 2-5% of survivors in the following
months. (1181) [Pulsioni A.: Survival of elderly patients with
acute myeloid leukaemia, Haematologica, 89, pp.: 296-303, 2004;
Pulsoni.pdf] .
In another recent study of 2004, carried out on 258 elderly
patients with Acute Myelogenous Leukaemia who underwent
chemotherapy with stem cell self-transplant, median survival
(50%) goes up to just 8 months. After 24 months, about 23-24% of
all patients are still alive. Then this percentage drops after
36 months and 48 months (4 years), when it seems that it finally
stabilizes at about 10% of survivors. (1182) [Oriol A.:
Feasibility and results of autologous stem cell transplantation
in de novo acute myeloid leukemia in patients over 60 years old.
Results of the CETLAM AML-99 protocol, Haematologica, 89, pp.:
791-800, 2004;
Oriol.pdf
Multiple Myeloma
About 25% of patients survive five years after treatment with
chemotherapy, less than 5% are still alive after 10 years.
(1183) [Kenneth C. Anderson: Management of Multiple Myeloma
Today, Seminars in Hematology, vol. 36, No.1, suppl.3, 1999
Allegato 21_Anderson.pdf ].
However, another study of 2000 (1367) based on a treatment
randomization for Stage-1 Multiple Myeloma showed no benefits
from chemotherapy compared to absence of treatment.
Last, a recent work of 2004 (1340) carried out on about 2700
patients shows that no-one of the patients was still alive five
years after the beginning of chemotherapy. (MORGAN.PDF
)
Hodgkin’s Lymphoma
A recent work of 2003 studied 97 patients who underwent
chemotherapy, radiotherapy and stem cell transplant, in a time
span of 18 years: from 1982 to 2000. In patients with
chemoresistant Lymphoma, median survival (50%) is only two years,
with the survival curve stabilizing at 30% five years after
treatment. However, in patients with chemosensitive Lymphoma the
survival curve goes down slowly and stabilizes in a very good
way during the sixth year, with a percentage of survivors of 60%
remaining the same in the ten following years. It is thought
that the survival curve does not tend to further change.(1184)
[P.L. Zinzani: High-dose therapy with autologous transplantation
for Hodgkin’s disease: the Bologna experience, Haematologica,
88,(05), pp.: 522-528, 2003;
http://www.haematologica.org ].
Note: as chemotherapy is notoriously ineffective for most
tumours, we wonder why it seems to be so effective in Hodgkin’s
Lymphoma. You should keep in mind that many drugs can
erroneously give haematological values similar to Acute
Lymphocytic Leukaemia, Hodgkin’s Lymphoma or Non-Hodgkin’s
Lymphoma. The patient’s immune response to germs or viruses
(e.g. Mononucleosis) can also erroneously lead to a diagnosis of
tumour.
It extremely important to remember that Reed-Sternberg cells are
typical not only of Hodgkin’s Lymphoma, but also of Epstein Barr
virus infectious mononucleosis (1292)[ J.Kurtin: Interfollicolar
Hodgkin’s disease, Society for Hematopathology, Hematopathology
Specialty Conference, 1996, Discussion, - Case # 5, Mayo Clinic,
Rochester, Minnesota,USA
http://researchpath.hitchcock.org/socforheme/specialty/Spechem965.html
]
The latter study was published ten years ago and stated that
Reed-Sternberg cells are different from Hodgkin’s Lymphoma’s
cells. Under the microscope, with immunoperoxidase staining in
paraffinated sections, Reed-Sternberg cells that are present in
interfollicular Hodgkin’s Lymphoma are phenotypically identical
to Hodgkin’s cells in lymphomas at the stage of nodular
sclerosis, mixed cellularity or lymphocytic depression. Indeed,
they are all positive both to anti-CD 15 antibodies (Leu-M1),
anti-CD30 antibodies (Ber-H2), anti-CD45 antibodies (leucocyte
common antigen), and to anti-KiB3 antibodies (1293)[Wilson CS:
Malignant lymphomas that mimic benign lymphoid lesion: a review
of four lymphomas, Semin. Diag. Pathos. 1995, 12(1), pp: 77-86];
(1294) [Fellbaum C.: Monoclonal antibodies k1B3 and Leu-M1
discriminate giant cells of infectious mononucleosis and of
Hodgkin’s disease, Hum Pathos. 1988, 19, pp: 1168-1173].
