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The basics ---

1. Was cancer definitely present , as shown by reliable tests, when treatment was commenced?

2. Did it go away? 
(or clearly respond otherwise, as judged by the same tests)

3. Was the advocated treatment the only one used ? 
(within 2-3 months of the apparent cancer response)

(N.B   The same principles apply to case reports produced by ralternative" practitioners and clinics, and in the following, "testimonial"  usually implies both.)

A "good" testimonial should fulfil these three requirements.  A handful of testimonials of this quality involving certain common cancer states  could provide powerful, almost indisputable, evidence of a useful ralternative" cancer treatment.   

Anything less  leaves doubt.  Weaker testimonials may be suggestive of  a possible treatment effect,  but they cannot stack up into strong evidence even when produced in numbers.   Indeed,  the more there are,  the more something  stands out like a sore thumb.  That is that alternative methods are hardly ever shown having these  unmistakable effects upon established human cancer, even though the usual claims require that they should be able to do so, and suitable cases are being treated  by the thousands.    Why is it that obvious cancers, such as those described in reference [1}  cannot be shown melting away in photographs or scans, under the influence of  reputed cancer-killers like Laetrile, or oxygen, or alkalisation,  or of the patients' supposedly reawakened immune systems?     

I believe this to be the fundamental reason why so many ralternative" cancer cure claims are not taken seriously.   No one expects sophisticated clinical studies of individuals who think they have a cancer cure, but we can expect some convincing cases.

The promoters of alternative cancer treatments have ordained that their methods be judged by testimonial and I can agree to that, so long as all the facts can be checked if necessary and a benchmark relevant to the precise claim is being applied  (the  benchmark above pertains to the most common claim of being able to either cure cancer or produce remission).   It also stands to reason that a cancer cure arising from within ":alternative" medicine will first declare itself with a few remarkable cases.     

ralternative" testimonials are nothing like the case reports published in  major medical journals in other respects.     A  testimonial is a story told so as to influence the treatment choices of persons having no depth of medical knowledge.   The story-teller is free to choose what information to supply and to mould it in ways that suit that end.     The motives may be good and based upon honest belief.   There may be no intention to mislead.   Testimonials nevertheless  almost always do mislead,  through the  wishful thinking and often severely limited medical knowledge of both the story-teller and the intended audience.          

The testimonials described below are examples of a generally very low standard.   However, they are not entirely without value.  They may tell us little about the treatment method, but  they can reveal a great deal about the claimant!     An example  of a case report that should by itself arouse serious doubts as to the trustworthiness of the author is outlined in this  Example (a rather technical one, I am afraid).  

A tolerance of weak testimonial is responsible for the morass facing cancer patients should they wish to try ralternatives".  Literally dozens of cancer cures hang upon about the same level of weak testimonial evidence and I defy anyone to confidently select out any that might actually work.     The fault lies not only with those selling or promoting the methods.   I strongly believe that cancer patients supplying testimonials have a duty of care towards other cancer patients  near that of medical practitioners.   Are they not offering medical advice from an influential position?  They should themselves investigate all matters bearing upon their case, and indicate doubt wherever it exists.    Cancer patients and their allies should also be more assertive,  querying flawed testimonials or ones that provide incomplete information.

Surely cancer sufferers deserve information they can trust.  

common problems

 Was cancer still present?    An extremely common flaw in testimonial is that the  cancer may have already been completely eliminated by previous treatments such as surgery.   It surely provides the true explanation for the  Binzel testimonials transcribed below.   This is part of the reason for rules 1 above, and also for rule 3,  as even treatments given with palliative intent (not expected to cure) sometimes have unexpectedly good  results. .    About fifty per cent of all invasive cancers are now completely and permanently cured by conventional methods, although the cure rate may vary from near zero to nearly 100% depending on cancer type and stage.    

 Cancer may never have been shown to be present  <examples> .    Yet cancer sufferers will be referred to such ridiculously unreliable evidence as showing how "thousands of people are curing themselves of cancer every day".  

Were all treatments disclosed?   Important conventional treatments may be overlooked in the story,  even though they provide a ready explanation for the benefits described  <example >.      Be prepared to  ask for more information, as I did in that case.     Such omissions are especially common with hormonally sensitive cancers, such as those of the breast and prostate.   It seems some patients don't regard commonly used  hormonal interventions as serious treatments,  even though they are capable of producing dramatic and prolonged remissions.  

