Our hospital treated 45 cases of colorectal cancer patients from March 2009 to December 2010 by using the treatment method of combining Chinese and Western medicine, effectively prolonging the survival period of patients and improving the quality of life of patients. The summary is as follows:
1. Materials and Methods
1.1 General Information
There were 45 cases of colorectal cancer patients, including 32 males and 13 females; ages ranged from 24 to 75 years old, with an average age of 49.3 years; disease duration was between 1 to 6 years. All patients showed varying degrees of fatigue, abdominal pain, diarrhea, constipation, bloody stools, pus in stools, weight loss, and intestinal obstruction symptoms. Patients underwent occult blood tests in stool, digital rectal examination, proctoscopy, colonoscopy, barium enema, ultrasound, and pathological examinations. CT or MRI was used based on the specific condition of each patient to determine the extent of lesion spread and the level of colon involvement by the cancer. After confirmation, there were 14 cases of ascending colon cancer, 5 cases of descending colon cancer, 3 cases of sigmoid colon cancer, 20 cases of rectal cancer, and 3 cases of transverse colon cancer. There were 5 cases combined with intestinal obstruction, 6 cases with cardiovascular disease, 3 cases with anemia, 3 cases with extensive peritoneal infiltration found, 4 cases with lymphatic metastasis, 1 case with lung metastasis, and 1 case with bone metastasis. According to the Chinese modified Dukes staging system: there were 13 cases in stage A, 21 cases in stage B, 9 cases in stage C, and 2 cases in stage D. According to the Border staging system: there were 14 cases in stage I, 22 cases in stage II, 5 cases in stage III, and 4 cases in stage IV. All patients underwent surgery and postoperative chemotherapy, with Karnofsky scores ranging from 60 to 90.
1.2 Treatment Methods
1.2.1 Surgical Treatment: Palliative resection was performed on 2 cases of Dukes stage D patients, while the rest of the patients underwent radical right hemicolectomy (13 cases), left hemicolectomy (5 cases), sigmoidectomy (3 cases), abdominoperineal resection for rectal cancer (11 cases), anterior resection of the rectum (8 cases), and radical transverse colectomy (3 cases) according to the different locations of the lesions. All patients received chemotherapy, immunotherapy, and traditional Chinese medicine treatment after surgery.
1.2.2 Chemotherapy Regimen: ① OLF regimen, where oxaliplatin was 130mg/m2 on day 1; leucovorin calcium was 100mg/m2, then combined with 5-fluorouracil 750mg/m2, intravenous infusion from day 1 to day 5; a cycle lasted 3 weeks, with more than 3 cycles of chemotherapy. ② MF regimen, where methotrexate was 200mg/m2 on day 1, 5-FU was 1200mg/m2 on day 2 via intravenous infusion, MTX medication 24 hours later, calcium folinate 25mg was given intramuscular injection once every 6 hours, for a total of 8 injections within 24 hours, with 2500ml fluid replacement within 24 hours. Intravenous infusion of 150mg sodium bicarbonate was also given simultaneously to alkalinize urine. Each cycle lasted 15 days, with more than 3 cycles of chemotherapy. ③ For patients in poor condition and fragile bone marrow, oral FT-207 or UFT combined with levamisole for one year was adopted. Blood routine, liver and kidney functions were checked weekly.
1.2.3 Immunotherapy: Immunotherapy was carried out before and after surgery and radiotherapy/chemotherapy: Interleukin-2 200,000 U intramuscular injection, every other day, with 4 weeks being one course.
1.2.4 Traditional Chinese Medicine Treatment: Both preoperative and postoperative patients could be actively given TCM treatment based on syndrome differentiation. Preoperative treatments mainly focused on damp-heat internal accumulation type and blood stasis-toxin internal obstruction type, while postoperative treatments mainly focused on spleen-kidney yang deficiency type, liver-kidney yin deficiency type, and qi-blood dual-deficiency type, adjusting drug dosage according to the patient's physical condition. Based on the five common clinical types of TCM classification for colorectal cancer: damp-heat internal accumulation type, blood stasis-toxin internal obstruction type, spleen-kidney yang deficiency type, liver-kidney yin deficiency type, and qi-blood dual-deficiency type, the following drugs were administered:
① Damp-heat Internal Accumulation Type: 10g each of Atractylodes, White Atractylodes, 30g raw Coix seed, 10g Poria, 10g Magnolia Bark, 30g Wild Grape Root, 30g Solanum Nigrum, 30g Patrinia Herb, 20g White-headed翁, 10g Corydalis Rhizome, 20g Red Vine.
