Poor bone marrow function and inability to tolerate postoperative adjuvant chemotherapy; identification and treatment to prolong survival of patients with intermediate to advanced gastric cancer after surgery
Li Jie
Department of Oncology, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine 100053
Case 2: The patient was male, 68 years old, with unexplained gastric and epigastric discomfort and dizziness in July 2001. The postoperative pathology showed “hypofractionated adenocarcinoma of the gastric sinus, invading the muscular layer and reaching the extra-plasma fat, with 6/19 lymph node metastasis on the side of the greater curvature”, stage IIIa. One month after surgery, he started 3 cycles of chemotherapy with the following drugs: 5-Fu 13.5g, E-ADM 270mg, PDD 450mg, with a second degree of myelosuppression and a minimum WBC of 2300/mm3, and subcutaneous injection of granulocyte colony-stimulating factor for more than 10 days. He refused chemotherapy and sought simple TCM treatment at our outpatient clinic. Li Jie, Department of Oncology, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine
First consultation: the patient complained of weakness, occasional abdominal distension, poor sleep, tastelessness, little stool and normal urine. The tongue is light red with yellowish greasy coating, and the pulse is thin and weak. Laboratory examination: WBC 2.7×109/L. Tumor markers CEA and Ca199 are normal. Identification: deficiency of both heart and spleen. Radix et Rhizoma Ginseng 15 g, Atractylodes Macrocephala 12 g, Poria 15 g, Radix Astragali 30 g, Radix Angelicae Sinensis 6 g, Radix Yuanzhi 9 g, Radix Ziziphi 18 g, Pericarpium Citri Reticulatae 10 g, Radix Sempervariae Sinensis 9 g, Radix Scutellariae Sinensis 18 g, Radix Scutellariae Sinensis 10 g, Radix Cynthiae Sinensis 18 g, Radix et Rhizoma Malt 30 g, Sempervagria 15 g, Radix Glycyrrhiza Uralensis 6 g. Decoction with water, 14 doses.
Second Diagnosis: The patient’s fatigue is reduced, appetite is increased, abdomen is not distended, occasional weakness, nasal function, sleep is poor, and bowel movement is regulated. The tongue is light and dark, with thin yellow coating and thin pulse. The patient refused chemotherapy and wanted to continue herbal treatment. Identification: Qi deficiency and blood stasis. The formula: Six Junzi Tang + Danggui Blood Tonic Plus Decrease, Prince Ginseng 15 g, Fried Atractylodes 12 g, Poria 15 g, Raw Astragalus 30 g, Radix Angelicae Sinensis 6 g, Hedychium Bark 15 g, Nightshade 18 g, Chen Pi 10 g, Qing Hanxia 9 g, Fried Citrus Aurantium 9 g, Tiger Balm 15 g, Vine Pear Root 18 g, Scutellaria Baicalensis 10 g, Xianhe Cao 18 g, Raw Wheat Sprout 30 g, Shenqu 15 g, White Flowered Serpent’s Tongue 30 g, Licorice 6. In November 2001, the patient was admitted to our ward and started intravenous injection of Chinese herbal medicine to help fight against cancer.
Since then, the patient came to our hospital 2 to 3 months a year for 3 years after surgery to receive intravenous eleuthero injection and thymidine while taking oral discriminatory Chinese medicine. After 3 years of postoperative Chinese medicine treatment, the blood picture was maintained at normal level without any further chemotherapy, the tumor markers were normal on reexamination, and no signs of metastasis and recurrence were found on gastroscopy and imaging. In the fourth year after surgery, he started to come to the hospital every 3 to 4 months to receive intravenous Huachansu injection + Chinese herbal medicine, and after 5 years after surgery, he was no longer hospitalized, but has been taking Chinese herbal medicine and our hospital preparation Xihuang Detoxification Capsules orally in the outpatient clinic, with additional Huachansu tablets in spring and autumn. There is no sign of recurrence or metastasis on comprehensive review, and the patient is clinically cured.
Comment: This patient had Ⅲa gastric cancer and 3 cycles of chemotherapy after surgery, but failed to complete the chemotherapy treatment cycle systematically due to poor bone marrow function. The patient’s poor bone marrow function was due to congenital deficiency of endowment, combined with postoperative deficiency of Qi and blood and the patient’s strong demand for simple TCM treatment, we chose the TCM individualized treatment plan based on Chinese medicine. In addition, considering that the patient’s evidence belongs to Qi deficiency and blood stasis, on the basis of that, we added tiger scepter, vine pear root and white flowered snake tongue herb to activate blood and detoxify anti-cancer, and at the same time applied eleuthero emulsion injection to strengthen the power of activating blood and anti-cancer. Elemene emulsion is a new national class II anticancer drug extracted from our Chinese herb Wen Curcuma, with β elemene as the main ingredient. New Compilation of Materia Medica: “Curcuma longa, bitter, pungent, warm, non-toxic. It enters the liver and spleen meridians.” It is bitter, pungent and warm, which enters the blood and the qi, and can break blood stasis, eliminate stagnation, move qi and relieve pain. Previous clinical and basic experiments have confirmed that this injection has the effect of activating blood circulation, relieving pain and fighting cancer, and may have better efficacy in the treatment of gastric cancer, especially for patients with blood stasis [2]. Therefore, the patient was treated with this injection and discriminative Chinese medicine for 3 years after surgery and chemotherapy.
However, considering the patient’s history of gastric cancer, there are still factors in the body that cause the production of gastric cancer cells, so the treatment should be based on the treatment of “residual toxicity”. The treatment should be based on the treatment rule of helping to detoxify [3]. We used Huachanin injection, which is derived from the extract of the skin of the Chinese giant toad, and experimental studies have proved that it can improve the immune capacity of the body and has an in vitro effect on a variety of gastrointestinal tumor strains [4]. Therefore, we chose this injection to detoxify and anti-cancer as one of the main consolidation treatments for 4-5 years after surgery. The patient successfully passed 5 years after surgery and in principle was cured and no further treatment was needed, but considering that the patient failed to complete chemotherapy systematically, the patient was advised to take oral discriminative Chinese medicine intermittently in the outpatient clinic and add detoxifying and anti-cancer Chinese medicine according to the season, and survived until now.
The patient has achieved long-term survival by using an individualized TCM treatment plan consisting of a Chinese herbal soup and a Chinese herbal injection based on her own constitution. Although this case is an isolated report, it can be found from the treatment process that patients with intermediate to advanced gastric cancer may still achieve long-term survival by adhering to individualized TCM treatment.