CHEMIOTERAPIA, STATISTICHE UFFICIALI
(raccolte dal dott. Nacci – English)
Chemioterapia : le statistiche ufficiali di guarigione e di sopravvivenza – Trieste, 21 aprile 2009
By Giuseppe Nacci dal suo libro: “Diventa Medico di Te Stesso” – Ed. Italo Svevo –
Riconoscimenti: The best book of the year 2006 – Riconoscimento del VFF “MARE NOSTRUM ®” – Austria
vedi anche: Parte del libro di Bonifacio – 40 casi di guarigione – vedi: Articolo sul Piccolo (TS)
vedi: 18 casi clinici di terapia Metabolica + Trentatre casi
FROM : “Thousand Plants against Cancer without Chemo” free E-BOOK in INTERNET ; see:
Official statistics of ChemoTherapy
We will now analyse survival times of patients with different malignant tumours after undergoing Chemo-Therapy:
(IV degree Astrocytomas, Head and Neck Cancers, small cell and non-small cell Cancer of the lung, small-cell Bronchial Carcinoma, Breast Cancer, Cancer of the Stomach, Cancer of the Pancreas, Kidney Cancer, Cancer of the Prostate, Ovarian Cancer, Cancer of the Uterus, Colorectal Cancer, acute and chronic myelogenous Leukemias, acute and chronic lymphatic Leukemias, Multiple Myeloma, Hodgkin’s lymphoma/ NON-Hodgkin’s lymphoma)
Percentage of survival after five years, in the case of fourth degree astrocytomas (multiform glioblastomas) is a mere 4-5%. .(1035) [McLendon R: Cancer, 98 (8), pp.: 1745-1748, 2003 ; Allegato 2_Lendon_Alperin.pdf ].
This latter scientific article states: “In 30 years, this rate has by no means improved…).
Head and Neck Cancers
Much research work has shown that post-surgical Chemotherapy does not prolong life in respect to patients that are not treated with Chemotherapy, however on a free food regime and no particular diet (60,435) [Stell P.M.: Br. J. Cancer, vol. 61, pp. 779-787, 1990 ; Allegato 3_Stell_Rawson.pdf ];[Chalmers T. in: De Vita: “Cancro, principi e pratica dell’oncologia”, Lippincott and Co, Philadelphia, 4.a edizione, pp 235-241, 1993 ].
Some researches – out of twenty-three studies on pre-operatory and post-operatory Chemotherapy – demonstrated that there is no difference between groups treated with Chemotherapy and groups not treated (without any particular diet to follow (72,74,98,195,397, 449) [Tannock I.F.: J.Clin. Oncol. , Vol. 6, pp.1337-1387, 1984];[Clark J.R.: Seminars in Oncology, vol. 15, Suppl. 3, pp. 35-44, 1988];[Dodion P.: Raven Press, New York, pp. 525-547, 1986];[Choski A.J.: Seminars in Oncology, vol. 15, Suppl. 3, pp. 45-49, 1998];[Schantz S.P. : in : De Vita V. “Cancro, principi e pratica dell’oncologia”, Lippincott and Co, Philadelphia, 4 a. edizione, pp. 574-630, 1993];[Jacobs C.: J. Clin. Oncol., vol. 8 pp. 838-847, 1990 ;Allegato 4_ Charlotte Jacobs.pdf
Finally, according to a recent study (2004) (1340), which considered over 7,500 patients, only 2.5% were still alive 5 years after initiating Chemotherapy (this work is available in PDF format at: MORGAN.PDF
Non-small Cell Lung Cancer
There are no evident indications of an advanced stage being influenced by Chemotherapy alone, concerning cases of advanced stage non-small cell lung carcinoma (2) [Abel U.: Biomed and Pharmacother, vol. 46, 1992, aggiorn. 1995, pp. 439-452] ; (241)[Lad T.E.: Immediate versus postponed combination chemotherapy (CAMP) for unresectable Non-Small Cell Lung Cancer: a randomized trial, Cancer Treatment Reports, Vol. 65, No.11-12, 1981 ; Allegato 5_Thomas E. Lad.pdf
In the case of non-small cell bronchial carcinoma, some studies show an improvement in survival that is not, however, statistically significant being so limited that they do not justify the use of toxic therapies like Chemo.
Authors of extended research work all share the same view on this statement: (16,39,158,259, 296, 361) [Bakowski M.T.: Cancer Treatments Reviews, vol.10, pp. 159-172, 1983 ; Allegato 6_Marie T. Bakowski.pdf
[Mitrou P.S.: Atemw.-Lungenkrhk., vol. 12, pp. 544-549, 1986];[Rankin E.M.: Slevin and Staquet, Studi randomizzati del cancro: un inventario critico per locazioni, Raven Press, New York, pp. 447-492, 1986];[Liu R.J.: Seminars in Oncol., vol. 20, pp. 296-301, 1993];[Hansen: J.Clin. Oncol., vol. 5, pp. 1711-1712, 1987];[Browen M.: in: Rosenthal S.: “Supporto medico del paziente con cancro”, W.B. Saunders Co, Philadelphia, pp. 200-215, 1987]
Even recently, survival percentages have not changed: a Japanese work (2000) showed that 24% of 41 patients undergoing Chemotherapy with Radiotherapy were still alive after 3 years and 10% after 5 years (1326). [ Japan Clinical Oncology Group Study 9306, Journal of Clinical Oncology, Vol. 20, No.3, 2002, pages: 797-803].
Another Japanese study (2004) demonstrated that only 2 patients out 70 patients treated with Chemotherapy and Radiotherapy responded completely to the therapy. Two years after the treatment 33% of patients were still alive (1327) [Yukito Ichinose: Uracil/Tegafur plus Cisplatin with concurrent Radioterapy for locally advanced Non-Small-Cell Lung Cancer: a Multi-institutional Phase II Trial, Clinical Cancer Research, Vol. 10, 2004, pp.: 4369-4373 ; Yukito Ichinose.pdf
The same results were obtained by a Dutch study (2004), which considered 57 patients undergoing Chemotherapy without Radiotherapy: 50% of patients were still alive after about 4 months, but after one year only 32% were alive and in December 2002, i.e. 2 years and a half after the onset of the therapy, all patients were dead (1328) [F.M. Wachters: Phase II Study of docetaxel and carboplatin as second-line treatment in NSCLC, Lung Cancer, 2004, Vol. 45, pp.255-262 ; Wachters.pdf ].
