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High-Dose Vitamin C Promotes Regression of Multiple Pulmonary Metastases Originating from Hepatocellular Carcinoma.

Seo MS, Kim JK, Shim JY - Yonsei Med. J. (2015)

Bottom Line: After undergoing initial transarterial chemoembolization (TACE), local recurrence with multiple pulmonary metastases was found.She refused further conventional therapy, including sorafenib tosylate (Nexavar).She then underwent subsequent TACE, resulting in remission of her primary hepatocellular carcinoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
We report a case of regression of multiple pulmonary metastases, which originated from hepatocellular carcinoma after treatment with intravenous administration of high-dose vitamin C. A 74-year-old woman presented to the clinic for her cancer-related symptoms such as general weakness and anorexia. After undergoing initial transarterial chemoembolization (TACE), local recurrence with multiple pulmonary metastases was found. She refused further conventional therapy, including sorafenib tosylate (Nexavar). She did receive high doses of vitamin C (70 g), which were administered into a peripheral vein twice a week for 10 months, and multiple pulmonary metastases were observed to have completely regressed. She then underwent subsequent TACE, resulting in remission of her primary hepatocellular carcinoma.

No MeSH data available.


Related in: MedlinePlus

Multiple well-defined nodules are evident in both lung fields on chest radiography (A) and chest CT scan (B) in September 2011, before the initiation of intravenous high-dose vitamin C treatment. Chest radiography in July 2012 (C) and chest CT in February 2013 (D) showing regression of the lesions.
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Figure 2: Multiple well-defined nodules are evident in both lung fields on chest radiography (A) and chest CT scan (B) in September 2011, before the initiation of intravenous high-dose vitamin C treatment. Chest radiography in July 2012 (C) and chest CT in February 2013 (D) showing regression of the lesions.

Mentions: A 74-year-old woman was found to have a 2.2-cm liver mass with multiple satellite nodules (T2N0M0) on abdominal-pelvic CT (APCT) in January 2011 (Fig. 1A). Protein induced by vitamin K absence or antagonist-II (PIVKA II) was within normal range, 28 mAU/mL, but alpha fetoprotein (AFP), 4040.05 ng/mL, was high, and anti-hepatitis C virus was positive. The patient initially received transarterial chemoembolization (TACE) in February 2011, but locally recurrent hepatocellular carcinoma with multiple pulmonary and mediastinal lymph node metastases were found on positron emission tomography-computed tomography (PET-CT) scan in July 2011 (Fig. 2A and B) and APCT in September 2011 (Fig. 1B). She refused further treatment, including sorafenib tosylate (Nexavar, Bayer Health-Care AG, Leverkusen, Germany), and then visited our clinic with anorexia and general weakness in September 2011 requesting high-dose vitamin C to manage her symptoms. Twenty grams of vitamin C in 250 mL normal saline was initially administered via an ante-cubital vein twice a week in September 2011 after urine analysis and renal function were confirmed to be within normal range. To neutralize acidic pH (3.5-5.0) of vitamin C, it was mixed with NaHCO3, resulting in pH 6.2 (UniCĀ®, 500 mg/mL from Unimed Pharmaceuticals, Seoul, Korea). In addition, normal saline was changed to distilled water as vitamin C dose increased to avoid too much intake of volume and sodium and too high concentration. Furthermore, magnesium sulfate 1 g was blended in the fluid to prevent vascular irritation.9 Notably, she did not have glucose-6-phosphate dehydrogenase deficiency. Prior to April 2012, no significant progression or regression of her multiple pulmonary metastases was found on serial chest X-ray, although she reported improved general wellbeing. In July 2012, multiple pulmonary nodules were found to have completely regressed on chest X-ray (Fig. 2C), which was confirmed on PET-CT scan in September 2012 (Fig. 2D). However, a 5.5-cm hepatic mass still remained on abdomen ultrasound and PET-CT scan (Fig. 1C). Considering her good performance status, we recommended repeated TACE, but she declined. Therefore, high-dose vitamin C administration was continued for more than a year. In July 2013, she finally decided to undergo TACE in addition to the high-dose vitamin C treatment. Subsequently, three rounds of TACE were performed. After the fourth round of TACE, the hepatic mass was found to have entirely regressed (Fig. 1D), and both PIVKA II and AFP levels had returned to normal range. The serial changes in AFP and PIVKA II levels are shown in Table 1. The patient denied any use of other anti-cancer medications or alternative therapies except pain medication for her intermittent abdominal pain. She was quite tolerant of high-dose vitamin C during the entire treatment period, but thirst was an occasional complaint, which was easily remedied by water intake.