Are there false assumptions as to prognosis?  Since testimonials rarely ever fulfil the rules described above their authors  have to use other ways to create an assumption that things would have gone badly if it were not for the treatment being advocated.   Examine how the expectation of a bad outcome is established.  Be prepared to research that question further. 

Ignoring the curative potential of surgery and other treatments has already been mentioned.   Sometimes  blatantly false information as to prognosis is provided,  as in Case No 18 in the Binzel testimonials .  

 It may be implied  that cancer always has a rapidly downhill course,  when most  types are quite variable in behaviour and some can even  quite regularly  undergo "spontaneous" remissions .      However, contrary to what some sceptics seem to think, spontaneous remission is one of the least common  reasons  for having doubts about testimonial.  It mainly arises with certain kinds of cancer: kidney cancer, melanoma, ."ome kinds of  lymphoma,  neuroblastoma in children and chronic lymphocytic leukemia,  --  although  possibly no cancer is completely immune.   The spontaneous remission issue can  be overcome very simply -- by producing more cured patients, especially examples from that majority of cancers where spontaneous remission is  very rare (of the order of 1 in 100,000).

Many testimonials depend  upon the assumption that doctors,  whose opinions may otherwise be held in great contempt,  can predict the prognosis of patients with serious cancers  to within a month or two.   It is actually notoriously difficult to predict outcomes with most kinds of cancer.      Many of the "six months to live"-type  predictions found in testimonial are so unlikely, given the described state of the cancer, as to suggest fabrication,  or at least faulty recall as to what was actually said.   If pressured for a prognosis experienced doctors will normally offer a wide range of possibilities, and perhaps  the bleakest one tends to stick in the distressed cancer patient's mind.    It is usually not difficult to check the facts in relation to any of the more common kinds of cancer.  Ask someone who should know.

  "The doctor was amazed   --  "  (by a patient's good  progress)   is thus as likely to reflect a doctor's inexperience of the sometimes erratic behaviour of cancer,  as an alternative treatment benefit.    Be wary when you encounter this phrase.    I am sure it can be a truthful observation,  but it is also commonly used as a prop for weaker  testimonials. 

Testimonials as to supposedly unusually prolonged survival before death are usually rather weak evidence for a useful treatment effect.   They would carry more weight if there was also evidence of definite cancer remission (disappearance or shrinkage of cancer) as per rule No 2.   Even with palliative use of chemotherapy lengths of survival are mostly correlated to the ability of the drugs to produce remission e.g. [5] .    

Tricks of the ralternative" trade.

Contrary to common belief,  living for  five years is NOT regarded as a cure by doctors,  although some cancers, such as bowel cancer,  very rarely do relapse so long after treatment .  Some cancers e.g. breast cancer have variants with substantial five year survival rates, even when left untreated .  

The promoters of alternative methods often lay the groundwork for their testimonials by first painting as dismal a portrait as possible as to the results of surgery and other conventional treatments.    Any good outcomes  can then be claimed as due to the addition of their treatment.  This is, again, why you should require clear evidence that the cancer was still active at the time the advocated treatment was commenced (rule 1).  Doctors test out cancer treatments this way and there is no reason why those providing alternative methods should do otherwise.   They should be eager to show what their methods can do in such cases.  

Others  try to bamboozle  their clients with tricked-up theories about cancer,  such as that there is no need to worry about the cancerous lumps  -- they are merely the symptoms of something else that they happen to have a cure for.   It is difficult not to see this as a cynical attempt to get around the fact that  their methods don't have any obvious impact on cancer at all,  or possibly even as a ploy to induce clients to continue buying their  products long after it should be clear that they are not working.    

Philip E. Binzel  MD,  whose testimonials are referred to below,  provides an excellent example of these last two strategies.   You can read his book online.   

Understanding adjuvant treatments. 