Small-cell Bronchial Carcinoma
In 1986, George et al. wrote “…. with only a modest percentage of remissions, the incapability of long-term palliatives (contained action of symptoms), and a very modest number of survivors after 2-3 years, even in patients treated at the initial stage of the illness, no treatment with Chemo can be considered a standard in dealing with small-cell lung carcinoma …” (127) [George TK, in : Cancer, vol. 58, pp. 1193-1198, 1986 ;Allegato 7_T. K. George.pdf
During the following ten years, Klastersky (1995) summarized the most important studies that had been carried out: “….. recently, a number of different chemotherapy regimes have been tried, in the hope of improving the results by increasing the intensity of the dose. All of these efforts, from the extreme (Chemotherapy with bone-marrow transplant) to the simplest (doubling of doses), have failed. No significant result has been obtained by increasing the chemotherapy doses in the treatment of small-cell bronchial carcinoma, nor has any improvement been noted through the combination of single agents…” (223) [Klastersky J., in Seminars in Oncology, vol. 22, Suppl. 2, pp. 11-12, 1995].
Kokron (1982) observed: “…in the control group that was not treated with Chemotherapy (however on a free food regime, with no particular diet, n.d.t.) evident advantages were due to the quality of life owing to the absence of side-effects tied to chemo-therapy and to the briefness of the terminal phase of the illness…” (232) [Kokron O., in : Onkologie , vol. 5, pp. 56-59, 1982].
According to a 2004 study (1340), which involved about 28,000 patients (some suffering from small cell cancer and others from non-small cell cancer), only 2% of them were still alive 5 years after starting Chemotherapy (the work is
available in PDF format: MORGAN.PDF .
There are many scientific works which demonstrate that Chemotherapy is essentially useless in the treatment of the breast cancer (71, 117, 183, 344, 373, 481).
[Chlebowski R.T.: A decade of breast cancer clinical investigation: results as reported in the program/proceedings of the American Society of Clinical Oncology, Journal of Clinical Oncology, Vol. 12, No.9, 1994, pp.: 1789-1795 ;
Allegato 8_Chlebowski.pdf ].
[A prospective randomized trial comparing Epirubicin monochemotherapy to two Fluorouracil, Cyclophosphamide, and Epirubicin regimens differing in Epirubicin dose in advanced breast cancer patients, Journal of Clinical Oncology, vol.9, No.2, 1991, pp.: 305-312 ; Allegato 9_French Epirubicin Study Group.pdf
[Hoogstraten B.: Combination chemotherapy and adriamycin in patients with advanced breast cancer, a Southwest Oncology Group Study, Cancer, 38, pp.. 13-20, 1976 ; Allegato 10_Hoogstraten.pdf
[Petru E.: No relevant influence on overall survival time in patients with metastatic breast cancer undergoing combination chemotherapy, J.Cancer Res.Clin.Oncol., 1988, No: 114, pp.: 183-185 ; Allegato 11_Petru.pdf
[Walters R.S.: Arandomized trial of two dosage schedules of mitomycin C in advanced breast carcinoma, Cancer,1992, Vol. 69, No.2, pp.:476-481; Allegato 12_Walters.pdf
As far as far the use of different combinations of Chemotherapies is concerned, a number of multicentric experimental studies conducted on women affected by breast cancer and published between 2003-2004 showed inconsistent results: disease-free time of about 5 months and median survival time of 15 months (1068) [Multicentre, phase II study evaluating capecitabine monotherapy in patients with anthracycline and taxane-pretreated metastatic breast cancer, Eur. J.Cancer, 2004; 40(4), PP:536-542 ; Allegato 13_Fumoleau.pdf ; in case of the so-known “Salvage chemotherapy”, the disease-free median survival time was only 8 months with an average response time of 4 months and a disease progression within 5 months (1069); disease progression-free survival time 3 years with median survival time of 2 years (1071); disease progression-free survival time of 8-10 months with median survival time of 18-19 months (1072). Finally, the “compassionate” use of Chemotherapy given by mouth: “…An open-label, non randomized, compassionate-use study was carried…” (1073).
(1070)[Phase II study of docetaxel in combination with epirubicin an protracted venous infusion 5-fluorouracil (ETF) in patients with recurrent or metastatic breast cancer. A Yorkshire breast cancer research group study, Br.J.Cancer, 2004, 90(11),pp.:2131-2134; Allegato 14_Humphreys.pdf], According to doctor Ulich Abel, there is no direct evidence that Chemotherapy prolongs survival time; this should be noted because all women affected by breast cancer undergo Chemotherapy before and after the surgical intervention (1306).
In March 1996, Dr. Nelson Erlick, Director of the ECRI (Emergency Care Research Institute), carried out an extended analysis of the case studies published by the medical literature on breast cancer in the years prior to 1994. 1.500 scientific research works were studied.
On the basis of all the available data, the following resulted:
1)In the initial phase Intensive Chemotherapy and Bone-marrow transplant give a higher “Response Incidence” compared to the standard Chemotherapy. In other words: the tumour mass diminishes (“Incidence of Response”). But, this “Response” does not last long and cancer soon after starts to advance one again;
2)Standard Chemo-therapy offers patients with breast cancer metastasis a longer “Duration of Response” (i.e. the number of months during which the reduction of tumour mass lasts longer), and furthermore more patients survive for a year compared to those treated with Intensive Chemotherapy and Bone-marrow Transplant;
3)Scientific research on Intensive Chemotherapy and Bone-marrow transplant has not yet identified any sub-group of population in which this treatment can guarantee a period of non-progression of cancer that is major to that referred to control groups.
Up until the present day, medical literature has never declared that Intensive Chemotherapy and Bone-marrow Transplant may actually heal/cure anyone from breast cancer. Intensive Chemotherapy and Bone-marrow Transplant produce an income of 150-200 thousand Euro-Dollars for each bone-marrow transplant. The latter without considering the high percentage of deceases during the months that follow bone-marrow transplant, owing to fatal infections caused by germs, that occur in patients that are momentarily deprived of adequate immune defences after heavy Chemotherapy and the lack of active bone marrow, that takes time to engraft, notwithstanding the transplant performed in the previous weeks.
As far as this is concerned, it is important to notice that in the Wall Street Journal of 17 November 1994, in an article on the front page about politic pressure on insurance companies, so that they paid for bone marrow transplantation in case of advanced stage breast cancer, the experts gave totally negative reports about this sort of approach.