High-Dose Vitamin C Promotes Regression of Multiple Pulmonary Metastases Originating from Hepatocellular Carcinoma.

Seo MS, Kim JK, Shim JY - Yonsei Med. J. (2015)

Multiple well-defined nodules are evident in both lung fields on chest radiography (A) and chest CT scan (B) in September 2011, before the initiation of intravenous high-dose vitamin C treatment. Chest radiography in July 2012 (C) and chest CT in February 2013 (D) showing regression of the lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC4541681&req=5

Figure 2: Multiple well-defined nodules are evident in both lung fields on chest radiography (A) and chest CT scan (B) in September 2011, before the initiation of intravenous high-dose vitamin C treatment. Chest radiography in July 2012 (C) and chest CT in February 2013 (D) showing regression of the lesions.
Mentions: A 74-year-old woman was found to have a 2.2-cm liver mass with multiple satellite nodules (T2N0M0) on abdominal-pelvic CT (APCT) in January 2011 (Fig. 1A). Protein induced by vitamin K absence or antagonist-II (PIVKA II) was within normal range, 28 mAU/mL, but alpha fetoprotein (AFP), 4040.05 ng/mL, was high, and anti-hepatitis C virus was positive. The patient initially received transarterial chemoembolization (TACE) in February 2011, but locally recurrent hepatocellular carcinoma with multiple pulmonary and mediastinal lymph node metastases were found on positron emission tomography-computed tomography (PET-CT) scan in July 2011 (Fig. 2A and B) and APCT in September 2011 (Fig. 1B). She refused further treatment, including sorafenib tosylate (Nexavar, Bayer Health-Care AG, Leverkusen, Germany), and then visited our clinic with anorexia and general weakness in September 2011 requesting high-dose vitamin C to manage her symptoms. Twenty grams of vitamin C in 250 mL normal saline was initially administered via an ante-cubital vein twice a week in September 2011 after urine analysis and renal function were confirmed to be within normal range. To neutralize acidic pH (3.5-5.0) of vitamin C, it was mixed with NaHCO3, resulting in pH 6.2 (UniCĀ®, 500 mg/mL from Unimed Pharmaceuticals, Seoul, Korea). In addition, normal saline was changed to distilled water as vitamin C dose increased to avoid too much intake of volume and sodium and too high concentration. Furthermore, magnesium sulfate 1 g was blended in the fluid to prevent vascular irritation.9 Notably, she did not have glucose-6-phosphate dehydrogenase deficiency. Prior to April 2012, no significant progression or regression of her multiple pulmonary metastases was found on serial chest X-ray, although she reported improved general wellbeing. In July 2012, multiple pulmonary nodules were found to have completely regressed on chest X-ray (Fig. 2C), which was confirmed on PET-CT scan in September 2012 (Fig. 2D). However, a 5.5-cm hepatic mass still remained on abdomen ultrasound and PET-CT scan (Fig. 1C). Considering her good performance status, we recommended repeated TACE, but she declined. Therefore, high-dose vitamin C administration was continued for more than a year. In July 2013, she finally decided to undergo TACE in addition to the high-dose vitamin C treatment. Subsequently, three rounds of TACE were performed. After the fourth round of TACE, the hepatic mass was found to have entirely regressed (Fig. 1D), and both PIVKA II and AFP levels had returned to normal range. The serial changes in AFP and PIVKA II levels are shown in Table 1. The patient denied any use of other anti-cancer medications or alternative therapies except pain medication for her intermittent abdominal pain. She was quite tolerant of high-dose vitamin C during the entire treatment period, but thirst was an occasional complaint, which was easily remedied by water intake.

Bottom Line: After undergoing initial transarterial chemoembolization (TACE), local recurrence with multiple pulmonary metastases was found.She refused further conventional therapy, including sorafenib tosylate (Nexavar).She then underwent subsequent TACE, resulting in remission of her primary hepatocellular carcinoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
We report a case of regression of multiple pulmonary metastases, which originated from hepatocellular carcinoma after treatment with intravenous administration of high-dose vitamin C. A 74-year-old woman presented to the clinic for her cancer-related symptoms such as general weakness and anorexia. After undergoing initial transarterial chemoembolization (TACE), local recurrence with multiple pulmonary metastases was found. She refused further conventional therapy, including sorafenib tosylate (Nexavar). She did receive high doses of vitamin C (70 g), which were administered into a peripheral vein twice a week for 10 months, and multiple pulmonary metastases were observed to have completely regressed. She then underwent subsequent TACE, resulting in remission of her primary hepatocellular carcinoma.

No MeSH data available.


Related in: MedlinePlus