Clinical course）An 81-year-old woman came to our clinic with a complaint of poor appetite and decreased body weight. She was discovered to have a widespread tumor from the gastric angulus to antrum on intragastric endoscopy. Between advanced age and poor systemic condition, the cancer was considered unresectable and the patient was scheduled to receive low dose chemotherapy and thermotherapy with hyperbaric oxygen treatment with colloidal iodine.

Treatment）Chemotherapy with 60 mg/day of oral TS-1 and 10 treatments of hyperthermia with concomitant colloidal iodine 200 mL x 2 doses/day for 10 days were ingested.

Results）Marked shrinkage of the tumor and hemostasis were observed. In 3 weeks after treatment the patient was again capable of oral alimentation.

Discussion）This case proved oral ingestion of colloidal iodine and iv infusion are safe methods of administration to patients who have high-risk complications or are of advanced age. Oral ingestion of colloidal iodine was confirmed to have a direct effect = improvement of the malignant tumor environment.

Clinical course）In January 2012 the patient received chemotherapy at another medical institution for scirrhous stomach cancer with hepatic metastases. However, due to decreased appetite and impaired hepatic
function, it was decided he would be unable to undergo any further treatment.

Treatment）The patient underwent thermotherapy and hyperbaric oxygen therapy and in addition to TS-1: 80 mg/day, he was started on oral colloidal iodine.

Results）The unevenness of the gastric mucosa was gone, and 3 months later, most of the mucosal lesions had disappeared.

Discussion）While no effective treatment is currently available for scirrhous gastric cancer, colloidal iodine improved gastric mucosal lesions. It inhibited the fibroblast exosomes of gastric wall origin that lead to increases in tumor size, and improves cancer microenvironments to inhibit "cancer tissues”. We believe our case provides interesting insight into the treatment method for scirrhous gastric cancer in a form of treatment effective in improving malignant tumor environments.

Treatment course）In September 2014 the patient was diagnosed with intrahepatic cholangiocarcinoma which was surgically excised at Tokyo Medical University Hospital. In July 2015 he suffered a recurrence where chemotherapy proved ineffective and he was hospitalized at our institution on January 7, 2015. There, he received thermotherapy and hyperbaric oxygen therapy together
with iv infusion of colloidal iodine. Symptoms improved after treatment allowing the patient to be discharged on February 14, 2016.

Treatment）120 mg Abraxane + 150 mg oxaliplatin was given once every 3
weeks for 2 courses of chemotherapy.  Colloidal iodine was given twice a day
at a dose of 200 mL per dose for 10 days. Next, colloidal iodine is ingested at a dose 40 mL x 4 times a day for 30days. Thermotherapy was administered 10times.

Results）Marked improvement of CT images was observed 4 weeks after
treatment. No signs of adverse drug reactions were noted after treatment.

Discussion）Intrahepatic cholangiocarcinoma is a type of tumor where chemotherapy is not very effective. Since colloidal iodine can be given as both an iv infusion and ingested orally, the drug is supplied into the liver with alleviation of the adverse drug reactions to chemotherapy while effects are potentiated. As a result, we observed very rapid efficacy on this treatment. Colloidal iodine ingestion is effective in intrahepatic cholangiocarcinoma.

Clinical course）The patient was diagnosed with chronic lymphocytic leukemia in June 2014 but due to her advanced age and chronic heart failure, she was not a candidate for chemotherapy and it was decided to observe the patient. In February 2016, the WBC increased to 230,000 and the patient was admitted for treatment due to aggravation of heart failure.Treatment was started with 200 mL once daily of colloidal iodine iv infusion. On February 27, WBC decreased to 110,000, the low-grade fever resolved, and the patient was able to eat again.

Discussion）The administration of colloidal iodine is effective against chronic lymphocytic leukemia and has anti-infective effects while having no adverse drug reactions allowing safe administration.

Clinical course）In 2015 the patient had melena which upon further evaluation was discovered to be rectal cancer. It had already metastasized to the lungs and spine, he was diagnosed with unresectable cancer and the patient came to our facility to receive thermotherapy and colloidal iodine treatment.

