sodium-bicarbonate and Liver-Neoplasms

The external pH of solid tumors is acidic as a consequence of increased metabolism of glucose and poor perfusion. Acid pH has been shown to stimulate tumor cell invasion and metastasis in vitro and in cells before tail vein injection in vivo. The present study investigates whether inhibition of this tumor acidity will reduce the incidence of in vivo metastases. Here, we show that oral NaHCO(3) selectively increased the pH of tumors and reduced the formation of spontaneous metastases in mouse models of metastatic breast cancer. This treatment regimen was shown to significantly increase the extracellular pH, but not the intracellular pH, of tumors by (31)P magnetic resonance spectroscopy and the export of acid from growing tumors by fluorescence microscopy of tumors grown in window chambers. NaHCO(3) therapy also reduced the rate of lymph node involvement, yet did not affect the levels of circulating tumor cells, suggesting that reduced organ metastases were not due to increased intravasation. In contrast, NaHCO(3) therapy significantly reduced the formation of hepatic metastases following intrasplenic injection, suggesting that it did inhibit extravasation and colonization. In tail vein injections of alternative cancer models, bicarbonate had mixed results, inhibiting the formation of metastases from PC3M prostate cancer cells, but not those of B16 melanoma. Although the mechanism of this therapy is not known with certainty, low pH was shown to increase the release of active cathepsin B, an important matrix remodeling protease.

Topics: Animals; Breast Neoplasms; Cathepsin B; Cell Line, Tumor; Female; Humans; Hydrogen-Ion Concentration; Liver Neoplasms; Lung Neoplasms; Male; Melanoma, Experimental; Mice; Mice, Nude; Mice, SCID; Neoplasm Invasiveness; Prostatic Neoplasms; Sodium Bicarbonate

A 77-year-old-man was admitted to hospital for treatment of a huge hepatocellular carcinoma by transarterial chemoembolization. After treatment, the patient developed acute tumor lysis syndrome with hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, metabolic acidosis and acute renal failure, which was successfully treated. In the treatments of solid organ tumors, acute tumor lysis syndrome is an extremely rare complication. To the best of the authors' knowledge, this patient is the third case of such a complication after transarterial chemoembolization for a hepatocellular carcinoma in the English literature.

Topics: Aged; Allopurinol; Antimetabolites; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Humans; Length of Stay; Liver Neoplasms; Male; Radiography; Rehydration Solutions; Sodium Bicarbonate; Treatment Outcome; Tumor Lysis Syndrome

The authors examined 40 patients with malignant tumors of various histogenesis, sites and extent, as well as 5 patients with benign tumors and other non-tumorous diseases. They also studied their electroencephalography and peripheral blood lymphocytic and erythrocytic ultrastructure in metabolic alkalosis temporarily induced by intravenous sodium hydrogen carbonate. In cancer patients without late metastases, alkalosis caused a transient normalization of previously altered electroencephalography, erythrocyte disaggregation and substantially reduced the count of killer cells in small and middle lymphocytes. These findings suggest that patients with malignant neoplasms have a generalized intracellular acidosis which can be temporarily abolished by plasma alkalinization.

Topics: Adult; Alkalosis; Ampulla of Vater; Common Bile Duct Neoplasms; Electroencephalography; Erythrocyte Aggregation; Erythrocytes; Female; Humans; Killer Cells, Natural; Liver Neoplasms; Lymphocyte Subsets; Lymphocytes; Male; Middle Aged; Neoplasms; Sodium Bicarbonate; Stomach Neoplasms

Chemotherapy for liver metastasis of breast cancer has rarely been found effective. We devised a new regimen of chemotherapy for recurrent breast cancer mainly using ifosfamide. It was found clinically applicable and particularly effective for liver metastasis. The tumor decreased in size and the levels of various tumor-markers markedly decreased following drug administration. This treatment has made for longer survival for some patients. Side effects could be well controlled with steroid hormones and Na-bicarbonate.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bicarbonates; Breast Neoplasms; Doxorubicin; Drug Administration Schedule; Female; Fluorouracil; Humans; Ifosfamide; Liver Neoplasms; Medroxyprogesterone; Medroxyprogesterone Acetate; Mitomycin; Mitomycins; Sodium; Sodium Bicarbonate

The utility of scintigraphic views obtained after administration of sodium bicarbonate-citric acid-simethicone crystals (E-Z-GAS) for the determination of gastric extrahepatic perfusion was evaluated in 20 technetium-99m macroaggregated albumin hepatic arterial perfusion studies performed in 19 patients. These crystals produce carbon dioxide gas, distend the stomach, and allow better delineation of gastric activity (extrahepatic perfusion to the stomach). Conversely, a lack of change in activity in the left upper quadrant after the effervescent crystals have been ingested suggests no gastric activity (and no extrahepatic perfusion to the stomach). These "air-contrast" views added useful information in 16 of 20 studies. In three cases prior hepatic arterial perfusion studies without air contrast were misinterpreted as lacking extrahepatic perfusion, which was only recognized on subsequent studies through the use of the air-contrast views. In another case extrahepatic perfusion was erroneously diagnosed on a hepatic arterial perfusion study without air contrast, with a follow-up air-contrast hepatic arterial perfusion study showing this to have been a false-positive diagnosis. Air-contrast views of the stomach can be extremely helpful in verifying or excluding the diagnosis of gastric extrahepatic perfusion on technetium-99m macroaggregated albumin hepatic arterial perfusion studies.

Topics: Bicarbonates; Carbon Dioxide; Citrates; Citric Acid; Drug Combinations; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Circulation; Liver Neoplasms; Pentetic Acid; Perfusion; Radionuclide Imaging; Regional Blood Flow; Retrospective Studies; Serum Albumin; Sodium Bicarbonate; Stomach; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Pentetate

Topics: Acidosis; Antineoplastic Agents; Bicarbonates; Carcinoma, Small Cell; Humans; Lactates; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Prognosis; Sodium Bicarbonate

Lactic acidosis is a life-threatening disorder in some cases. Treatment should be directed at the primary cause. Sodium bicarbonate should be added if the acidosis is very severe, or if the rate of hydrogen ion production is very rapid and not controlled. In contrast, with moderate degrees of steady state lactic acidosis and poor dietary intake, the risks of therapy with sodium bicarbonate or dichloroacetate may actually outweigh the benefits in a cachectic patient unless a dietary glucose and/or protein load is given.

Topics: Acidosis; Bicarbonates; Cachexia; Dichloroacetic Acid; Glycolysis; Humans; Lactates; Liver Neoplasms; Male; Middle Aged; Sodium Bicarbonate