Yongling Gong

Traditional Medicine-2015Birmingham, UK

August 03 – 05, 2015

Traditional Traditional

MedicineMedicine

20152015

Yongling Gong, MD

Department of OncologyNanjing 1st Hospital Nanjing Medical UniversityNanjing 210006China

Therapeutic Value of Chinese Herbal Decotion in Radiation Pneumonia of Oesophageal

Carcinoma

-------a retrospective observational clinical case report

China is located in the high area of oesophageal carcinoma, but in recent years the incidence has been increasing significantly.

Oesophageal carcinoma might be the first leading cause of death from cancer in some Chinese metropolis such as Linxian County, Henan Province, where the situation is more serious, there are currently high morbidity  of about 100/100,000, with increasing mortality of 32.22/100,000 .

Background

More patients with advanced recurrent oesophageal carcinoma are now encountered.

Efforts to develop more effective drugs for treatment of recurrent or metastatic oesophageal carcinoma have been intensifying.

BackgroundChinese medicine is a medical system that is capable of treating a very wide range of conditions .

Together with acupuncture, massage, and food cures, they form the four distinct methods of treatment in traditional Chinese medicine (also known as TCM or T.C.M.)

Today, TCM still plays a major part of health care in China, and is provided in state hospitals alongside with Western medicine.

Basic differences between Western medicine and TCM:

Western medicine

→treatment of symptoms TCM

→ causes of those symptoms

Background

Few reports are available regarding treatment and outcome with the combination of chemo/radio-therapy and Chinese herbal medicine.

Here, we report on a retrospective observational clinical case :

Therapeutic Value of Chinese Herbal Decotion in Radiation Pneumonia of Oesophageal Carcinoma.

BackgroundChinese herbs might be an additional choice with its better benefits and tolerability in the treatment of radiation pneumonia (RP) of oesophageal carcinoma.

Aiming at starting the ball rolling and contributing humble effort to promote traditional Chinese medicine, we performed the present study to observe the curative effect of Chinese herbal Decoction of Runfei combined with hormone and antibiotic drugs in treating RP of oesophageal carcinoma.

Case presentationA 56-year-old male underwent surgery for cancer of the uper easophagus (T3N2M0) in Aug. 2014.

Case presentationA 56-year-old male underwent surgery for cancer of the uper easophagus (T3N2M0) in Aug. 2014.

Case presentationCase presentationPathology poorly-differentiated squemous cell arcinoma lymphnoid metastasis(3/9) IHC :

Diagnosis Esophageal carcinoma (T3N2M0)

Case presentation

Postoperative chemotherapy

No

Following postsurgery adjuvantradiotherapy of three dimensional conformal radiotherapy was administered. 51 Gy/28f.

Final date of radiotherapy

2014-11-22

Case presentationTwo months later, severe pneumonia had been found by Chest X-ray

Diffuse patchy shadows / ground glass appearance

Case presentationThe end of 2014•Complaint

dry cough, chest pain, dyspnea

palpitations , headedness

weakness and fatigue, etc

Dec, 2014•Hospitalized in the oncological depatment

Case presentationAccompanied complications

pleural effusion hypoxyia/arrhythmia pericardial effusion Clinical signs and symptoms, such as cough, bronchial asthma, back pain, vomiting , fever, tachycardia, and leukocytosis, are relatively nonspecific. Clinical Impression

Radiation Pneumonia (RP)

Case presentationTreatment of hormone and antibiotic. Hydroprednisone Injection 60mg qd ivgttFluconazole Injection 0.1 qd ivgttCefminox Sodium for Injection 2 bid ivgtt(sputum smear: double infection)Superinfection was related with the age of patients, hypoimmunity, extensiveusage of the antibiotics and neutropenia.

In the meantime, we administered Chinese herbal medicine(Run Fei Decoction, mixed a variety of effective herbal components) to help him to recover from the poor condition.

Objection Get far better bebefits and tolerability.

Chinese herbal medicine Run Fei Decoction mixed a variety of effective herbal components

Case presentation

Fei Decoction 1 Fei Decoction 2

Material and methods Decoction of Run Fei(Unit: gram ): Get far better bebefits and tolerability Membranous milkvetch root (50-120) Chinese angelica root 10 Red peony root 10

Peach seed 10 Safflower 10 Pangolin 10 Pollen 10 Cassia twig 6 Processed radix aconiti lateralis 5 Ligusticum wallichii 6 Codonopsis 30 Fructus aurantii 8 Salvia miltiorrhiza 10 Platycodon grandiflorum 6 Radix bupleuri 12 Rhubarb 6 (to be decocted later)

Sig: decoct medicinal herbs in 300 ml water per day, 150ml, bid(9:00/am, 15:00 pm).

