Systematic assessment of the influence of quality of studies on mistletoe in cancer care on the results of a meta-analysis on overall survival.

PURPOSE: Mistletoe treatment in cancer patients is controversial, and a Cochrane review concluded that due to heterogeneity, performing a meta-analysis was not suitable. However, several systematic reviews included meta-analyses in favor of mistletoe. The aim of this work was to assess the influence of the methodological quality of controlled studies on the results of a meta-analysis regarding overall survival. METHODS: Between April and August 2022, Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL and Web of Science were systematically searched. In addition, reference lists of previously published meta-analyses were checked for relevant publications. A random effects meta-analysis with clustering was performed. The risk of bias within the studies was assessed using ROB 2.0 and ROBINS-I. RESULTS: The search identified 4685 hits, and 28 publications reporting on 28 298 patients were included in the quantitative analysis. Overall, the analysis led to a significant result in favor of mistletoe therapy (overall HR = 0.61 with 95% CI [0.53;0.7]). According to our subgroup analysis of randomized studies, studies of higher quality (lower risk of bias) did not lead to a significant result in favor of mistletoe therapy (HR = 0.78; CI = [0.30; 2.00]). CONCLUSIONS: In the case of mistletoe therapy, the results of the meta-analysis strongly depended on the methodological quality of the included studies. Calculating meta-analyses that include low-quality studies may lead to severe misinterpretation of the data.

Education of complementary and alternative medicine in adult education centers in Germany: a web-based survey.

BACKGROUND: Adult education centers are an important part of health education worldwide. Our aim was to evaluate the courses offered by German adult education centers with regard to complementary medicine and nutrition. METHODS: A systematic web-based search was done for the websites of German adult education centers and courses were analyzed considering topics, scientific soundness, and qualification of instructors. RESULTS: Our search revealed 502 courses, 360 (71.7%) related to complementary and alternative medicine (CAM) and 176 courses on nutrition (35.1%). CAM courses most often presented methods with a focus on traditional Eastern medicine with yoga and similar mind-body practices (41.9%), traditional Chinese medicine (TCM; 13.3%), and ayurvedic medicine (11.4%). Content concerning nutrition mainly included controversial fasting methods like alkaline fasting, detox diets, and therapeutic fasting (43.8%), as well as Eastern traditional diets from TCM and ayurveda (21.7%). Most of the courses were given by non-medical practitioners (NMPs; 36.4%), while only very few physicians were engaged. CONCLUSION: There are substantial doubts on the scientific background of many courses offered for lay adult health education. Besides direct misinformation, many courses reinforce alternative and non-evidence-based notions in society. Adult education centers should reconsider the topics of their courses as well as the professional qualifications of the instructors.

Karnofsky Performance Score Is Predictive of Survival After Palliative Irradiation of Metastatic Bile Duct Cancer.

BACKGROUND/AIM: Palliative irradiation is effective in alleviating symptoms in patients with metastatic cancer in general. However, little data exist regarding irradiation of metastatic bile duct cancer. Selection of the best regimen for such a patient should be based on their survival prognosis. PATIENTS AND METHODS: This study included five patients irradiated for metastatic bile duct cancer and aimed to identify predictors of survival by analyzing six factors: age, gender, general condition (Karnofsky performance score), metastatic site receiving palliative irradiation, metastases outside irradiated sites and time between diagnosis of bile duct cancer and palliative irradiation. RESULTS: In the whole series, median survival was 3 months. Survival rates at 3 and 6 months were 40% and 40%, respectively. A Karnofsky performance score >70% had a borderline significant association with better survival (p=0.05). CONCLUSION: Karnofsky performance score was identified as predictor of survival and should be considered when assigning the radiation regimen to patients with metastatic bile duct cancer.

Outcomes After Radio(chemo)therapy for Non-Metastatic Bile Duct Cancer.