You will also encounter the assumption that a patient's outlook must have been very grim if doctors were advising more severe kinds of treatment,  such as radiotherapy and chemotherapy.     Sometimes that is true, but these measures are also now commonly used as  radjuvants" (add-ons)  to surgery.    The prognosis for cure may already be reasonably good but results are known to be improved by the additional measures.     It is thus not at all unusual for such patients to remain alive and well (and supplying testimonials) after refusing to have them.

radiotherapy, for example,  is mainly only suitable for the treatment of small regions of the body.   It is recommended after surgery when there is a significant risk of cancer coming back at  the operation site or nearby i.e.  the surgeon cannot be sure that he/she has "got it all"..   Sometimes that risk is extremely high,  as when  lumpectomy (wide excision-biopsy) is performed  in the hope of avoiding mastectomy for breast cancer.   Without radiotherapy the risk of a local recurrence in the breast may eventually be as high as 40% after lumpectomy alone,  leading to mastectomy or worse.    Yet that means 60% of patients would get by without it.   If patients are prepared  to accept this and other risks,  they can elect to do so. 

Similar considerations apply to adjuvant chemotherapy, except that it has the ability to treat the whole body,  almost regardless of where cancer cells may have travelled to.  .  The hope here is to prevent cancer coming back later in the bones, lungs,  liver or elsewhere (metastases),  where, with a few notable exceptions, it can usually not be cured.    But it may only work sometimes, improving  long-term cure rates a little.   For example, in one very large study the ten year cancer-free survival rate in women under fifty years old with  stage 1 breast cancer was 78% with an early version of chemotherapy but 72% without it. [4]     It is up to the patient  to decide whether a  six per cent better chance of being alive and well in ten years is worth a six month course of chemotherapy .   Most doctors would feel justified in recommending it, but, again, most patients will get by without it.    

You may now understand why an extremely common kind of breast cancer testimonial has no real basis.   The story-teller claims to have cured their breast cancer  "without any conventional treatments ".   They don't know that the simple excision biopsy or lumpectomy that they had to establish the diagnosis of cancer will be enough on its own to "get it all" and cure many early  breast cancers.  They are attributing to alternative measures outcomes that were simply due to luck.    I present such a testimonial in . and point out that there are also  a lot of women who have lost this gamble but whose stories get far less publicity. .   

There are  testimonials in relation to other cancers where it is wrongly assumed that a patient's prognosis would have been hopeless without ALL the  recommended treatments,  when the extra treatments were merely being advised so as to offer the best chance of cure .

What to take little notice of

I have not made much of apparent symptom responses to alternative treatments.    It is not that they may not be important, but even some cancer symptoms such as pain can respond to placebos and cancer patients can develop quite erroneous perceptions as to their progress.   Some poor souls become convinced they are getting better even as all around them can see nothing but decline and patients nearly always feel better for a while with any new treatment.    This is why the emphasis has to be upon tangible changes in the cancer itself.     All known useful treatments of cancer have such obvious effects,  in at least some cases.     

I provide below some examples of common  problems with testimonial.     Some of the more subtle and  technical problems with testimonial have been described in my discussion of  anecdotal evidence.  I examine other case histories there.

Observe that most testimonials have multiple faults that could have been avoided by the most basic research,  or discussion with an experienced oncologist.     This is understandable when alternative circles devote much energy into cultivating distrust of doctors and their publications     Yet how can you know what to believe, and who to trust, if you only ever look at one side of the story?   

SAMPLE TESTIMONIALS (this will expand as time goes on)

Not Cancer

Critical information withheld?

False prognosis?

Testimonials have an afterlife.

Frank Misrepresentations

1. Not cancer.

From  the web site --

I first noticed the tumor in my left breast in April 1994 when I felt a sharp pain when I got a hug. I assumed it was a bruise, but it did not go away. My wife Lyn checked it and found a small lump directly behind the nipple. It grew in size and discomfort for seven months till it was about 1.25 inches across and 0.25 inches thick, and was starting to head toward my armpit. I was still taking eight grams of vitamin C daily with the other anti-oxidants. Then in November 1994, we got Dr. Hulda Regehr Clark's first book, The Cure for All Cancers. In the book she gives her theory that cancer is caused by a common parasite, the human intestinal fluke (fasciolopsis buskii), "catalyzed" by isopropyl alcohol accumulated in the liver.

On November 23, 1994, I began the herbal parasite program. Lyn went through the house clearing out all isopropyl-tainted soaps, shampoos, foods, body products, cleaners and other solvents. She put four cardboard boxes of the stuff outside under our deck. After five days on the parasite herbs I noticed that the pain reduced greatly. Dr. Clark says the parasites die on the fifth day with the herbs. After two weeks Lyn could feel a noticeable decrease in the size of the tumor, and after three months the tumor was gone!

