Regression of squamous cell carcinoma of the lung by Chinese herbal medicine a case with an 8year f.docx

Regression of squamous cell carcinoma of the lung by Chinese herbal medicine a case with an 8year f.docx

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RegressionofsquamouscellcarcinomaofthelungbyChineseherbalmedicineacasewithan8yearf

RegressionofsquamouscellcarcinomaofthelungbyChineseherbalmedicine:

acasewithan8-yearfollow-up

H.L.M.Liang,C.C.L.Xue

andC.G.Li

TheRMITChineseMedicineResearchGroup,BundooraWestCampus,RMITUniversity,P.O.Box71,Bundoora,Vic.3083,Australia

Received10June2003; 

revised1August2003; 

accepted19August2003. ;

Availableonline29November2003.

Abstract

A51-year-oldwomandiagnosedwithsquamouscellcarcinoma（SCC）ofthelung（T2N2M0）bycytologicaltestsandaCTscanhassurvivedfor8years.Duringthisperiodoftime,shehadbeentreatedwithChineseherbalmedicinealonefor4years.TheherbalprescriptionconsistedofnineChinesemedicinalherbs.Theseherbshavebeenreportedtopossessanti-tumourandimmuneenhancingeffects.Therefore,itissuggestedthattheherbaltreatmentforthispatientmighthavecontributedtothecompleteregressionofherlungcarcinoma.Furtherresearchontheactionsoftheseherbsiswarranted.

AuthorKeywords:

Squamouscellcarcinoma;Non-smallcelllungcancer;Chineseherbalmedicine;Casereport

ArticleOutline

1.Introduction

2.Casereport

3.Discussion

Acknowledgements

References

1.Introduction

Lungcancerisoneofthemostprevalentcancersandhasthehighestmortalityofallformsofcancers[1].Although,surgery,chemotherapyandradiotherapyareroutinelyusedforlungcancertreatment,littleprogresshasbeenmadeinthetreatmentofthisconditionoverthepast20years[2].Inrespectofthehistologicalsubtypesoflungcancer,squamouscellcarcinoma（SCC）accountsforapproximately30%oflungcancerpatients[3].TherearesomecasereportsofregressionofSCCwithconventionalmedicaltreatment[4,5and6].However,therehavebeennoreportsofregressionofSCCwithChineseherbalmedicinetreatment.ThiscasereportdealswithapatientwithSCCofthelungwhowastreatedwithChineseherbalmedicineoveraperiodof8yearsoffollow-up.

2.Casereport

A51-year-oldCaucasianfemalepresentedwithahistoryofepisodicbronchitisandwheezingsincechildhood,andsmokingapproximately20cigarettesdailysinceshewasateenager.Thechiefcomplaintduringherinitialvisitwasofhersufferingfatigue,recurrentcough,dyspnoea,sweatsandinsomniaovertheprevious12months.Thesesignsandsymptomstendedtobeaggravatedbypainfulfeelingsintheupperbackandchest.Inaddition,shehadlost23 kgofbodyweightoveraperiodof4monthspriortotheinitialconsultationwiththepractitioner.

SheunderwentachestX-rayinvestigationon10April1995,aroundednodulesizedapproximately15 mmindiameterappearedinthemiddleareaofherrightlung.Therighthilumappearedprominent.Atelectasiswasintherightmiddleandlowerzones（Fig.1）.HerchestCTscanwasconductedon19April1995andaneoplasm（11 mmindiameter）inthesuperiorportionoftherightmiddlelobeofthelungwasdetected.Enlargementoflymphnodeswerealsoreportedintherighthilumandmediastinum.Thelargestmediastinallymphnodemeasured,approximately25 mmindiameter,layanteriortothecarina.Atelectasisintherightmiddlelobewasalsodetected（Fig.2）.Fine-needleaspiration（FNA）biopsywasperformedon18May1995andbasedoncytologicalinvestigation（Fig.3,Fig.4andFig.5）,thediagnosisofapoorlydifferentiatedsquamouscellcarcinomaoftherightlungwasmade.

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Fig.1.（10April1995）:

aroundednodule,approximately15 mmindiameter,canbeseeninthemiddleareaoftherightlung.Therighthilumappearsprominent.Atelectasiswaspresentintherightmiddleandlowerzones（pre-treatmentimage）.

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Fig.2.（19April1995）:

an11 mmnodulecanbeseeninthesuperiorportionofrightmiddlelobeofthelung.Therewaslymphnodeenlargementintherighthilumandmediastinum.Atelectasisintherightmiddlelobewasalsodetected（pre-treatmentimage）.

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Fig.3.（Giemsa40×,purple）:

groupsoflargecarcinomacells（cytologicalphotograph）.

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Fig.4.（Papanicolauo40×,blue）:

premorphicnuclei（i.e.showsizeandshapevariation）,prominentnucleoliandgranularchromatin（cytologicalphotograph）.

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Fig.5.（Keratin20×,brown）:

keratinpositive（immunohistochemistrymarkertoprovethetumouriscarcinoma）（cytologicalphotograph）.

