Reynel María, Villegas Yván, Werthmann Paul G, Kiene Helmut, Kienle Gunver S
Centro Médico Antroposófico, Lima, Peru.
Institute for Applied Epistemology and Medical Methodology at the University of Witten/Herdecke.
Medicine (Baltimore). 2020 Jan;99(5):e18990. doi: 10.1097/MD.0000000000018990.
Thymic neuroendocrine tumor (TNET) is very rare and characterized by a tendency to invade adjacent structures, frequent metastasis, resistance to therapy, and a poor prognosis. Viscum album extracts (VAE) have shown immunological, apoptogenic, and cytotoxic properties.
A 54-year-old Peruvian man was suffering from constant fatigue, cough, dyspnea, and fever for a couple of months.
He was diagnosed with TNET (12.8 cm × 10 cm × 7 cm) stage IIIa, G1. Due to the size and extensive invasiveness (vena cava superior, also obstructing 85% of its lumen, pericardium, and pleura), the TNET was inoperable.
We report the case of this patient who declined chemotherapy and was treated instead with sole subcutaneous VAE 3 times per week for 85 months. No other tumor-specific intervention was applied.
Quality of life (QoL) improved substantially. The patient returned to work, and the tumor remained stable for 71 months. Thereafter, the tumor progressed, and the patient died 90 months after initial diagnosis. Besides self-limited local skin reactions around the application site, no side effects occurred.
This is an exceptionally good course of disease of an inoperable, large, obstructing, and invasive TNET with a reduced baseline condition (Karnofsky index: 50-60) due to pronounced symptoms. Given the considerable reduction of symptoms and improved QoL following the onset of VAE therapy and other reports describing long disease stability and improvement of the QoL using VAE in different cancer types, we presume that the VAE treatment was supportive in this case. As TNETs are rare and few trials are available, future treatments of TNETs using VAE should be carefully documented and published to help determine whether further investigation of the use of VAE in TNET treatment is worthwhile.
胸腺神经内分泌肿瘤（TNET）非常罕见，其特点是倾向于侵犯相邻结构、频繁转移、对治疗耐药且预后不良。欧洲槲寄生提取物（VAE）已显示出免疫、诱导凋亡和细胞毒性特性。
一名54岁的秘鲁男子持续数月感到疲劳、咳嗽、呼吸困难和发热。
他被诊断为IIIa期、G1级的TNET（12.8厘米×10厘米×7厘米）。由于肿瘤大小及广泛侵袭性（上腔静脉，其管腔85%被阻塞，还有心包和胸膜），该TNET无法手术切除。
我们报告该患者的病例，他拒绝化疗，改为每周皮下注射VAE 3次，持续85个月。未应用其他肿瘤特异性干预措施。
生活质量（QoL）显著改善。患者恢复工作，肿瘤稳定71个月。此后肿瘤进展，患者在初次诊断90个月后死亡。除了应用部位周围出现自限性局部皮肤反应外，未出现其他副作用。
这是一例无法手术切除、体积大、阻塞性且侵袭性的TNET的异常良好病程，由于明显症状，患者基线状况较差（卡诺夫斯基指数：50 - 60）。鉴于VAE治疗开始后症状明显减轻且QoL改善，以及其他报告描述在不同癌症类型中使用VAE可实现长期疾病稳定和QoL改善，我们推测在该病例中VAE治疗起到了支持作用。由于TNET罕见且可用试验较少，未来使用VAE治疗TNET的情况应仔细记录并发表，以帮助确定进一步研究VAE在TNET治疗中的应用是否值得。