Reed-Sternberg cells are highly reactive lymphocytes which
elaborate a variety of cytokines and growth factors. According
to this article, it is likely that follicular hyperplasia is
induced by Reed-Sternberg as a reaction to Hodgkin’s Lymphoma.
According to Doggett (1295) [Doggett R.: Interfollicular
Hodgkin’s disease, Am. J. Surg. Pathos. 1983, 7, pp.: 145-149
1999
Allegato 22_DOGGETT.PDF ], Interfollicular Hodgkin’s disease
stage must be seen as the result of partial involution of the
ill nodule, and not as a distinctive sub-type of the disease. In
biopsies carried out on patients, one can see different stages
of lymph nodes (nodular sclerosis, mixed cellularity,
interfollicular areas). Therefore, the types of Hodgkin’s
Lymphoma with follicular hyperplasia must be differentiated from
other diseases, such as para-cortical immunoblastic reactions:
1.a) immunity reactions against various viruses, including
Epstein Barr virus (1296) [Child CC: Infectious Mononucleosis.
The spectrum of morphologic changes simulatine lymphoma in lymph
nodes and tonsils. Am.J.Surg.Pathol. 1987; 11(2), pp.: 122-132 ;
Allegato 23_CHILDS.PDF];
1.b) post-vaccination lymphadenitis (1297) [Hartsock RJ.:
Postvaccinial lymphadenitis: Hyperplasia of lymphoid tissue that
simulates malignant lymphomas, Cancer 1968, 21, pp.: 632-649];
1.c) lymphadenopathies of autoimmune disorders such as adult
Still's disease (1298) [Valente RM: Characterization of lymph
node histology in adult onset Still’s disease. J.Rheumatol.
1989, 16, pp.: 349-354];1.d) Systemic Lupus Erythematosus (SLE)
1.e) lymphadenopathy associated to drug hypersensitivity (1299)
[Abbondanzo SL: Dilantin-associated lymphadenopathy. Spectrum of
histopatholologic features, Am. J. Surg. Pathol. 1995, 19(6),
pp.: 675-686]; (1300) [Saltstein SL: Lymphadenopathy induced by
anticonvulsant drugs and mimicking clinically and pathologically
malignant lymphomas, Cancer 1959, 12, pp: 164-182].
All these disorders can be associated to para-cortical and
follicular hyperplasia.
All these conditions in a benign disease must be separated from
Interfollicular Hodgkin’s lymphoma.
However, in infectious mononucleosis, a subset of immunoblasts
can have cytological characteristics that are virtually
identical to those of Reed-Sternberg cells.
The diagnosis of Hodgkin’s Lymphoma is supported by a positive
immunoreactive test made with anti CD-15 antibodies and a
negative immunoreactive test made with anti-CD 45 antibodies.
In Hodgkin’s Lymphoma with Reed-Sternberg cells,
immunoreactivity to anti-CD 15 antibodies is about 15-20%.
However, all previously investigated benign immunoblastic
reactions are negative to anti-CD15 tests, and positive to
anti-CD 45 tests. According to Reynolds (1301), Epstein Barr
virus reactive atypical immunoblasts are however phenotypically
similar to Hodgking’s Lymphoma cells. Reynolds observed that it
is possible to differentiate infectious mononucleosis from
Hodgkin’s Lymphoma thanks to the following three features:
1.a) Immunoreactivity to CD15 (if Hodgkin’s Lymphoma).
1.b) Absence of immunoreactivity to CD15 for Epstein Barr virus
reactive immunoblasts.
2.a) Presence of small collarette-shaped T cells around
Hodgkin’s cells.
2.b) Absence of small collarette-shaped T cells in Epstein Barr
virus infectious mononucleosis.
3.a) presence of Epstein Barr proteins in viral infections.
(1301)[Reynolds DJ: New characterization of infectious
mononucleosis and a phenotypic comparison with Hodgkin’s disease,
Am J. Pathos. 1995, 146(2), pp.: 379-388 ;
Allegato 24_RAYNOLDS.PDF]
The immunophenotype of Reed-Sternberg cells is very variable.
Thus, the presence of these cells shouldn’t be immediately
interpreted as a diagnosis of Hodgkin’s or non-Hodgkin’s
Lymphoma, as the use of CD-3, DAKO-M1 (CD15), L26 (CD 20), BerH2
(CD 30), MT1 (CD 43), DAKO-LCA (CD45RB), UCHL1 (CD45R0), LN2
(CD74) and DAKO-EMA antibodies in patients has been proven not
to be fully reliable (1302) [Wei-Sing Chu: Inconsistency of the
immunophenotype of Reed-Sternberg cells in simultaneous and
consecutive specimens from the same patients, American Journal
of Pathology, vol. 141, No.1, 1992, pp: 11-17].