As far as early breast cancers are concerned, Philip Day in his famous book “Cancer: Why We’re Still Dying to Know the Truth” recounts (pages 20-21) the incredible discovery of Doctor Irwin Bross of Roswell Memorial Park Institute in New York:
“… If a woman is diagnosed with early breast cancer, i.e. without metastasis, a simple scientific datum should be known. When a pathologist diagnoses a lesion such as “an early breast cancer”, in the majority of cases the pathologist makes a mistakes because actually it is not a breast cancer. Most women are affected by a tumour similar to a cancer when seen under an illuminated microscope. It is possible that this tumour will not metastasize, which happens in case of a real cancer. The first controlled clinical trial regarding adjuvant therapies in the treatment of the breast cancer was conducted in my department. Doctor Lesile Blumenson and I made a surprising discovery: more than half patients had a tumour but it seemingly looked rather like a benign lesion. Our discovery did not arouse much interest among professional doctors. They would never accept the idea to admit the scientific truth as at that time the therapy consisted in the radical mastectomy.
Admitting the truth could have led some women – whose breast had been removed because of a wrong diagnosis – to undertake legal proceedings against those incompetent doctors. Doctors from National Cancer Institute – furious – did not allow us to continue the research. They probably succeeded in covering up our discovery and stopping other publications. Breast cancer and cancer of the prostate have the same statistical results: when the functions of the two sexual organs decrease, cells often become abnormal and look like tumour cells.
The Journal of the American Medical Association reported surprisingly high survival times for patients affected from cancer of the prostate which were not treated. This demonstrates that 7 cancers out of 8 were NOT actually cancers.
Therefore, there is no reason for women to get into panic when the word “cancer” is pronounced. It is the panic that makes them easy victims…”
Finally, according to a recent study (2004) (1340), which considered over 42,000 patients, only 1.5% were still alive after 5 years from the first Chemotherapy cycle (this work is available in PDF format at: MORGAN.PDF
Cancer of the Stomach
Kingston evaluated the effectiveness of chemotherapy drugs versus placebo (however on a free food regime, with no particular diet), in patients presenting non-operable gastric carcinoma. The group of 95 patients that underwent Chemotherapy showed an average survival time more or less equal to survival of patients on placebo (221) [Kingston R.D.: Clinical Oncology, vol. 4, pp. 55-69, 1978].
The unanimous evaluation of many other authors is that medical literature does not give any proof of prolonging life through Chemotherapy in the case of stomach carcinoma (178,277,300,358) [Moertel CG.: Cancer, vol. 36, pp. 675-682, 1975];[Queiber W.: Onkologie, vol. 9, pp. 319-331, 1986];[Hockey M.S.: Slevin and Staquet, Raven Press, New York, pp. 221-240, 1986];[Mc Donald: Seminars in Oncology, vol. 15, Suppl. 3, pp. 42-49, 1988].
Twelve randomized studies, that compared post-surgical Chemotherapy to control patients (on a free food regime, with no particular diet) have demonstrated the more or less same time of survival. (7,210,171,154).[Alexander H.L. .in:DeVita: Cancro, principi e pratica dell’oncologia, Lippincott and Co., Philadelphia, 1993, 4.a ediz.];[Kelsen D.: Seminars in Oncol., vol. 18, pp. 543-559, 1991];[Hermans J.: J.Clin.Oncol. Vol. 11, pp. 1441-1447, 1993];[Hallissey M.T.: The Lancet, vol. 343, pp. 1309-1312, 1994].
During the last 10 years the situation has not improved. According to a Japanese study (2004) which considered about 500 patients from 1985 to 1997, 8% were still alive 2 years after beginning Chemotherapy and only 2% after 5 years. (1317) [Yoshida M., Jpn J. Clin. Oncol. 2004, 34, pages: 654-9, FREE full text article at: http://www.jjco.oupjournals.org ]
Other recent works demonstrate that Complete responses were achieved only in few cases; an American research (2005) involving 43 patients affected by Cancer of the stomach and the esophagus showed only one Complete Response and 5 Partial Responses; after 6 months 50% of the patients were alive, after 15 months 20% and after 2 years 12% (1318) [Enzinger PC. : A phase II trial of irinotecan in patients with previously untreated advanced esophageal and gastric adenocarcinoma, Dig. Dis. Sci. 2005, 50, pp.: 2218-2223; Enzinger.pdf
According to the results of an Italian study (2006) involving 52 patients, 50% were still alive one year after the first Chemotherapy cycle but only 3 cases of Complete Response and 15 cases of Partial Response were observed. We are waiting to know the percentage of patients alive after 2 and 5 years (1319) [Felici A.: Bi-weekly chemotherapy with cisplatin, epirubicin, folinic acid and 5-fluiorouracil continuous infusion plus g-csf in advanced gastric cancer: a multicentric phase II study, Cancer Chemother. Pharmacol., 2006, 57, pp.: 59-64 ; Felici.pdf ].
According to a study conducted in Korea, only one Complete Response and 13 Partial responses were observed out of 30 patients undergoing Chemotherapy; median survival time for all patients was 11 months. (1320). [Lee SH: Br. J. Cancer, 2004, 91, pages: 18-22].
Another Korean study (2005) considered 43 patients undergoing Chemotherapy from January 2002 to November 2002. Also the results of this study showed the slow decrease of surviving patients: about 40% of them 9 months after the beginning of the therapy, 20% after 14 months, then about 18% after about 20 months and following less than 5% 2 years and a half after the first Chemotherapy (1324)[Do-Youn: Docetaxel + 5-Fluorouracil + Cisplatin 3 day combination chemotherapy as a first-line treatment in patients with unresectable Gastric Cancer, Japanes Journal Clin. Oncol., 2005, 35, pp.: 380-385; Do-Youn Oh.pdf ] .
