title: High-Dose Viscum album Extract Treatment in the Prevention of Recurrent Bladder Cancer: A Retrospective Case Series.
abstract: BACKGROUND
  Viscum album extract (European mistletoe), containing immuno-active compounds with dose-dependent cytotoxic activity, is being used as an adjuvant cancer treatment in Europe. Few studies have yet been done with high-dose, fever-inducing Viscum album treatment.
  
  
  OBJECTIVE
  To explore whether subcutaneous injections of high-dose Viscum album have a preventive effect on risk of recurrence of bladder cancer.
  
  
  METHODS
  We retrospectively analyzed the case records of patients with resectable bladder cancer who underwent initiation of high-dose Viscum album treatment at our clinic between January 2006 and December 2012.
  
  
  METHODS
  We calculated tumor recurrence and progression risk and explored case records to assess whether treatment had a likely, possible, or unlikely beneficial effect.
  
  
  RESULTS
  Eight patients were identified, 7 of whom had nonmuscle-invasive bladder cancer and 1 with muscle-invasive cancer. Four patients had frequently recurring tumors before treatment. Among the 8 patients, 28 episodes of recurrence were observed. Median tumor-free follow-up duration was 48.5 months. High-dose Viscum album showed a possible beneficial effect in 5 of 8 patients, could not be assessed in 2 patients, and had an uncertain effect in 1 patient. No tumor progression was observed. Treatment was generally well tolerated and no patient stopped treatment because of side effects.
  
  
  CONCLUSIONS
  High-dose Viscum album treatment may have interrupted frequently recurring tumors in individual patients with recurrent bladder cancer. Prospective studies are needed to assess whether this treatment offers an additional, bladder-sparing preventive option for patients with intermediate- to high-risk nonmuscle-invasive bladder cancer.. Treatment was generally well tolerated and no patient stopped treatment because of side effects.
authors.affiliation: Research Associate for the ARCIM Institute in Filderstadt, Germany, and an Attending Pediatrician at the Fribourg Hospital in Switzerland. tido.von.schoenangerer@gmail.com.
authors.forename: Tido
authors.initials: T
authors.lastname: von Schoen-Angerer
authors.affiliation: Attending Physician at the Alexander von Humboldt Klinik in Bad Steben, Germany. dr.wilkens@humboldtklinik.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Wilkens
authors.affiliation: Senior Researcher for the Institute for Applied Epistemology and Medical Methodology at the University of Witten/Herdecke in Freiburg, Germany. gunver.kienle@ifaemm.de.
authors.forename: Gunver S
authors.initials: GS
authors.lastname: Kienle
authors.affiliation: Director of the Institute for Applied Epistemology and Medical Methodology at the University of Witten/Herdecke in Freiburg, Germany. helmut.kiene@ifaemm.de.
authors.forename: Helmut
authors.initials: H
authors.lastname: Kiene
authors.affiliation: Medical Director of the ARCIM Institute in Filderstadt, Germany, and a Researcher in the Department of Pediatrics at the University Hospital Tübingen in Germany. j.vagedes@arcim-institute.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Vagedes
mesh_terms: D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D010936:Plant Extracts / Q000008:administration & dosage*; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D028182:Viscum album
chemical_list: D010936:Plant Extracts