Allegato 25_CHUENGLISH.PDF
Another work showing that it is difficult to diagnose Reed
Sternberg cells in Hodgkin’s Lymphoma vs infectious
mononucleosis, is the work of Bitsori (1303) [Bitsori M.:
Reed-Sternberg cells in atypical primari EBV infection, Acta
Pediatrica, Vol. 90, No.2, 2001, pp: 227-229,3]. In particular,
the distribution of Leu MI (CD15) antibodies themselves is not
reliable (1304) [Sewell HF: Reaction of monoclonal antiLeu M1 -
a myelomonocytic marker (CD15) –with normal and neoplastic
epithelia 1987, Journal of pathology, Vol. 151, No.4, pp.:
279-284;
Allegato 26_SEWELL.PDF ]
Finally, we report the question of differential diagnosis of
sarcoidosis and lymphomas themselves, as the former is very
often a consequence of chemotherapy (1305) [Dickerman Hollister:
Sarcoidosis mimicking progressive Lymphoma, Journal of Clinical
Oncology, 2005, pp.: 8113-8116].
Non-Hodgkin’s Lymphoma
In a recent work of 2005, 374 patients who underwent
chemotherapy were taken into consideration. Based on the
International Prognostic Index (IPI), patients were divided into
4 groups: low risk, low-intermediate risk, high-intermediate
risk, and finally high risk. The various survival curves that
were obtained are not so different from the ones we already knew
from medical literature:
1) median survival (50%) of about one year for high risk
patients, with a percentage of about 10% of survivors after the
fifth year, and the curve going down in the following years;
2) median survival (50%) of about 3 years for high-intermediate
risk patients, with a percentage of survivors of about 25% after
the sixth year;
3) median survival (50%) of about 4 years for low-intermediate
risk patients, with a percentage of survivors of about 40% after
he sixth year and about 37% after the seventh year;
4) median survival (50%) of about 8 years for low risk patients,
with a percentage of survivors slightly lower in the following
years.(1185) [M.van Agthoven: Cost determinants in aggressive
non-Hodgkin’s lymphoma, Haematologica, 90(5), pp.: 661-672,
2005].
Note: as chemotherapy is notoriously ineffective for most
tumours, we wonder why it seems to be so effective in
Non-Hodgkin’s Lymphoma. You should keep in mind that some drugs
can erroneously give haematological values similar to Acute
Lymphocytic Leukaemia, Hodgkin’s Lymphoma or Non-Hodgkin’s
Lymphoma. The patient’s immunitary response to germs or viruses
(e.g. Mononucleosis) can also erroneously lead to a diagnosis of
tumour. For example we quote a recent Italian medicine book
(1307), Savagno L.: “I linfomi Non Hodgkin”, Piccin Editore,
pp.: 202:
“… translocation is necessary but not sufficient for the
neoplastic transformation of B lymphocytes. The reader should
agree that monoclonality is usually a signal of malignancy,
however this is not an absolute rule and there are exceptions.
We have already seen that, at the beginning of an intense and
specific immune (defensive) reaction, lymphocytes proliferate
indicating a uniform activation, and only a constraint that
physiologically intervenes later makes reactive proliferation
self-limiting. An enlightening clinical example is the case of
F.R., a 28-year-old young man that underwent biopsy in 1994
because of a necrotizing tonsillitis with satellite adenopathy.
The diagnosis of 3 different pathologists suggested a malignant
lymphoma with small classification differences among the three
doctors. One of them had also detected that tonsillar
lymphocytes were monoclonal. When the medical oncologist visited
F.R., before any antiblastic or radiant treatment, he still had
a lymph node measuring 2 cm in diameter in the gonion, while the
tonsillar lesion had spontaneously healed during treatment with
sulphamidic drugs. A lymph node cytoaspiration showed a
homogeneous layer of atypical lymphoblasts that were often in
mitosis and that looked malignant. Two days later, when F.R. had
to be given the test results, his lymph node had reduced to a
maximum diameter of 5mm.