This is an absolutely typical story for gynaecomastia,  a common (but rarely discussed for obvious reasons) benign condition of the male breast.   It mostly resolves spontaneously after some months. .  It is commonly due to medications and in this instance could have been due to one of the alternative  products he was taking.    

Women also often provide testimonials of presumed   "breast cancers" going away with alternative treatments.    Yet at least nine out of ten female  breast lumps are benign (i.e. not cancer), and even  suspicious breast lumps coming to biopsy prove to be mostly benign.  They are usually due to variants of hormonally dependent fibrocystic disease and many will go away by themselves after a few menstrual cycles.    

It is difficult to think of any situation where a testimonial lacking a biopsy diagnosis of cancer is worthy of notice, although metastatic cancer can often be confidently diagnosed by typical appearances on imaging (scans, x-rays) and marker studies.  

The author of the above testimonial claims to have cured himself of incurable cancer twice.  The other instance was a level lll melanoma,  removed from his shoulder in 1987.    Level lll  means that the melanoma has not yet gone through the full thickness of the skin or even into the reticular dermis, the thickest layer of the skin.  It does not mean an advanced cancer, and no other spread is described.  . Simple excision will be curative in the vast majority of such cases.  The graph at  shows that the 15 year survival rate of Stage l melanoma, as this was,  is in the vicinity of  75-80%) .   The surgeon seems to have offered him unnecessarily aggressive treatment if this story is true in all other respects.  

Here is another example where  there was no diagnosis of cancer, but you are expected to believe there was.  --

My name is ---------. My husband ---------- was diagnosed with cancer of the
lung 3 years ago. His  routine physical checkup at the VA hospital
revealed a tumor in one of his lung. The doctors wanted to perform a
biopsy immediately to find out if the growth was malignant and they were
already talking about radiation and chemo "therapy". From past
experience and knowledge, I knew that this was not the answer. These so
called "therapies" provide no hope for real cure. Biopsies are very
traumatic to the body and chemo/radiation are well known to destroy the
immune system. Instead, I immediately began to treat him with
Homeopathy, raw vegetable juice, herbal formula in tincture/extract form
such as the essiac formula, the Hoxy formula, and
For the past 2 years doctors have continued to monitor Chuck's tumor
with CAT scan and PET scan. The tests revealed that a small mass still
remains in his lung, but the doctors aren't concerned about it because
the tumor has completely stopped growing and ------- experiences none of
the usual symptoms associated
with lung cancer. To this day he remains healthy and well.

Who knows?   There is some tiny chance that this may have been cancer, I suppose,  but if it has stayed absolutely stationary over these two years the chances are very high that it was always a benign lump of several possible kinds. This would be a very unusual way for a cancer to behave under any known effective  treatment.    

An example from alternative medical legend  is the personal testimonial of William Kelley, inventor of the Kelley cancer treatment, who claims to have cured himself of pancreatic cancer.   Yet the diagnosis was never confirmed by surgery or biopsy and there are indications of a much more chronic problem going back over many years, with symptoms strongly suggesting a depressive illness and mostly not at all suggestive of pancreatic cancer.  The fact that his doctors were unsure of the diagnosis  in the days well before modern scans, and were considering diagnostic surgery  cannot be taken as proof that cancer existed.   It is sometimes claimed in alternative circles that he was found to have extensive cancer at operation but in his own account he states that he refused surgery.


2. Critical information withheld.

 A well-known Australian sporting figure had advanced prostate cancer.  He appeared on television and was widely quoted in the newspapers claiming that symptoms had improved and  his very high PSA levels had fallen dramatically through  the use of an antioxidant herbal drink.   The company selling the product was using his story to promote it.

He was also receiving hormonal treatments  that very commonly induce such remissions.   He did not reveal this until I asked him directly on his blog <  > but, to his credit, he  did so then. 

Barry unwisely stopped his hormonal treatments and later required radiotherapy for secondary cancer in his spine  (Mackay "Daily Mercury"  Jan 17th, 2007).    His death was announced in February 2007.     His web site still supports the original claims, proposing that his death was entirely due to a blood clot.   That is a not uncommon terminal event, but  those maintaining the site should eventually supply clearer information about the state of his cancer, such as recent PSA levels.   Cancer sufferers deserve the fullest disclosure with such important claims as those to do with cancer treatment.   