Effect:

Decoction 1 Tonifying Qi and lifting yang Inducing diuresis for removing edema Clearing lung and expelling pus

Decoction 2 (on the basis of Fei Decoction1 ) Increasing efficiency of purgation Poison-discharging Sig: Decoct medicinal herbs in 300 ml water qd 150ml, bid(9:00/am, 15:00/pm)

After taking the Chinese herbs for 2 weeks, • Decrease of diffuse patchy shadows and ground glass

appearance on Chest X-ray • Diminsh of pleural and pericardial effusion• the patient felt free from the complaint of pulmanory

and cardiac discomfort. • Conventional lab test: normal range• QOL→improved.

• Patient → discharged from hospital • Further maintenance monotherapy with

Chinese herbal medicine(Run Fei Decoction)• Follow-up interval history physical examination conventional laboratory test determination of tumor markers chest X ray and CT.

Case presentation

DiscussionAbnormal activation and infiltration of tumour cell are leading causes of patient death.

Therefore, clearing about the pathogenesis and seeking effective treatments are quite significant.

Radiotherapy is the most basic treatment, but it is difficult to completely remove the lesions, and easy to induce RP after this radiation treatment.

The curative rate of RP with conventional antibiotic drug therapy after radical radiotherapy is dismay, and a majority of patients mostly suffer from clinical complications.

.

Discussion

Evaluations to the curative effect of radiotherapy are unsatisfactory.

squemous cell arcinoma is sensitive Glandular cell arcinoma is moderately sensitiveother types are not sensitive to radiotherapy.

The impact of radionecrosis to lung function also presented clinically.

.

Discussion

However, drug resistance, toxic and side effects with coventional therapies, and it is difficult to ensure the drug perfusion within the lesion area.

Even the horometherapy is restricted in its application in clinical medicine due to its complexity and high side effects.

The later immunological therapy and molecular targeting treatment once became the hotspots, but their existing limitations often made them merely an armchair strategist and made it difficult for them to be widely applied clinically.

.

Discussion

It has become an indisputable fact that the treatment of RP is characterized by poor clinical efficacy and adverse outcome

Here, enumerating the typical case which decoction of Run Fei used to treat RP and then making relevant discussions.

Discussion

Consent Written informed consent was

obtained from the patient for presentation of this case report and any accompanying images.

Our RP patient reported is completely cured we chose the other way and selected a CTM participation in clinical anti-RP treatmentFurther Chinese traditional treatment decoction /powderWe managed to have prolonged PFS (Progression-Free-Survival) TTP(Time-to-Progression

Summary

CTM considers human body as a dynamic platform in which all organs are correlative and bind each other. Relationship among heart, liver, spleen, lung and kidney is like interlinking between mother and son.

DiscussionClincal treatment of Chinese traditional medicine take into consideration patient's whole condition, including both body and mental condition, rather than confines to the lesion itself

Distinguished prescriptions →individual

Effect increase energy heighten sense of well-being reduce the side effect of radiation and chemotherapy refresh marrow function improve appetite and sleep.

DiscussionThe research of Chinese traditional medicine anti-tumor effect has made great achievements in recent years.With the development of science, it has obtained a new understanding of etiology ， pathogenesis ， and treatment of the tumor for human beings, who will pay a great deal of attention to the molecular mechanism of the anti-tumor effect in traditional Chinese medicine.

Conclusions It is clear that traditional Chinese medicine has a good prospect in the treatment of RP, and it is of great value to be applied. And the traditional Chinese medicine also has the effect of anti tumor, and has the advantages of multiple approaches, multiple targets, more efficacy and less side effects

An additional choice with better benefits and tolerability in the treatment of RP

AcknowledgementsAt the College Liling Zhu (Clinincal treatment with Chinese herbal decoction)Congfeng Niu (Collection of patients’ materials treated with decoction)Haijun Wan(Analysis of prescription and paper writing )Guangmei Lv (Evaluation of treatment with decoction)

CollaboratorsXudong Xia, Chinese medicine specialist, Wuxi, JiangsuQiang Wang, Prof , Dept of ICU, Tiantan Hospital , BeijingYuanxing Xiong, Prof, Provical Traditional Hospital ,NanjingPing Li, Prof, Dept of Gastroenterology , Changhai Hospita l, Shanghai

FundingMinistry of Health and Welfare of Nanjing Award ZKX-13013 Jiangsu Provincal Traditional Medical Foundation 〔 YB2015071 〕

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