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Thepatientdecidednottotakeupanywesternmedicaltherapies,butafterconsultingaChinesemedicinepractitioner,totryChineseherbalmedicine.TheprescriptionofChinesemedicinalherbsincludedthefollowingingredients（Table1）.Theherbalmedicinewasadministereddaily,intwoseparatedecoctions.Thepreparationandingestionofthedecoctionwereasfollows:

forthefirstdecoction,fourcups（1 l）ofcoldwaterwereaddedtotheherbalmixture,whichwasthenboiledforapproximately50 mintoreducethevolumetoabout250 ml.Thisdecoctionwastakenineachmorning.Theremainingherbalmixturewasusedformakingaseconddecoctionwhichwastakenineachafternoon:

thiswaspreparedbyusing750 mlofcoldwater,andboiledforapproximately30 mintoreducethevolumetoabout150 ml.

Table1.IngredientsoftheChineseherbalformula

Full-sizetable（9K）

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After2monthsofCHMtreatment,thepatient’scoughandwheezingwasrelieved,phlegmwasreducedandchestpaincleared,andshealsoreportedthatherlethargywasdiminished.After4monthsoftreatment,shereturnedtofull-timeemployment.HerchestX-ray,on21September1995,indicatedthatherlungwaswellaeratedandclearwithoutpulmonarymass,atelectasisorconsolidation;themediastinumwasnotwidened;andnonewlesionwasrevolved（Fig.6）.HerrepeatedCTscanunderwenton22November1995confirmedthatthenodulepreviouslynotedintherightmiddlelobewasnolongerseen;therighthilarlymphadenopathyhadreducedsignificantlyandnoenlargedlymphnodesinthisregionweredetected（Fig.7）.ThepatientreturnedtotheclinicforChinesemedicineconsultationmonthlyandreceivedcontinuousChineseherbalmedicinetreatmentforaperiodofapproximately4yearsuntilMarch1999.Duringthisperiodoftime,shedidnotreceiveconcurrentwesterntreatmentsuchassurgery,chemotherapy,radiotherapyorothermedicationforherlungcarcinoma.Therewasacontinuousfollowupofthepatientoverthelast8yearsandshewasinsoundhealthconditionwhenthisreportwasprepared.HerchestX-raysandCTscanshavebeenconductedannually,whichhaveindicatednosignofrecurrenceormetastasisofthelungcarcinoma.Inaddition,therewerenoobvioussideeffectsreportedthroughoutthetreatmentperiod.

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Fig.6.（21September1995）:

thelungappearswellaeratedandclear.Thereisnopulmonarymass,atelectasisorconsolidation.Themediastinumisnotwidened（post-treatmentimage）.

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Fig.7.（22November1995）:

thenodulepreviouslynotedintherightmiddlelobeisnolongerpresent.Therighthilarlymphadenopathyisreducedandnodefinitelyenlargedlymphnodeinthisregionwasdetected（post-treatmentimage）.

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3.Discussion

ThediagnosisforthispatientwasconfirmedasapoorlydifferentiatedsquamouscellcarcinomaontherightlungbycytologicalexaminationandalungCTscan.Thesizeofthetumourattheinitialvisitwas11 mmindiameter.However,itwasassociatedwithatelectasisintherightmiddlelobe（T2）andenlargedlymphnodesintherighthilumandmediastinumasreportedintheCTscan.Thesefindingsindicatedthatthelungcancerhadspreadtotheadjacenthilarandmediastinallymphnodes（N2）.Therewasnodistantmetastasis（M0）.Accordingtotheinternationalsystemforstaginglungcancer[7],thiscasewasclassifiedasstageIIIa（T2N2M0）.Apoor5-yearsurvivalrateaftersurgicalresectionhasbeenreported,withlessthan10%ofpatientssurvivingmorethan5years[8].

Insteadofusingconventionalmedicaltreatmentprocedures,thispatientchosetobetreatedwithChineseherbalmedicine.Themajorityofindividualherbs,includedintheformulationforthepatient,wereselectedonthebasisofhavingalonghistoryofsymptomsassociatedwithlungcancer[9].Inaddition,thepharmacologicalactionsofsomeoftheseherbshavebeendocumented[10].Forinstance,Oldenlandiadiffusa,alsoknownasHerbaHedyotisdiffusae（Baihuasheshecao）hasbeenreportedtoenhancemacrophagefunctioninvitroandtoinhibittumourgrowthinvivo[11].AlkaloidsisolatedfromHouttuyniacordata（Yuxingcao）wereshowntohavecytotoxiceffectsagainstfivehumantumourcelllinesinvitro（A-549,SK-OV-3,SK-MEL-2,XF-498andHCT-15）[12].TheextractoftherootsofPanaxnotoginseng（Sanqi）wasdemonstratedforananti-carcinogenicactivity[13],andpolysaccharidesfromP.notoginsenginducedtheproductionofinterferon-gammaandtumournecrosisfactor[14].Moreover,thecytotoxicpolyacetylenesisolatedfromPanaxquinquefolium（Xiyangshen）showedstrongcytotoxicactivitiesagainstleukaemiacells（L1210）[15],whileCVT-E002,anaqueousextractcontainingmainlyoligosaccharidesandpolysaccharidesfromP.quinquefoliumalsoactedasanimmuno-boosteronmurinespleencellsandperitonealmacrophagesinvitro[16].ThisinformationmightbeusefultoexplainthepossibletherapeuticmechanismsofChines