Another Swiss study (2004) showed that only one Complete Response wasachieved out of 52 patients; 50% were still alive after 9 months, about 24% after 18 months, 20% after 20 months, 18% after 24-30 months and about 10% after 2 years. Survival percentages after 4 years are not known yet (1323) [Roth AD: 5-Fluorouracil as protracted continuous intravenous infusion can be added to full-dose docetaxel (Taxotere)-cisplatin in advanced gastric carcinoma: a phase I-II trial, Ann. Oncol. 2004, 15, pp.: 759-764; Roth.pdf
Another Korean research conducted in 2002 showed that only one Complete Response and no less than 19 Partial Reponses were achieved out of 35 patients receiving Chemotherapy from 1999 to 2001; but the percentage of alive patients was 50% after 10 months, going down then to 20% after 18 months. Survival percentages after 5 years were not published (1325) [Eun Kyung Cho: Epirubicin, Cisplatin, and Protractedvenous infusion of 5-Fluorouracil for advanced gastric carcinoma, Journal Korean Med. Sci., 2002, 17, pp.. 348-52 ; Eun Kyung.pdf
Finally, according to a recent study (2004) (1340), which considered over 5,000 patients with cancer of the stomach, only 0.7% were still alive 5 years after initiating Chemotherapy. On the contrary, out of 2,500 patients suffering from cancer of the esophagus, about 5% of them were still alive 5 years after the first Chemotherapy cycle (work available in PDF format at: MORGAN.PDF
Cancer of the Pancreas
The average time of survival is 3 months in patients that undergo Chemotherapy, whereas in control patients (on a free food regime however, and no particular diet), that have not undergone Chemotherapy, the average time of survival is approx. 4 months (118) [Frey C., Cancer, vol. 47, pp. 27-31, 1981]. With Chemotherapy response results of over 30% have been reached (reduction of the tumour mass) (38,285,321,401) [Scheithauer W.: Tumor Diagnostik and Therapie, vol. 5, pp. 44-48, 1984; O’Connel: Seminars in Oncol., vol. 3, pp. 1032-1039, 1985;Meyer: Tumor Diagnostic and Therapie, vol. 8, pp. 54-58, 1987;Brennan: .in:DeVita “Cancro, principi e pratica dell’oncologia”, Lippincott and Co, Philadelphia, 4 a. edizione, pp. 849-882, 1993], but the survival period of time, compared to patients NOT treated with Chemotherapy (likewise on a free food regime and no particular diet) does not change.
Even considering more recent studies, the results do not change; for example, in 2006, using new chemotherapeutic agents such as Gemcitabine in association with Docetaxel, only 3 out of 43 German patients demonstrated a Complete
Remission; only 6 patients in all were still alive just one year after starting the therapy…but it is also known that the survival time after 2 and 5 years decreases further (1309). [Ridwelski K.: Eur. Pharmacol., 2006, 32, pages: 297-302].
Another study, which was conducted in 2005, considered 46 patients receiving Gemcitabine in association with 5 Fluorine-Uracile (5 F-U); the median disease-free survival time was only 3 months and a half. About 75 patients died already one year after initiating the therapy. Also in this case data on survival time at 2-5 years are not available (1310). [Santasusana JM: Clin. Transl. Oncol. 2005, 7, 493-498]
According to a research carried out by the European Organisation for Research and Treatment of Cancer Gastrointestinal Group, at one year the survival rate is about 30% but with percentages of 10% at 16 months and about 1-2% at 2 years (1311); [Lutz MP.: J. Clin. Oncol., 2005, 23, pages: 9250-6, Full text article at http://www.jco.org ]
Rates of a further research are: 30% one year after initiating the therapy, 10% at about 18 months and about 2% at more than 2 years (1312). [Ko A:, J. Clin. Oncol. 2006, 24, pages 379-385].
Better results were not reached even using microembolization and infusion of Cisplatin, Mitoxantrone and Mitomycin. Out of 265 cases treated in Germany between 1995 and 2005, 42-85% of patients were still alive one year after initiating the therapy, but the survival rate fell down to 20% after about 2 years and 10% after 4 years and settled at 5% after 5-6 years (1313) [K. Aigner: Celiac axis infusion and microembolization for advanced stage III/IV pancreatic cancer – a phase II study on 265 cases, Anticancer Research, 25, pp.: 4407-4412, 2005 ; Allegato 16_Karl R. Aigner.pdf .
Another research showed only one case of Complete Response and 2 of Partial Responses out of 68 treated patients; the median survival time was 8 months, in particular the median survival time was about 6 months in patients with hepatic metastasis and about 9 months in patients without. In case of peritoneal carcinomatosis, the median survival time was 7 months and a half, as against 9 months in patients without peritoneal carcinosis. Percentages of patients alive after 2 and 5 years are not available. But the study revealed that only one
Complete Response and 3 Partial Responses were achieved 54 months (4 years and a half) after initiating the therapy (1314) [Oman M.: Phase I/II trial of intraperitoneal 5-Fluorouracil with and without intravenous vasopressin in non-resectable pancreas cancer, Cancer Chemother. Pharmacol., 2005, 56, pp. 603-609; Oman.pdf
According to the results of another study involving 565 patients, the average disease-free survival time following Chemotherapy was only 4 months (1315). [Oettle H.: Ann. Oncol., 2005, 16, pages: 1639-1645, full text article at: http://www.annonc.oupjournals.org
Chemotherapy given by mouth did not produce better results: a study conducted in 2005 on 58 patients treated with Rubitecan by mouth showed a survival time of 17% after 6 months but this percentage falls to 9% already after one year (1321).
Finally, another study conducted in 2004 demonstrated that only 20% of 48 patients treated by the North Central Cancer Treatment Group, USA, were still alive 9 months after starting the therapy. This percentage settled in the following months but it slowly decreased reaching 10% at the end of the study, i.e. after 2 years. We are waiting to know the percentage of patients alive after 5 years. (1322).
Instead, according to the results of a 2004 study (1340) involving over 5,000 patients, none of them was alive 5 years after the first Chemotherapy (work available in PDF format at: MORGAN.PDF ).
(1737) [F. Di Costanzo : Gemcitabine with or without continuous infusion 5-FU in advanced pancreatic cancer: a randomised phase II trial of the Italian oncology group for clinical research (GOIRC), British Journal of Cancer, No. 93, pp. 185-189, 2005 ; Allegato 17_F Di Costanzo.pdf .
Survival after two years from diagnosis is notoriously considered an anedoctal case, or with very low survival percentages two years after the diagnosis (10-20%), if underwent chemotherapy (1174,1175) [Gattinoni L.: Renal cancer treatment: a review of the literature, Tumori, 2003, 89(5), pp.: 476-484; Flaningan RC.: Metastatic renal cell carcinoma, Curr. Treat. Options Oncol. 2003, 4(5), pp.: 385-390].
According to the results of a 2004 study (1340) involving about 6,000 patients, none of them was alive 5 years after the first Chemotherapy (work available in PDF format at: MORGAN.PDF ).
Cancer of the Prostate
On the 4th November 1995, the scientific magazine The Lancet announces “…. 90% of cases of prostate cancer never become clinically significant. The percentage of survival at 10 years among patients that had never received any treatment (either Surgery, or Radiotherapy, or Chemotherapy, or Hormonetherapy) was 91,5% against 77% of patients that underwent Radiotherapy…”.
