A study evaluated the safety and efficacy of combining mild hypoglycemia, hyperthermia therapy, and a ketogenic diet with chemotherapy for the treatment of non-small cell lung cancer. Patients received carboplatin and paclitaxel chemotherapy only if their blood counts were within specified thresholds. Dose reductions were made for toxicity. Between treatments, patients were encouraged to follow a ketogenic diet and received hyperthermia therapy, during which their tumor region was heated to increase temperature. Outcomes of treatments were monitored through bloodwork and evaluation of tumor response.
A study evaluated the safety and efficacy of combining mild hypoglycemia, hyperthermia therapy, and a ketogenic diet with chemotherapy for the treatment of non-small cell lung cancer. Patients received carboplatin and paclitaxel chemotherapy only if their blood counts were within specified thresholds. Dose reductions were made for toxicity. Between treatments, patients were encouraged to follow a ketogenic diet and received hyperthermia therapy, during which their tumor region was heated to increase temperature. Outcomes of treatments were monitored through bloodwork and evaluation of tumor response.
A study evaluated the safety and efficacy of combining mild hypoglycemia, hyperthermia therapy, and a ketogenic diet with chemotherapy for the treatment of non-small cell lung cancer. Patients received carboplatin and paclitaxel chemotherapy only if their blood counts were within specified thresholds. Dose reductions were made for toxicity. Between treatments, patients were encouraged to follow a ketogenic diet and received hyperthermia therapy, during which their tumor region was heated to increase temperature. Outcomes of treatments were monitored through bloodwork and evaluation of tumor response.
A study evaluated the safety and efficacy of combining mild hypoglycemia, hyperthermia therapy, and a ketogenic diet with chemotherapy for the treatment of non-small cell lung cancer. Patients received carboplatin and paclitaxel chemotherapy only if their blood counts were within specified thresholds. Dose reductions were made for toxicity. Between treatments, patients were encouraged to follow a ketogenic diet and received hyperthermia therapy, during which their tumor region was heated to increase temperature. Outcomes of treatments were monitored through bloodwork and evaluation of tumor response.
A complete blood count (CBC) and serum urea and cre-
atinine analysis were required from all patients on the day of treatment, and full dose chemotherapy was administered only when the neutrophil count was >2000/lL, platelet count was >100 000/lL and hemoglobin was >9.0 g/dL. Carboplatin dosage was calculated using the Calvert formula before each chemotherapy session, based on creatinine val- ues using the Cockcroft-Gault formula. In case of neutro- penia, anemia and/or thrombocytopenia, treatment was postponed for approximately a week and supportive treat- ments as well as granulocyte-colony stimulating factors (G- CSF) were administered for 3 consecutive days. CBCs and blood biochemistry analyses, including renal function tests, were repeated in each patient at least once weekly. Red blood cell (RBC) transfusions and platelet transfusions were given when values below the specified thresholds were detected. Carboplatin and paclitaxel doses were reduced by 20–25% only during the subsequent treatment. In case of severe myelosuppression, unacceptable toxicity, deterioration of performance status or multiple delays, schedule individual- ization was allowed and doses were reduced up to 30%. Primary prophylaxis with G-CSF was not given. Chemotherapy was mostly administered in an outpatient set- ting; however, patients were hospitalized in case of Grade 3 or febrile neutropenia or Grade 3–4 infection. Figure 2. Placement of hyperthermia electrode. View from left (A) and Patients that achieved complete response (CR), partial above (B). response (PR) or stable disease (SD) status continued to receive maintenance therapy with the same regimen until death. Those with progressive disease were assigned to in doses ranging between 5 and 20 IU (in order to achieve a second-line chemotherapy with a single agent such as erloti- state of mild hypoglycemia with blood glucose levels around nib, gemcitabine, or docetaxel. Patients with ALK fusion 50–60 mg/dl for normoglycemic patients and in accordance received targeted therapy as second-line treatment following with MSCT protocols) [24–26]. progression after chemotherapy. Patients visited our clinic for treatment sessions following 12 h of fasting, and their blood glucose level was measured Ketogenic diet, hyperthermia and hyperbaric upon admission. Then this level was down-titrated to the tar- oxygen therapy geted pretreatment mild hypoglycemia level with insulin administration. An IV line for dextrose administration was Patients were encouraged to consume a ketogenic diet, always kept open. Patients were closely monitored for hypo- which is high in fat and low in carbohydrate. However, it is a glycemia signs/symptoms and blood glucose levels by the mild rather than a strict ketogenic diet, where patients avoid attending physician and an experienced nurse. In normogly- food with a high amount of carbohydrates. Every patient cemic patients, fasting blood glucose levels upon admission received a brief training regarding the diet restrictions and ranged between 70 and 90 mg/dl, while the achieved pre- was given a food list. All patients were asked to keep a diet- treatment glucose ranged between 50 and 59 mg/dl. For dia- ary record. In addition to proactively encouraging and ques- betics on the other hand, a more individualized approach tioning the patient for the ongoing ketogenic diet, blood was adopted. In diabetics (14 patients, none of which were sugar levels were measured as a part of routine procedures on insulin and all were on oral anti-diabetic therapy) blood before insulin administration at each visit. Based on blood glucose level was lowered to around 90 mg/dl based on the sugar levels and dietary records (if the patient was able to individual patient’s condition. All diabetic patients were man- complete successfully), a feedback was given to the patient aged together with endocrinology specialist support. Fasting at each visit on how effective the diet was and what modifi- blood glucose levels ranged between 95 and 160 mg/dl for cations or precautions are still required. diabetic patients. For these patients, the achieved pretreat- For each 60-min hyperthermia session, OncoTherm EHY- ment levels ranged between 65 and 95 mg/dl. Following the 3010 HT device (OncoTherm, Troisdorf, Germany) was used achievement of target blood sugar level, treatment was initi- to gradually increase the temperature of the tumoral region. ated together with oral sugar intake. All patients received a Thoracic tumors and thoracic metastases were targeted. A chemotherapy regimen consisting of paclitaxel 75 mg/m2 large enough mobile electrode positioned over the tumoral (over 60 min) and carboplatin AUC 2 (after paclitaxel, region was used based upon each individual patient’s condi- over 30 min). tion to cover the primary tumor and thoracic metastases (if
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