A new cytoaspiration was carried out; this showed that there
were no more proliferating atypical lymphoblasts. A completely
different cell population had substituted them: they were almost
exclusively mature plasmacells. Lymphocytes had typically
evoluted into blasts, that in their turn changed into
plasmacells. This allowed to understand the whole episode
correctly: it wasn’t a neoplastic disease, but a
phlogistic-reactive disease. No antitumoral treatment was
therefore given. The young man is now going towards the mature
age without lymphoma, ten years after this episode. The lesson
here is that monoclonality is almost a constant feature in
neoplasias, but in itself it is not enough for an absolutely
certain diagnosis…[ (1307), Savagno L.: I linfomi Non Hodgkin,
Piccin Editore, pp.: 202:
Allegato 27_SALVAGNO.PDF ]
Conclusion
Paul Winter shows a harsher version of facts and explains the
dynamics of the system in this way: “It is unlikely that a
doctor consciously stops an oncologic therapy to protect his
business or his career. But every doctor has his own ideas about
what isthe best treatment, based on what he learned.
However, chemo pharmaceutical multinationals have a very strong
influence on what is taught to doctors. Doctors are too busy to
study more statistics about cancer treatments, and take for
granted that what they are taught at university, or what is
shown in medical journals, is the best possible treatment, as it
is scientifically proven. Nor can they suspect that such
treatments are the best thing only for chemo pharmaceutical
multinationals, which exert their influence on “high-level
medical cultural institutions” belonging to them… (Winter, Paul:
the Cancell Home page,
http://www.best.com/handpen/Cancell/cancell.htm .
On 9 January 1991, dr. Martin F. Shapiro wrote on the Los
Angeles Times, supporting the idea according to which
chemotherapy is NOT curative and that it really has very little
effect on the most common types of cancer: “While some
oncologists inform their patients on the lack of evidence that
this therapy really works, other doctors could have been mislead
by scientific documents that are optimistic about chemotherapy
without guarantees. Other doctors are still sensitive to
economic benefits. Doctors can earn much more money with
chemotherapy than giving comfort to dying patients and their
families…”.
Dr. Samuel Epstein stated on 4 February 1992: “We are worried
that the system that was founded against cancer, the National
Cancer Institute (NCI), the American Cancer Society (ACS) and
about twenty more centres for cancer treatment have mislead and
confused the public opinion and the Congress (of the United
States) through repeated statements according to which we are
about to win the war against cancer…”.
As far as chemotherapy is concerned, the author of this work
claims the right to complete freedom of therapy and technical
autonomy (art. 12, Italian Medical Deontology Code), because of
his contrary clinical beliefs, founded on countless scientific
trials. He responsibly chooses to apply more suitable diagnostic
and therapeutic remedies, practising what is often stated in
legal literature, especially in Amedeo Santosuosso’s work
(“Libertà di cura e libertà di terapia. La medicina tra
razionalità scientifica e soggettività del malato”, Il Pensiero
Scientifico Editore, 1998, page 57), where he states, as a
comment to article 19 of the Medical Deontology Code:
“…Freedom of evaluation by the doctor is controlled by article
19, called “Refusal of professional performance”. According to
this article, that substantially reproduces the text of the
previous Deontology Code, the doctor can refuse to perform his
job, if he is asked to do something against his conscience or
his clinical beliefs, unless his behaviour is immediately and
seriously harmful for the patient…”
It should be noticed that this rule is particularly broad and
strict. Indeed, it allows objection of conscience not only when
the law allows it and according to those procedures, but in all
cases. Moreover, it allows to refuse therapies because of mere
clinical beliefs, even when no conscience questions are involved.
The only limit is about extreme situations, when the patient
could be seriously and immediately harmed.
Besides, the Court of Cassation is very clearly in favour of the
doctor’s autonomy in therapeutic choices. This is a sentence of
2001 (Section IV, sent. n. 301/2001):
“…It is fair to emphasize the doctor’s autonomy in therapeutic
choices, because, as medicine has no own scientific protocols
based on mathematics, it often implies different practices or
solutions that were shown to be effective thanks to experience.
These solutions have to be chosen with a careful evaluation of a
series of variants that only a doctor can evaluate. This freedom
of therapeutic choices cannot be ill-considered nor based only
on personal experience. Once the choice is made, the doctor must
continue to carefully observe the situation, in order to
intervene immediately in case an emergency arises, if he
understands that his choice was not appropriate. When all this
is realized, the doctor cannot be responsible of a possible
failure.
To evaluate if the therapeutic choice was right and if he acted
out of inexperience, the judge must give an “ex-ante” judgement,
that is, he must go back to the moment when the doctor has to
choose, and consider the scientific bases of his choice…”.
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