Comment of the author on the latter work published: Radiotherapy, as is known, destroys even the local defences, first of all the lymph nodes near the tumour, that abound in Natural-Killer Lymphocytes, unfortunately extremely sensitive to radiations.
Once again The Lancet, on 9th December 1995, comes down heavily with the shock announcement: “…. radical surgery in the treatment of prostate cancer, manages only to spread the illness: monitoring 14 consecutive surgical operations, tumour cells that came from the prostate after the operation were discovered in the blood stream of 12 patients. In those same patients no tumour cells were revealed in their blood stream before the operation took place….”
According to the results of a 2004 study (1340) involving about 32,000 patients, none of them was alive 5 years after initiating Chemotherapy (work available in PDF format at:
101 women treated with a standard dose of “Cisplatine” showed the same period of survival as other 306 women treated instead with higher doses of “Cisplatine” (22,78)[Bella M.: Abstract No. 706, in: Proc. Amer. Soc. Clin. Oncol., vol.11, pp.223, 1992] [Colombo N.: Abstract No. 614, in: Proc. Amer. Soc. Clin. Oncology, vol. 12, pp 255, 1993].
Other studies confirm these results (81,329,330) [Conte P.F.: Abstract No. 880, in: Proc. Amer. Soc. Clin. Oncol. 12, pp 273, 1993];[Ozols R.F, “Journal of Clinical Oncology”, Vol. 5, pp 641-647, 1987.];[ Ozols R.F.: Seminars in Oncol., vol. 21, Suppl. 2, pp. 1-9, 1994].
According to the results of a 2004 study (1340) involving about 4,200 patients, only 9% of patients were still alive 5 years after initiating Chemotherapy (work available in PDF format at: MORGAN.PDF ).
Cancer of the Uterus and Endometrium
In the case of metastasis cured with different combinations of chemotherapy drugs it is possible to have a partial response percentage of the tumour of over 40%, but according to randomized studies this does not result in any prolonging of survival time. (31,186,327,455,492,) [Williams, C.J.: Raven Press, New York, pp. 417-446, 1986];[ Thigpen J.T.: Cancer, Vol. 60, pp. 2104-2116, 1987];[Hoskins WJ.in:DeVita:Cancro, principi e pratica dell’oncologia, Lippincott and Co, Philadelphia, 4.a edizione, pp. 1125-1152, 1993]; [Omura G.A.: Seminars in Oncol. Vol. 21,pp. 54-62, 1994];[Bonomi P.: J.Clin.Oncol., vol.3, pp. 1079-1085, 1985].
In actual fact, in an extended study on 260 women in class IIb and IV, the combination of Chemotherapy and Radiotherapy proved to be even worse that Radiotherapy alone (450) [Tattersall M.H.: J.Clin. Oncol., Vol. 13, pp. 444-451, 1995 ; Allegato 19_M.H.N. Tattersall.pdf .
According to the results of a 2004 study (1340) involving about 6,000 patients, none of them was alive 5 years after the first Chemotherapy cycle. On the contrary, out of 2,500 patients suffering from cancer of the cervix, about 12% of them were still alive 5 years after the first Chemotherapy cycle (work available in PDF format at: MORGAN.PDF ).
According to Nicholls (317) [Nicholls J.: in : Slevin and Staquet, Studi randomizzati del cancro: un inventario critico per locazioni, Raven Press, New York, pp. 241-271, 1986] and Kane (204) [Kane M.J.: Seminars in Oncology, vol. 18, pp. 421-442, 1991], the groups of patients not treated with Chemotherapy (but however on a free food regime, with no particular dietary restrictions), showed a major survival time compared to those patients that had undergone Chemotherapy.
Even results obtained on 1523 patients, through hepatic arterial infusion chemotherapy, do not show an advantage in survival and, in contrast with the actual aim of these studies, even present an increase in liver metastasis. (301,429, 485) [Soybel D.L.: Current Problems in Cancer, vol. 11, pp. 257-356, 1987];[Weber W.: SAKK Anticancer Research, Vol. 13, pp. 1839-1840, 1993];[Moertel CG.: The New Engl. J. Med., vol. 330, pp. 1136-1142, 1994].(175) [Hine K.R.: Prospective randomised trial of early cytotoxic therapy for recurrent colorectal carcinoma detected by serum CEA, Gut 25, pp.: 682-688, 1984 ; Allegato 20_Hine.pdf ].
Today the situation is not better. According to the results of an American study (2005) considering 110 patients, only a Partial remission was achieved.
The average survival time for all patients was 6 months. More impressing was the drop in the number of disease progression-free patients (20%), which settled at 15% after 4 months and fell down to less than 5% 7-8 after initiating the therapy; the reported graph shows the slow but inexorable decrease of alive patients at 5, 10, 15 and 20 months, with a final survival percentage of 10% after 18 months (1316).
Finally, according to a recent study (2004) (1340), which considered over 30,000 patients affected by colorectal cancer, only 1-3% of them were still alive 5 years after initiating Chemotherapy (this work is available in PDF format at: MORGAN.PDF ).
Chronic Lymphocytic Leukaemia
In a recent Polish study carried out on 229 patients who underwent chemotherapy, median survival (50%) for this disease is about 3-4 years, with the survival curve becoming slightly more stable in the following years, with 8-9 year survival values of 30% for patients older than 65, and of 15-20% for adult patients younger than 65.(1176) [T. Robak: The effect of subsequent therapies in patients with chronic lymphocytic leukaemia previously treated with prednisone and either cladribine or chlorambucil, Haematologica, 90, pp.: 994-996, 2005].
In another recent, 10-year long work, 78 patients out of a total of 134 initial patients were subsequently brought to the second stage of therapy, as they were still considered to be able to continue chemotherapy. Progression-free survival turned out to be lower than 3-4 years for more than 75% of the 78 patients. Most of the 56 patients that were thought not to be able to continue clinical trials with the other 78 patients were excluded for the following reasons: hepatitis B virus infection, Listeria monocytogenes infection, Zoster virus infection, persistent cytopenia, autoimmune hemolytic anemia, non-hematologic neoplasia, cerebral hemorrhage, persistently high transaminase levels.(1177) [F.R.Mauro: Fludarabine + prednisone + alfa-interferon followed or not by alfa-interferon maintenance therapy for previously untreated patients with chronic lymphocytic leucemia: long term results of a randomized study, Haematologica 88(12), pp.1348-1355, 2003]
Note: according to the author of this work, dr. Giuseppe Nacci, this sort of exclusions from chemotherapy treatment protocols are very common and tend to alter the final results.