(Addendum Jan 2008 -- Barry's web site has now been taken down.)


3. False information as to prognosis?  (the Binzel testimonials)

"Case No. 18: B.W.

This 44-year-old woman was seen for the first time on 2/6/81. She had
been found one month prior to have carcinoma of the descending colon
with 7 positive lymph nodes. A colostomy was not required. She received
no radiation or chemotherapy.

She was started on a nutritional program. Now. some 13 years later, she
has had no recurrence of her disease and leads a normal, active life.

What is so unusual about this patient? She had cancer of the colon with
metastases. The odds of her surviving 5 years were one in one-thousand.
Yet, she lives a normal life with no recurrence of her disease after 13
years. "

 After surgery the five year survival rate in such a patient is NOT one in 1000.   It can vary from about 25% to in excess of 60% depending on the extent  of gland involvement along the blood vessels.  In fact, the  overall,  ten year survival rate for colon cancer with lymph node metastases is now about 56% [2]..   It is rare for colon cancer to recur after even five years after initial treatment, so that these patients can be regarded as permanently cured by their surgery. 

This testimonial comes from a book called ralive and Well" [3] by Philip E. Binzel, MD  who believes he can cure cancer using nutritional methods and Laetrile.   

There is nothing very unusual about that outcome. .  Nor about case  no 8,  from the same source.--

This 45-year-old woman first was seen by me on 1/28/80 with a history of having been found to have carcinoma of the colon in September, 1979. Surgery was done, there were no metastases, and she received no radiation or chemotherapy. She was placed on a nutritional program. That was 14 years ago. She is now 59 years old and has had no recurrence of her disease.

And another that almost certainly represents the natural course of the disease after curative surgery  (case No 5)--

This 70-year-old woman was seen by me for the first time on 9/19/88. She had one-half of her stomach removed one month prior because of carcinoma. She received no radiation or chemotherapy. She has been on her nutritional program for five years. Now at the age of 75, she remains well with no recurrence at the primary site or with any metastases.

Hardly any of the 21 case reports that Binzel recounts in his book represent rare or unusual outcomes.     If you read his book  you will find out  why his testimonials are of this type.    He believes that conventional methods do nothing for cancer, a very convenient belief for a cancer charlatan..      <Back>

5.  Cancer testimonials have an afterlife.

Testimonials often merely reflect what a person believed, or wanted to believe, at one point in their illness, yet I don't think I have ever seen one retracted  when the claims later proved false or the patient died, as is usually the case whenever someone tries to treat established cancer with alternative methods alone.

This man had a squamous cancer of the floor of the mouth that was growing out through his lower lip when I first encountered him.   He refused any conventional treatments, believing all the foul things said about doctors and their methods within alternative circles ("Get thee behind me, Satan", I was told when I once suggested he might reconsider some conventional measures if his current choice of treatments did not help).. 

 Over the course of two years or so he strongly advocated many alternative  methods, having absolute faith that with those and the help of God he would one day be cured. .   His faith could not be faulted.   

One of his testimonials can be found  on the Cansema site (Case #061503 at )    At the time he believed the "black salve"  (Cansema)  was curing the cancer, although  it was causing him so much pain he was at one time seeing a dentist for  local anaesthetic injections before applying it..

This is what his cancer looked like later, shortly before his death. 


Needless to say his testimonial is still there on the Cansema site [1] as of January  2007,  

The cancer never apparently metastasised, which means that he should have had a good chance of cure with conventional methods, mainly surgery, if he had sought it early in the illness.  The treatment may have had to be  been drastic and  unpleasant because of the location of the cancer adjacent to the lower jaw.    (Thanks to you-know-who for the additional photos and further information as to his progress.)

Illustrating the influence of personal belief in testimonial, this man became convinced that he was seeing Hulda Clark's parasites in the bloody discharge from  the cancer.  He proudly announced that he had proved her theories about parasites and circulated photographs supposedly displaying them.    Here are examples -- clearly streaks of bloody mucus..     



6. An example of frank misrepresentation.  (Accessed 15th January 2008)

This is a case report from the web site of a doctor promoting the theory that cancer is a fungus and can be cured by bicarbonate of soda.    I looked at about ten case reports on his site and found only one that seriously tries to demonstrate clear-cut regression of established cancer with this extremely unlikely treatment method.  Most are skimpy short term accounts suggesting dubious benefits.