BACKGROUND/AIM: The role of radio(chemo) therapy for non-metastatic bile duct cancer is not well defined. This study provides additional data for this rare situation. PATIENTS AND METHODS: Data of eight patients receiving radio(chemo)therapy for non-metastatic bile duct cancer were retrospectively analyzed regarding local control, metastases-free survival and overall survival. In addition to the entire cohort, five tumor- or treatment-related factors were investigated: tumor stage, histologic grading, point in time of radio(chemo)therapy, upfront surgery and concurrent chemotherapy. RESULTS: Median overall survival was 37 months. Overall survival rates at 3 and 5 years were 56% and 38%, respectively. Lower histologic grading was significantly associated with better overall survival (p=0.042). Metastases-free survival rates at 3 and 5 years were 38% and 19%, while local control rates were 43% and 21%, respectively. Concurrent radiochemotherapy (vs. radiotherapy alone) resulted in significantly improved local control (p=0.014). CONCLUSION: Radiochemotherapy can achieve promising results in selected patients with non-metastatic bile duct cancer.

A scoring system for predicting the survival prognosis of patients receiving stereotactic body radiation therapy (SBRT) for 1-3 lung metastases.

INTRODUCTION: The main goal of the present study was the development of a survival scoring system for patients treated with stereotactic body radiation therapy (SBRT) for very few lung metastases. Such an instrument would be of value when selecting the optimal dose for individual patients with a limited number of pulmonary lesions. METHODS: Forty-six patients receiving SBRT for 1-3 lung metastases were retrospectively analyzed. The biologically effective dose plus nine characteristics [gender, age, performance score, interval from tumor diagnosis to SBRT, primary tumor type, additional (extra-pulmonary) metastases, major location of lung metastases, number of pulmonary lesions, and volume treated with SBRT] were evaluated. Characteristics significantly associated with the survival on Cox regression analysis were incorporated in the scoring system. Scoring points were received from 1-year survival rates divided by 10. Sums of these scoring points represented the scores for the individual patients. RESULTS: Survival rates at 1 and 2 years were 66 and 56 %, respectively. On Cox regression analysis, performance score (p = 0.025), the type of primary tumor (p = 0.013) and the additional metastases (p = 0.032) had a significant impact on survival. Scores for patients ranged from 15 to 25 points. Three groups were designed: 15 points, 16-20 points, and 21-25 points. One-year survival rates were 0, 52, and 83 %, respectively (p = 0.005); 2-year survival rates were 0, 52, and 66 %, respectively. CONCLUSION: A survival scoring system for patients receiving SBRT for very few lung metastases was developed. This score allowed us to estimate the survival prognosis of these patients and can aid physicians when aiming to choose the optimal SBRT dose for individual patients.

A New Score for Estimating Survival After Definitive Radiochemotherapy of Limited Disease Small Cell Lung Cancers.

INTRODUCTION: Most patients with limited disease small cell lung cancer (LD-SCLC) receive definitive radiochemotherapy. Some patients cannot withstand combined modality treatments. Patients with short life expectancies should receive less time-consuming programs. For patients with favorable prognoses, cure while avoiding late toxicity is important. Personalized treatment programs are required. An instrument to estimate the survival after radiochemotherapy of LD-SCLC was created. METHODS: Seventy-one patients receiving definitive radiochemotherapy for LD-SCLC were retrospectively analyzed. Eight factors were evaluated for survival including gender, age, Karnofsky performance score, T-stage, N-stage, tumor substage, number of pack years, and pre-radiotherapy hemoglobin level. Factors that were significant (p < 0.05) or showed a trend (p ≤ 0.08) on multivariate analyses were incorporated in the score. Scoring points were derived from 2-year survival rates divided by 10 and added to scores for individual patients. RESULTS: On multivariate analysis, gender (p = 0.03), performance score (p < 0.001), and pre-radiotherapy hemoglobin level (p = 0.04) were significant, and tumor substage showed a trend (p = 0.08). Taking into account the 2-year survival rates of these factors, scores for single patients ranged from 9 to 26 points. Three groups were identified: 9-13, 14-18, and 19-26 points. One-year survival rates were 8, 73, and 100 %, respectively (p < 0.001). Two-year survival rates were 0, 35, and 87 %, respectively (p < 0.001). The 3-year survival rates were 0, 19, and 75 %, respectively (p < 0.001). CONCLUSION: This score including three groups with significantly different survival rates is a helpful instrument for personalization of therapy for patients with LD-SCLC. When using this instrument, the limitations if this study must be taken into account.

