How to Integrate Tumor Treatment

Tumor is now a common disease and multi-morbidity. Besides traditional surgery, radiotherapy and chemotherapy, tumor treatment also includes molecular targeted therapy, biological therapy, interventional therapy, heat therapy, cryotherapy and Chinese medicine, etc. In the face of so many treatment methods, how should we choose? The treatment of tumor is divided into local treatment and systemic treatment. Local treatment is to treat the tumor locally, including surgery, radiotherapy, interventional therapy, heat therapy, freezing, etc. Systemic treatment is to treat the whole body, and at present, the circulatory system is the medium to achieve the systemic penetration of drugs through blood circulation, including chemotherapy, biological therapy, molecular targeted therapy, etc. Both local treatment and systemic treatment have their advantages and shortcomings, and only a reasonable combination of both can achieve a better treatment effect, which is integrated treatment. The definition of comprehensive treatment is: according to the patient’s physical condition, tumor pathological type, invasion scope and development trend, the existing treatments are applied in a planned and rational way, with the aim of increasing the cure rate and improving the patient’s quality of life. The classic example of comprehensive tumor treatment is the treatment of breast cancer. Surgery is the main treatment for breast cancer, but still many patients will have local recurrence and distant metastasis after surgery, even if the scope of surgical resection is expanded, the chance of local recurrence and distant metastasis does not decrease significantly, while giving local radiotherapy and systemic chemotherapy after surgery makes the chance of local recurrence and distant metastasis decrease significantly. For early stage breast cancer patients, breast-conserving surgery combined with postoperative radiotherapy can achieve the same treatment effect as radical surgery or modified radical surgery. For HER-2 positive breast cancer patients, targeted Herceptin in combination with chemotherapy can reduce the risk of death by nearly 50%. For hormone receptor-positive breast cancer patients, adjuvant endocrine therapy is also available to further reduce the risk of recurrence and metastasis. In addition to the choice of treatment, the rationalization of various therapies is also important for oncology treatment, which of course needs to be supported by evidence-based medical evidence. For example, the treatment of small cell lung cancer is mainly based on radiotherapy. The past experience is to give chemotherapy first and then give radiotherapy after chemotherapy to avoid lowering the blood concentration of chemotherapy drugs due to local vascular occlusion after radiotherapy, but recent studies have confirmed that the early involvement of radiotherapy can significantly improve the survival rate, therefore, small cell lung cancer should be given simultaneous radiotherapy as early as possible, even if sequential radiotherapy is chosen, the Therefore, small cell lung cancer should be given synchronous radiotherapy as early as possible, and even if sequential radiotherapy is chosen, the timing of radiotherapy should be as early as possible to ensure better treatment effect. In addition, the treatment strategy of rectal cancer has changed a lot in recent years. Traditionally, surgical resection is performed first and radiotherapy is given after surgery according to the stage, but nowadays, evidence-based medical evidence has confirmed that for stage II and III rectal cancer, preoperative radiotherapy and preoperative simultaneous radiotherapy have lower local recurrence rate and longer overall survival compared with postoperative radiotherapy, and there is no increase in postoperative complications. Therefore, for rectal cancer patients, preoperative simultaneous radiotherapy is a more reasonable choice at present. Even if postoperative radiotherapy is chosen, the time of radiotherapy should be chosen within 3 months after surgery, otherwise the efficacy of radiotherapy will be affected. In addition to surgery, radiotherapy and chemotherapy, how should we choose other treatments? Interventional therapy is the first choice for unresectable primary liver cancer, but for liver metastases, since most of them are portal vein blood supply, interventional embolization often cannot achieve good results, so radiofrequency therapy or argon helium knife cryotherapy may be a better choice at this time. Surgery, radiotherapy, chemotherapy to kill the tumor cells below 10^6 and then biological therapy to kill the remaining tumor cells would be the best complement. Although molecular targeted drugs sometimes have unexpected efficacy, they are only effective for some specific groups of people, for example, Erysal and Trokai are effective up to 70% for lung cancer patients with EGFR mutation, but only 0-1% for patients without EGFR mutation. Although the efficacy of TCM in cancer treatment is not outstanding, it has incomparable advantages over Western medicine in supporting the righteousness and eliminating the evil and improving the body condition of tumor patients. Although with the development of modern medicine, the division of labor is becoming more and more detailed, but in the current situation that tumors cannot be cured by a single means, multidisciplinary comprehensive treatment is still the best treatment mode. Only through multidisciplinary efforts to develop a scientific and reasonable treatment plan for tumor patients can bring the greatest benefit to patients.