The case is illustrated by CT scans. The top two are supposed to show the disappearance of lung metastases and the bottom two regression of the primary cancer in the liver ( they are labelled the wrong way round and you must click on the films to enlarge them) .

But look at the shape of the heart in the centre of the first lung scan (the large round white blob).   The second scan, supposedly showing that the metastases have gone,  is at a very different level.   It is MUCH  higher up, above the level of the heart,  at the level of the aorta and pulmonary vessels.    We cannot tell from these films whether the metastases are gone or not! .

Suspiciously, the patient's name and the numerals that should show the true level of the CT scan "cut" have been lopped off the top left hand corner of the second scan, yet this  information is present on the other three scans.  It suggests an amateurish attempt to obscure what is obvious enough from the anatomy,  but it also means we can't even know for sure that the second scan belongs to the same patient.

There's more.  The liver scans are also not quite at the same level, one being at +260 mm and the other at  + 270 mm.   They seem to show little change in the overall size of the cancer. The reader is presumably expected to  interpret the obvious darker area in the liver (extreme left) as the extent of the cancer, but this is merely some necrosis or liquefaction in its centre.  The cancer is the larger surrounding circle of shading.  It appears slightly darker than the surrounding liver in the first picture.   While not mentioned in the text, intravenous contrast has clearly been given during the second scan to allow blood flow to show up, so the (living) cancer tissue now shows up as a lighter shadow.  The usual increase in vascularity (blood vessels) at the edge of the cancer shows up clearly in this later film. 

I cannot rule out a weak cytotoxic effect of intra-arterial bicarbonate -- the alkalinity could well kill many types of cells including cancer cells.    My argument is that having gone to the trouble to catheterise this man's hepatic artery, it is very likely that far superior results would be obtained by infusing more potent chemotherapeutic agents.   Also, we know that hepatic artery occlusion from the infusion of such an irritant will itself result in temporary shrinkage of about 30% of hepatic metastases, so that the small changes shown here over a 4-5 month period is very weak evidence for any specific anticancer effect of bicarbonate. 

Finally, why does this man's story stop in 2002?   I leave the reader to draw their own conclusions as to his subsequent progress.

Could these be unconscious deceptions and omissions?   Not from someone claimed to be an experienced, genuine oncologist.   Even if they were some kind of innocent mistake they would suggest someone who cannot be trusted to be making reliable judgements as to the worth of his treatment.    Back


[1]  Over the course of a few weeks' correspondence with  one of the principals of a prominent and typical alternative cancer clinic he produced three current cases that would have provided ideal tests of his treatment.   Below are photos of one of them, a patient with an enormous BCC on his back and a second smaller one higher up, never treated conventionally.   This is an absolutely ideal case for demonstrating the effects of a cancer treatment.   Another case had visible secondaries from melanoma, and the third had a probable lymphoma deposit near an eye.   The inability to show effects on patients with such obvious, active, cancers is one of the strongest reasons for doubting the claims of alternative practitioners.  I believe they must already know that their methods don't work noticeably on patients with active cancers, even though this probably applies to most of their clientele.

 I asked for a progress report on the BCC some months later.  There was no improvement, attributed to the patient being unable to follow the full protocol. I was told that ra year and a half of rigorous adherence to a very strict regimen"  was required, even though at other times I was told by the same person that dramatic changes can often be seen in cancers within a few weeks.  I asked for examples of that, but none suggestive of anticancer activity were forthcoming (resolution of edema and inflammation around cancers was mentioned but these can come and go naturally, perhaps helped by the severe salt restriction this particular method imposes).  



2. . McLeish JA, Thursfield VJ, Giles GG. Survival From Colorectal Cancer in Victoria: 10-year follow up of the 1987 management survey. ANZ J. Surg. 2002,72: 352-356


4. Early Breast Cancer Trialists' Collaborative Group: Polychemotherapy for early breast cancer: An overview of the randomised trials. Lancet 352:930-942, 1998.

5,  Buyse and others.  Relation between tumour response to first-line chemotherapy and survival in advanced colorectal cancer: a meta-analysis  Lancet. 2000 Jul 29;356(9227):373-8.  Links

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