Impact of the Radiation Dose and Completion of Palliative Radiotherapy on Survival in Patients Treated for Locally Advanced Lung Cancer.

AIM: To compare three total radiation dose levels for their impact on survival in patients receiving palliative radiotherapy (RT) for locally advanced lung cancer. PATIENTS AND METHODS: Radiation dose (equivalent dose in 2 Gy fractions=EQD2: 31-40 Gy vs. 41-46 Gy vs. 47-52 Gy), completion of RT as planned, plus nine factors were analyzed for survival in 125 patients. RESULTS: On multivariate analysis, EQD2 47-52 Gy (p=0.018), completion of planned RT (p=0.002), lower T-category (p=0.027) and lower N-category (p=0.008) were positively associated with survival. Thirty-six patients (29%) could not receive the complete planned RT dose, 19% in the 31-40 Gy group, 36% in the 41-46 Gy group and 31% in the 47-52 Gy group, respectively. Six-month survival rates of these patients were 0%, 18% and 18%, respectively. CONCLUSION: Higher RT doses resulted in significantly better survival than lower doses. The favorable results were impaired when the planned treatment could not be completed.

Stereotactic Body Radiotherapy (SBRT) with Lower Doses for Selected Patients with Stage I Non-small-cell Lung Cancer (NSCLC).

SBRT is very effective for stage I NSCLC. Biologically effective doses (BED) >100 Gy are recommended. Elderly patients and those with a limited performance status may not tolerate these high doses. This study investigated the outcomes after lower dose SBRT (BED < 90 Gy) in 46 patients with stage I NSCLC, who were aged ≥70 years or in reduced general condition. Local control rates at 1, 2, and 3 years were 100, 95, and 95 %, respectively. Rates of freedom from distant progression were 83, 63, and 54 %, and survival rates were 77, 57, and 36 %, respectively. Seventeen patients died during the follow-up, 11 (65 %) from distant progression of NSCLC, and six (35 %) from non-malignant causes. No patient developed radiation-induced pneumonitis. Thus, SBRT with BED <90 Gy resulted in excellent local control and appears to be a reasonable option for stage I NSCLC in elderly patients and those with a poor performance status.

Value of Comorbidity Scales for Predicting Survival After Radiochemotherapy of Small Cell Lung Cancer.

The Charlson Comorbidity Index plus three comorbidity scales were evaluated for survival after radiochemotherapy of limited stage SCLC. For the Charlson Comorbidity Index, 2-4 points were compared to 5-8 points. For the Age-Comorbidity Score, 2-6 points were compared to 7-10 points. For the Medical Research Council (MRC) Breathlessness Scale, grades 0-2 were compared to grades 3-5. For the Simplified Comorbidity Score, 0-5 points were compared to 6-11 and 12-17 points. Charlson Comorbidity Index (p = 0.022) and MRC Breathlessness Scale (p < 0.001) showed significant associations with survival, the Age-Comorbidity Score a trend (p = 0.06). For the Simplified Comorbidity Score, no significant correlation was found (p = 0.54). Absolute differences in survival ≥20 % were observed for the MRC Breathlessness Scale at 1, 2, and 3 years, for the Charlson Comorbidity Index at 1 year, and for the Age-Comorbidity Score at 2 years. Thus, particularly the MRC Breathlessness Scale can contribute to personalization of the treatment of SCLC.