Respectful Insolence

Doctors have found statistical evidence that alternative treatments such as special diets, herbal potions and faith healing can cure apparently terminal illness, but they remain unsure about the reasons.

A study of patients with incurable lung cancer who were given weeks to live and received only low-dose radiotherapy to make their final weeks more comfortable found a small number recovered completely.

Researchers who followed 2,337 patients whose disease was too advanced for curative treatment found that 25 had survived five years and 18 had achieved "an apparent cure". They appeared to have been cured by treatment that "would not normally be considered to have any curative potential whatsoever".

The researchers, led by Michael MacManus, a consultant radiation oncologist in Melbourne, say: "Our data indicate that a chance for prolonged survival and possibly even cure exists for approximately 1 per cent of patients with non small cell lung cancer who receive palliative radiotherapy.

"It is important that the frequency of this phenomenon should be appreciated so that claims of apparent cure by novel treatment strategies or even by unconventional medicine or 'faith healing' can be seen in an appropriate context."

Unorthodox cancer cures have included vitamin C, laetrile extracted from apricot stones, and the Gershon diet of raw vegetables.

The discovery of a small group of patients who unexpectedly recovered could yield new insights into the disease, the researchers say.

Unexpected long-term survival after low-dose palliative radiotherapy for nonsmall cell lung cancer

Michael P. MacManus, M.D., Jane P. Matthews, Ph.D, Morikatsu Wada, Andrew Wirth, Valentina Worotniuk, David L. Ball, M.D.

BACKGROUND
Many experienced oncologists have encountered patients with proven nonsmall cell lung cancer (NSCLC) who received modest doses of palliative radiotherapy (RT) and who unexpectedly survived for > 5 years; some were apparently cured. We used a very large prospective database to estimate the frequency of this phenomenon and to look for correlative prognostic factors.

METHODS
Patients with histologically or cytologically proven NSCLC, treated with palliative RT to a dose of 36 Gy, were identified from a prospective database containing details of 3035 new patients registered from 1984-1990.

RESULTS
An estimated 1.1% (95% confidence interval, 0.7-1.6%) of 2337 palliative RT patients survived for 5 or more years after commencement of RT, including 18 patients who survived progression-free for 5 years. Estimated median survival was 4.6 months. Five-year survivors had significantly better Eastern Cooperative Oncology Group performance status at presentation than non-5-year survivors (P = 0.024) and were less likely to have distant metastases (P = 0.020). RT dose did not appear to be a significant prognostic factor. Patients who survived 5 years without progression had an estimated 78% probability of remaining free from progression in the next 5 years.

CONCLUSIONS
Approximately 1% of patients with proven NSCLC survived for > 5 years after palliative RT, and many of these patients appeared to have been cured by a treatment usually considered to be without curative potential. Because of the potential for long-term survival, doses to late-reacting normal tissues should be kept within tolerance when prescribing palliative RT in NSCLC.

Our data indicate that a chance for prolonged survival and possibly even cure exists for approximately 1% of patients with NSCLC who receive palliative RT. This is a very small proportion, but lung cancer is a very common malignancy. It is important that the frequency of this phenomenon should be appreciated, so that claims of apparent cure by novel treatment strategies or even by unconventional medicine or faith healing can be seen in an appropriate context. All patients in this study had histologic or cytologic diagnoses of NSCLC in an appropriate clinical context. It is possible that errors could have been made in diagnosis in a proportion of cases, but it is very unlikely that all of the cases were misdiagnoses. In many of these patients, biopsy specimens were generous, including some surgical cases. It is well known that conventional cytologic or histopathologic tumor morphology is, by itself, a poor predictor of treatment response in NSCLC. The phenomenon reported here is potentially an important one, in that a subset of patients with NSCLC appears to have disease that is curable with minimal therapy and that prospective identification of such patients could potentially profoundly influence treatment.