Acute Lymphoblastic Leukaemia in Adults
Recent works regarding life-saving chemotherapy for patients with primarily refractory or relapsed Acute Lymphoblastic Leukaemia carried out on 135 adults show that survival percentages tend to linearize only after the first year from chemotherapy, with survival percentages lower than 20%. After 24 months, the percentage of patients still alive is lower than 10%.(1178) [Camera A.: GIMELA ALL –Rescue 97: a salvage strategy for primary refractory or relapsed adult acute lymphoblastic leucemia, Haematologica, 89(2), pp.145-155, 2004. http:
Acute Lymphoblastic Leukaemia in Children
If treated with chemotherapy, Acute Lymphoblastic Leukaemia in Children has a less dramatic prognosis compared to adults. Indeed, recent studies carried out in 1998 on 2038 children (a very wide sample) show variable survival percentages between 42% and 66.8%, 10-12 years after chemotherapy, with a stabilization of the mortality curve around the fifth-sixth year after treatment with chemotherapy.(1179) [R. Consolini: Clinical relevance of CD10 expression in childhood ALL, Haematologica 83, pp.: 967-973, 1998]
Note: as chemotherapy is notoriously ineffective for most tumours, we wonder why it seems to be so effective in Acute Lymphoblastic Leukaemia. You should keep in mind that many drugs can erroneously give haematological values similar to Acute Lymphocytic Leukaemia, Hodgkin’s Lymphoma or Non-Hodgkin’s Lymphoma.
The patient’s immune response to germs or viruses (e.g. Mononucleosis) can also erroneously lead to a diagnosis of tumour. (SEE further).
Chronic Myelogenous Leukaemia
The following reported data have been obtained from 1084 patients who underwent chemotherapy; almost all of them had bone marrow stem cell transplant. In comparison with Acute Myelogenous Leukaemia, the median survival is better: about 60% of patients are still alive after 24 months and the survival curve tends to stabilize on slightly lower values in the following years. The situation for patients with Chronic Myelogenous Leukaemia in the progressive phase is different: only 50% of patients are still alive after 12 months. The percentage drops to 35% after 24 months and then stabilizes around 30%. (1180) [De Souza: Validation of the EBMT risk score in chronic myeloid leucemia in Brazil and allogeneic transplant outcome, Haematologica, 90, pp.: 232-237, 2005. De Souza.pdf]
Acute Myelogenous Leukaemia
A recent study of 2004 carried out on 621 elderly patients (older than 60) who underwent chemotherapy shows that the median survival (50%) is just 5-7 months. With an aggressive chemotherapy, less than 10% were still alive after 20 months; on the contrary, with a conservative approach (low-dose chemotherapy), about 20% of patients were still alive after 20 months. This figure dropped to 10% after another 20 months. Both curves drop to less than 2-5% of survivors in the following months. (1181) [Pulsioni A.: Survival of elderly patients with acute myeloid leukaemia, Haematologica, 89, pp.: 296-303, 2004; Pulsoni.pdf] .
In another recent study of 2004, carried out on 258 elderly patients with Acute Myelogenous Leukaemia who underwent chemotherapy with stem cell self-transplant, median survival (50%) goes up to just 8 months. After 24 months, about 23-24% of all patients are still alive. Then this percentage drops after 36 months and 48 months (4 years), when it seems that it finally stabilizes at about 10% of survivors. (1182) [Oriol A.: Feasibility and results of autologous stem cell transplantation in de novo acute myeloid leukemia in patients over 60 years old. Results of the CETLAM AML-99 protocol, Haematologica, 89, pp.: 791-800, 2004; Oriol.pdf
About 25% of patients survive five years after treatment with chemotherapy, less than 5% are still alive after 10 years. (1183) [Kenneth C. Anderson: Management of Multiple Myeloma Today, Seminars in Hematology, vol. 36, No.1, suppl.3, 1999 Allegato 21_Anderson.pdf ].
However, another study of 2000 (1367) based on a treatment randomization for Stage-1 Multiple Myeloma showed no benefits from chemotherapy compared to absence of treatment.
Last, a recent work of 2004 (1340) carried out on about 2700 patients shows that no-one of the patients was still alive five years after the beginning of chemotherapy. (MORGAN.PDF )
A recent work of 2003 studied 97 patients who underwent chemotherapy, radiotherapy and stem cell transplant, in a time span of 18 years: from 1982 to 2000. In patients with chemoresistant Lymphoma, median survival (50%) is only two years, with the survival curve stabilizing at 30% five years after treatment. However, in patients with chemosensitive Lymphoma the survival curve goes down slowly and stabilizes in a very good way during the sixth year, with a percentage of survivors of 60% remaining the same in the ten following years. It is thought that the survival curve does not tend to further change.(1184) [P.L. Zinzani: High-dose therapy with autologous transplantation for Hodgkin’s disease: the Bologna experience, Haematologica, 88,(05), pp.: 522-528, 2003; http://www.haematologica.org ].
Note: as chemotherapy is notoriously ineffective for most tumours, we wonder why it seems to be so effective in Hodgkin’s Lymphoma. You should keep in mind that many drugs can erroneously give haematological values similar to Acute Lymphocytic Leukaemia, Hodgkin’s Lymphoma or Non-Hodgkin’s Lymphoma. The patient’s immune response to germs or viruses (e.g. Mononucleosis) can also erroneously lead to a diagnosis of tumour.
It extremely important to remember that Reed-Sternberg cells are typical not only of Hodgkin’s Lymphoma, but also of Epstein Barr virus infectious mononucleosis (1292)[ J.Kurtin: Interfollicolar Hodgkin’s disease, Society for Hematopathology, Hematopathology Specialty Conference, 1996, Discussion, – Case # 5, Mayo Clinic, Rochester, Minnesota,USAhttp://researchpath.hitchcock.org/socforheme/specialty/Spechem965.html ]
The latter study was published ten years ago and stated that Reed-Sternberg cells are different from Hodgkin’s Lymphoma’s cells. Under the microscope, with immunoperoxidase staining in paraffinated sections, Reed-Sternberg cells that are present in interfollicular Hodgkin’s Lymphoma are phenotypically identical to Hodgkin’s cells in lymphomas at the stage of nodular sclerosis, mixed cellularity or lymphocytic depression. Indeed, they are all positive both to anti-CD 15 antibodies (Leu-M1), anti-CD30 antibodies (Ber-H2), anti-CD45 antibodies (leucocyte common antigen), and to anti-KiB3 antibodies (1293)[Wilson CS: Malignant lymphomas that mimic benign lymphoid lesion: a review of four lymphomas, Semin. Diag. Pathos. 1995, 12(1), pp: 77-86]; (1294) [Fellbaum C.: Monoclonal antibodies k1B3 and Leu-M1 discriminate giant cells of infectious mononucleosis and of Hodgkin’s disease, Hum Pathos. 1988, 19, pp: 1168-1173].