Treatment）We administered chemotherapy with XELOX treatment, thermotherapy, and hyperbaric oxygen for 10 courses each. Simultaneously, the patient received 200 mL of iv infusions of colloidal iodine once daily for 10 days and the lesion area was lavaged with the same solution using an endoscope.

Results）The massive tumor lesion that caused the melena decreased in size by 50% after 1 month of treatment and after 3 months had shrunk to a tiny lesion. Although increases in the metastases to the lungs and spine were not observed, no improvement in the metastases into the abdominal lymph nodes were noted.

Discussion）Direct effects of colloidal iodine through iv infusion and lavage of the tumor site led to direct effects on the mucosal lesion with low dose chemotherapy, thermotherapy, hyperbaric oxygen response rate, and treatment efficiency. It was confirmed safe use with no adverse drug reactions. Direct administration is a useful administration method and is believed to have contributed to shrinkage of the tumor itself

Clinical course）A 95-year-old man was transported by ambulance to emergency care because of hematemesis. Emergency endoscopy revealed a large hemorrhagic ulcerous lesion together with gastric cancer. Because of his advanced age and chronic heart failure, it was determined that the tumor was unresectable and it was decided to treat with low dose chemotherapy, thermotherapy, and hyperbaric oxygen together with colloidal iodine.

Treatment）120 mg Abraxane® was administered along with thermotherapy and hyperbaric oxygen therapy for a total of 10 treatments each while colloidal iodine was given by iv infusion at a dose of 100 mL x 2 doses/day for 10 days and directly into the stomach through insertion of a Levin tube.

Results）Concurrent use of colloidal iodine iv infusion, made it possible to achieve marked shrinkage of the tumor lesion with hemostasis in just 2 weeks.

Discussion）This case shows that concomitant use of direction application of colloidal iodine potentiates the effects of chemotherapy without adverse  drug effects and can safely be used in older patients. Moreover, we confirmed that lavage of the hemorrhage site has hemostatic effects. Ingested colloidal iodine is a weakly acidic solution with a pH of 7.0 but it was believed to have potent effects in removing activated oxygen to achieve hemostasis and improve mucosal lesions.

Clinical course）While being followed after pacemaker implantation in October 2016, the patient was diagnosed with gastric cancer after endoscopy for anemia. Her poor systemic condition made surgery impossible and so she was treated with only 1 dose of 120 mg Abraxane + Cyramza® (Ramucirumab) injection and oral ingestion of colloidal iodine.

Treatment）After only 1 dose of chemotherapy, the patient received 6 courses of thermotherapy and 6 courses of hyperbaric oxygen therapy. On November 2, 2016, marked improvement of the lesion was noted on intragastric endoscopy.

Clinical course）Diagnosed in May 2014 with unresectable esophageal cancer and treated with radiotherapy and chemotherapy. Thereafter, the patient required stent placement due to esophageal narrowing. Eating issues led to the patient visiting our clinic in September 2015 to receive thermotherapy and colloidal iodine treatment. After treatment, improvement of stenosis allowed the patient to start eating again.

Treatment）Paclitaxel (Abraxane®) 120 mg + CBDCA 150 mg once every 3 weeks for 2 courses, 10 thermotherapy sessions, and 200 mL of iv colloidal iodine given once daily for 10 days.
Results: Shrinkage of esophageal cancer was noted with improvement of the narrowing and decreases in tumor markers.

Results）Shrinkage of esophageal cancer was noted with improvement of the narrowing and decreases in tumor markers.

Clinical course）This patient was diagnosed in March 2015 with unresectable Stage IVb pancreatic cancer. Chemotherapy was ineffective and in October 2015 the patient started treatment with thermochemotherapy, hyperbaric oxygen, and colloidal iodine iv infusion. Four weeks later, CT images revealed a marked shrinkage of the tumor with improvement in tumor marker levels (CA19-9).