Reed-Sternberg cells are highly reactive lymphocytes which elaborate a variety of cytokines and growth factors. According to this article, it is likely that follicular hyperplasia is induced by Reed-Sternberg as a reaction to Hodgkin’s Lymphoma. According to Doggett (1295) [Doggett R.: Interfollicular Hodgkin’s disease, Am. J. Surg. Pathos. 1983, 7, pp.: 145-149 1999 Allegato 22_DOGGETT.PDF ], Interfollicular Hodgkin’s disease stage must be seen as the result of partial involution of the ill nodule, and not as a distinctive sub-type of the disease. In biopsies carried out on patients, one can see different stages of lymph nodes (nodular sclerosis, mixed cellularity, interfollicular areas). Therefore, the types of Hodgkin’s Lymphoma with follicular hyperplasia must be differentiated from other diseases, such as para-cortical immunoblastic reactions:
1.a) immunity reactions against various viruses, including Epstein Barr virus (1296) [Child CC: Infectious Mononucleosis. The spectrum of morphologic changes simulatine lymphoma in lymph nodes and tonsils. Am.J.Surg.Pathol. 1987; 11(2), pp.: 122-132 ; Allegato 23_CHILDS.PDF];
1.b) post-vaccination lymphadenitis (1297) [Hartsock RJ.: Postvaccinial lymphadenitis: Hyperplasia of lymphoid tissue that simulates malignant lymphomas, Cancer 1968, 21, pp.: 632-649];
1.c) lymphadenopathies of autoimmune disorders such as adult Still’s disease (1298) [Valente RM: Characterization of lymph node histology in adult onset Still’s disease. J.Rheumatol. 1989, 16, pp.: 349-354];1.d) Systemic Lupus Erythematosus (SLE)
1.e) lymphadenopathy associated to drug hypersensitivity (1299) [Abbondanzo SL: Dilantin-associated lymphadenopathy. Spectrum of histopatholologic features, Am. J. Surg. Pathol. 1995, 19(6), pp.: 675-686]; (1300) [Saltstein SL: Lymphadenopathy induced by anticonvulsant drugs and mimicking clinically and pathologically malignant lymphomas, Cancer 1959, 12, pp: 164-182].
All these disorders can be associated to para-cortical and follicular hyperplasia.
All these conditions in a benign disease must be separated from Interfollicular Hodgkin’s lymphoma.
However, in infectious mononucleosis, a subset of immunoblasts can have cytological characteristics that are virtually identical to those of Reed-Sternberg cells.
The diagnosis of Hodgkin’s Lymphoma is supported by a positive immunoreactive test made with anti CD-15 antibodies and a negative immunoreactive test made with anti-CD 45 antibodies.
In Hodgkin’s Lymphoma with Reed-Sternberg cells, immunoreactivity to anti-CD 15 antibodies is about 15-20%. However, all previously investigated benign immunoblastic reactions are negative to anti-CD15 tests, and positive to anti-CD 45 tests. According to Reynolds (1301), Epstein Barr virus reactive atypical immunoblasts are however phenotypically similar to Hodgking’s Lymphoma cells. Reynolds observed that it is possible to differentiate infectious mononucleosis from Hodgkin’s Lymphoma thanks to the following three features:
1.a) Immunoreactivity to CD15 (if Hodgkin’s Lymphoma).
1.b) Absence of immunoreactivity to CD15 for Epstein Barr virus reactive immunoblasts.
2.a) Presence of small collarette-shaped T cells around Hodgkin’s cells.
2.b) Absence of small collarette-shaped T cells in Epstein Barr virus infectious mononucleosis.
3.a) presence of Epstein Barr proteins in viral infections. (1301)[Reynolds DJ: New characterization of infectious mononucleosis and a phenotypic comparison with Hodgkin’s disease, Am J. Pathos. 1995, 146(2), pp.: 379-388 ;
The immunophenotype of Reed-Sternberg cells is very variable. Thus, the presence of these cells shouldn’t be immediately interpreted as a diagnosis of Hodgkin’s or non-Hodgkin’s Lymphoma, as the use of CD-3, DAKO-M1 (CD15), L26 (CD 20), BerH2 (CD 30), MT1 (CD 43), DAKO-LCA (CD45RB), UCHL1 (CD45R0), LN2 (CD74) and DAKO-EMA antibodies in patients has been proven not to be fully reliable (1302) [Wei-Sing Chu: Inconsistency of the immunophenotype of Reed-Sternberg cells in simultaneous and consecutive specimens from the same patients, American Journal of Pathology, vol. 141, No.1, 1992, pp: 11-17]. Allegato 25_CHUENGLISH.PDF
Another work showing that it is difficult to diagnose Reed Sternberg cells in Hodgkin’s Lymphoma vs infectious mononucleosis, is the work of Bitsori (1303) [Bitsori M.: Reed-Sternberg cells in atypical primari EBV infection, Acta Pediatrica, Vol. 90, No.2, 2001, pp: 227-229,3]. In particular, the distribution of Leu MI (CD15) antibodies themselves is not reliable (1304) [Sewell HF: Reaction of monoclonal antiLeu M1 – a myelomonocytic marker (CD15) –with normal and neoplastic epithelia 1987, Journal of pathology, Vol. 151, No.4, pp.: 279-284; Allegato 26_SEWELL.PDF ]
Finally, we report the question of differential diagnosis of sarcoidosis and lymphomas themselves, as the former is very often a consequence of chemotherapy (1305) [Dickerman Hollister: Sarcoidosis mimicking progressive Lymphoma, Journal of Clinical Oncology, 2005, pp.: 8113-8116].
In a recent work of 2005, 374 patients who underwent chemotherapy were taken into consideration. Based on the International Prognostic Index (IPI), patients were divided into 4 groups: low risk, low-intermediate risk, high-intermediate risk, and finally high risk. The various survival curves that were obtained are not so different from the ones we already knew from medical literature:
1) median survival (50%) of about one year for high risk patients, with a percentage of about 10% of survivors after the fifth year, and the curve going down in the following years;
2) median survival (50%) of about 3 years for high-intermediate risk patients, with a percentage of survivors of about 25% after the sixth year;
3) median survival (50%) of about 4 years for low-intermediate risk patients, with a percentage of survivors of about 40% after he sixth year and about 37% after the seventh year;
4) median survival (50%) of about 8 years for low risk patients, with a percentage of survivors slightly lower in the following years.(1185) [M.van Agthoven: Cost determinants in aggressive non-Hodgkin’s lymphoma, Haematologica, 90(5), pp.: 661-672, 2005].
Note: as chemotherapy is notoriously ineffective for most tumours, we wonder why it seems to be so effective in Non-Hodgkin’s Lymphoma. You should keep in mind that some drugs can erroneously give haematological values similar to Acute Lymphocytic Leukaemia, Hodgkin’s Lymphoma or Non-Hodgkin’s Lymphoma. The patient’s immunitary response to germs or viruses (e.g. Mononucleosis) can also erroneously lead to a diagnosis of tumour. For example we quote a recent Italian medicine book (1307), Savagno L.: “I linfomi Non Hodgkin”, Piccin Editore, pp.: 202:
“… translocation is necessary but not sufficient for the neoplastic transformation of B lymphocytes. The reader should agree that monoclonality is usually a signal of malignancy, however this is not an absolute rule and there are exceptions. We have already seen that, at the beginning of an intense and specific immune (defensive) reaction, lymphocytes proliferate indicating a uniform activation, and only a constraint that physiologically intervenes later makes reactive proliferation self-limiting. An enlightening clinical example is the case of F.R., a 28-year-old young man that underwent biopsy in 1994 because of a necrotizing tonsillitis with satellite adenopathy. The diagnosis of 3 different pathologists suggested a malignant lymphoma with small classification differences among the three doctors. One of them had also detected that tonsillar lymphocytes were monoclonal. When the medical oncologist visited F.R., before any antiblastic or radiant treatment, he still had a lymph node measuring 2 cm in diameter in the gonion, while the tonsillar lesion had spontaneously healed during treatment with sulphamidic drugs. A lymph node cytoaspiration showed a homogeneous layer of atypical lymphoblasts that were often in mitosis and that looked malignant. Two days later, when F.R. had to be given the test results, his lymph node had reduced to a maximum diameter of 5mm.
A new cytoaspiration was carried out; this showed that there were no more proliferating atypical lymphoblasts. A completely different cell population had substituted them: they were almost exclusively mature plasmacells. Lymphocytes had typically evoluted into blasts, that in their turn changed into plasmacells. This allowed to understand the whole episode correctly: it wasn’t a neoplastic disease, but a phlogistic-reactive disease. No antitumoral treatment was therefore given. The young man is now going towards the mature age without lymphoma, ten years after this episode. The lesson here is that monoclonality is almost a constant feature in neoplasias, but in itself it is not enough for an absolutely certain diagnosis…[ (1307), Savagno L.: I linfomi Non Hodgkin, Piccin Editore, pp.: 202: Allegato 27_SALVAGNO.PDF ]
Paul Winter shows a harsher version of facts and explains the dynamics of the system in this way: “It is unlikely that a doctor consciously stops an oncologic therapy to protect his business or his career. But every doctor has his own ideas about what isthe best treatment, based on what he learned.
However, chemo pharmaceutical multinationals have a very strong influence on what is taught to doctors. Doctors are too busy to study more statistics about cancer treatments, and take for granted that what they are taught at university, or what is shown in medical journals, is the best possible treatment, as it is scientifically proven. Nor can they suspect that such treatments are the best thing only for chemo pharmaceutical multinationals, which exert their influence on “high-level medical cultural institutions” belonging to them… (Winter, Paul: the Cancell Home page,http://www.best.com/handpen/Cancell/cancell.htm .
On 9 January 1991, dr. Martin F. Shapiro wrote on the Los Angeles Times, supporting the idea according to which chemotherapy is NOT curative and that it really has very little effect on the most common types of cancer: “While some oncologists inform their patients on the lack of evidence that this therapy really works, other doctors could have been mislead by scientific documents that are optimistic about chemotherapy without guarantees. Other doctors are still sensitive to economic benefits. Doctors can earn much more money with chemotherapy than giving comfort to dying patients and their families…”.
Dr. Samuel Epstein stated on 4 February 1992: “We are worried that the system that was founded against cancer, the National Cancer Institute (NCI), the American Cancer Society (ACS) and about twenty more centres for cancer treatment have mislead and confused the public opinion and the Congress (of the United States) through repeated statements according to which we are about to win the war against cancer…”.
As far as chemotherapy is concerned, the author of this work claims the right to complete freedom of therapy and technical autonomy (art. 12, Italian Medical Deontology Code), because of his contrary clinical beliefs, founded on countless scientific trials. He responsibly chooses to apply more suitable diagnostic and therapeutic remedies, practising what is often stated in legal literature, especially in Amedeo Santosuosso’s work (“Libertà di cura e libertà di terapia. La medicina tra razionalità scientifica e soggettività del malato”, Il Pensiero Scientifico Editore, 1998, page 57), where he states, as a comment to article 19 of the Medical Deontology Code:
“…Freedom of evaluation by the doctor is controlled by article 19, called “Refusal of professional performance”. According to this article, that substantially reproduces the text of the previous Deontology Code, the doctor can refuse to perform his job, if he is asked to do something against his conscience or his clinical beliefs, unless his behaviour is immediately and seriously harmful for the patient…”
It should be noticed that this rule is particularly broad and strict. Indeed, it allows objection of conscience not only when the law allows it and according to those procedures, but in all cases. Moreover, it allows to refuse therapies because of mere clinical beliefs, even when no conscience questions are involved. The only limit is about extreme situations, when the patient could be seriously and immediately harmed.
Besides, the Court of Cassation is very clearly in favour of the doctor’s autonomy in therapeutic choices. This is a sentence of 2001 (Section IV, sent. n. 301/2001):
“…It is fair to emphasize the doctor’s autonomy in therapeutic choices, because, as medicine has no own scientific protocols based on mathematics, it often implies different practices or solutions that were shown to be effective thanks to experience. These solutions have to be chosen with a careful evaluation of a series of variants that only a doctor can evaluate. This freedom of therapeutic choices cannot be ill-considered nor based only on personal experience. Once the choice is made, the doctor must continue to carefully observe the situation, in order to intervene immediately in case an emergency arises, if he understands that his choice was not appropriate. When all this is realized, the doctor cannot be responsible of a possible failure.
To evaluate if the therapeutic choice was right and if he acted out of inexperience, the judge must give an “ex-ante” judgement, that is, he must go back to the moment when the doctor has to choose, and consider the scientific bases of his choice…”.
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