Treatment）Chemotherapy with 150 mg of Abraxane + GEM 600 mg once every 3 weeks for 2 courses. Thermotherapy and hyperbaric oxygen therapy were administered 10 times each. Colloidal iodine was given twice a day at a dose of 200 mL per dose for 10 days.

Discussion）Administration of colloidal iodine potentiated the effects of low dose chemotherapy, thermotherapy and reduced adverse effects. By avoiding adverse drug reactions, it was possible to continue long-term use of chemotherapy.

Clinical course）In April 2014, the patient underwent gastrectomy for gastric cancer. In July, 2017, liver metastases was discovered and failed to respond to chemotherapy. The patient therefore presented to our department.

Treatment）150 mg Abraxane® injection + Xylamza® injection with thermotherapy and hyperbaric oxygen treatment with 200 mL x 2 doses/day of colloidal iodine iv together with oral ingestion for 1 month. The result was marked shrinkage of liver metastases.
Results: Shrinkage of esophageal cancer was noted with improvement of the narrowing and decreases in tumor markers.

Clinical course）In September 2014, the patient had undergone surgery to treat rectal cancer.
Thereafter, an intrapelvic lesion recurred and despite treatment with chemotherapy and radiotherapy, disease activity could not be controlled and the patient visited our institution

Treatment）The patient was treated with 2 courses of XELOX + Avastin(R) injection with 100 mL x 2 doses/day for 14 days of colloidal iodine injection together with thermotherapy and hyperbaric oxygen therapy. Thereafter, the intrapelvic tumor stopped growing and shrinkage was observed.

Discussion）Before shrinkage of the tumor during the course of treatment, lesion growth was initially noted in a form of pseudo-progression. This phenomenon is often observed with immune checkpoint inhibitors and colloidal iodine formulations are believed to have a similar mechanism of action as immunotherapy.

Treatment Course）The patient received transverse colon surgery for colon cancer in June 2017. In February 2019, the cancer recurred as a huge mass with a fistula in the peritoneum and abdominal wall. The patient was started on XELOX + Avastin in March. In addition to thermotherapy, hyperbaric oxygen therapy, and oral XERODA, the patient also ingested a colloidal iodine preparation.
Colloidal iodine was also injected through the fistula and the site lavaged multiple times.

Results of treatment）After approximately 1 month, closure of the abdominal wall fistula was observed with marked shrinkage of the tumor volume to 40% of the original size.

Clinical course）In January 2017 the patient presented with loss of appetite and abdominal bloating which led to a diagnosis of scirrhous gastric cancer. The patient was already ineligible for surgery and was told he would only be given palliative care with oral TS-1 administration. In July of the same year, he presented with a decrease in oral intake and difficult moving and so he was admitted to our hospital for treatment. After admission, despite attempts at Cell-free and Concentrated Ascites Reinfusion Therapy there were no improvements in ascities and so Denver peritoneovenous shunt was inserted. For this procedure, after draining off a massive amount of ascites, 1500 mL of colloidal iodine solution was used for replacement instead of the traditional normal saline solution. The pH of the ascites is usually≧7.3 while the colloidal iodine solution is strongly alkaline at pH 8.5 but it could be used as replacement with no issues. Thereafter, no further accumulation of ascities was noted.

treatment）Before the start of chemotherapy, 200 mL of colloidal iodine was used once daily for 10 consecutive days. Thereafter, chemotherapy was administered. Treatment with 120 mg of paclitaxel (Abraxane®) + Ramucirumab (Cyramza®) injection was now possible and concomitant thermotherapy and hyperbaric oxygen treatment was also instituted. Just 1 month after the start of treatment, the patient was ambulatory and became capable of oral alimentation and could be discharged.

Discussion）In patients with ascites, appropriate adjuvant therapy involves concomitant use of Denver Shunt placement and hyperbaric oxygen therapy. While draining ascitic fluid, the fluid is replaced with colloidal iodine thus enabling chemotherapy and thermotherapy to achieve better efficacy. In patients with peritoneal seeding, colloidal iodine was safely administered into the peritoneal cavity and due to direct administration into the peritoneal cavity, the result was an improved microcirculation environment.