② Blood Stasis-Toxin Internal Obstruction Type: 10g each of Sparganium Rhizome and Curcuma Rhizome, 30g Patrinia Herb, 30g Red Vine, 30g Purslane, 30g Smilax Rhizome, 30g Solanum Nigrum, 30g Snakeberry, 10g Gallnut, 10g Magnolia Bark, 30g Tu Fuling, 60g Cat's Claw, 30g Snake Tongue Grass, 30g Pear Vine Root, 30g Half-Branch Lotus.
③ Spleen-Kidney Yang Deficiency Type: 20g Codonopsis, 10g each of Atractylodes and White Atractylodes, 10g Poria, 10g Psoralea, 10g Nutmeg, 6g Dry Ginger, 10g Pomegranate Peel, 30g Raw Astragalus, 30g Raw Coix Seed, 6g Fried Licorice, 10g Herba Geranii, 10g Gallnut.
④ Liver-Kidney Yin Deficiency Type: 20g each of Prepared Softshell Turtle Shell and Tortoise Shell, 20g Sweet Wormwood, 20g Lycium Root Bark, 30g Platycladi Seed, 12g Prunus Semen, 6g Cannabis Seed, 10g Sparganium Rhizome, 20g Curcuma Rhizome.
⑤ Qi-Blood Dual-Deficiency Type: 15g Codonopsis, 30g Raw Astragalus, 30g Poria, 6g Cinnamon, 20g Platycladi Seed, 50g Fried Jujube Seed, 30g Polygala, 20g Amomum, 20g Fried White Atractylodes, 10g Cardamom Seed, 12g Fried Rice Sprout, 25g Fried Barley Sprout, 15g Tangerine Peel, 20g Radix Sanguisorbae, 6g Charcoal of Sophora Flower, 6g Charcoal of Human Hair.
All these herbs were decocted into a soup for internal use, one dose per day, divided into morning and evening servings, and treatment lasted for 1 to 3 courses based on the patient's condition.
1.3 Efficacy Evaluation
The clinical treatment effect of patients was determined according to the WHO-established standards for evaluating the recent efficacy of solid tumors. Cure: Symptoms disappeared after radical resection, incision healed, no complications, tumor completely disappeared, lasting more than 4 weeks; Improvement: After palliative surgery, symptoms improved, the product of the maximum diameter and the maximum vertical transverse diameter of the tumor decreased by more than 50%, no new lesions appeared, lasting more than 4 weeks, or shrinkage less than 50% but increase less than 25%; No Effect: The product of the maximum diameter and the maximum vertical transverse diameter of the tumor increased by more than 25%, or new lesions appeared.
2. Results
Cured 21 cases, improved 16 cases, ineffective 8 cases. The survival rates and recurrence rates of patients observed after treatment at 1, 2, and 3 years were 86.7%, 24.4%, 75.6%, 42.5%, 48.9%, and 26.5%, respectively. In terms of toxic side effects, after symptomatic administration of TCM, 9 cases experienced a decrease in white blood cells, and 12 cases experienced vomiting.
3. Discussion
Surgical treatment of colorectal cancer is the main treatment method in clinical practice. However, even after radical resection, about one-third of patients still experience recurrence and metastasis. Through chemotherapy and immunotherapy, even biological and gene therapy, the survival rate of patients can be improved, and survival time extended. During the treatment of colorectal cancer, the normal function of the body is inevitably damaged, and chemotherapy often causes gastrointestinal reactions, bone marrow suppression, and other toxic side effects. The mechanism of action of Chinese medicine in inhibiting tumor growth may involve inhibiting the growth of tumor cell walls, DNA synthesis, and cancer cell division, and destroying the molecular mechanisms of tumor cell proteins. Based on the five classifications of TCM for colorectal cancer, differentiated treatment and symptomatic medication are provided, and the combination and dosage of Chinese medicine are adjusted appropriately according to the different states of the patient at different times. Reasonable comprehensive differentiation and treatment of patients can achieve ideal results. According to TCM theory, insufficient vital energy, wet-toxic stagnation, and condensation are the basic pathogenesis of colorectal cancer, and surgical trauma further damages vital energy. In clinical research, we classified colorectal cancer into five common clinical types: damp-heat internal accumulation type, blood stasis-toxin internal obstruction type, spleen-kidney yang deficiency type, liver-kidney yin deficiency type, and qi-blood dual-deficiency type. These types have both individuality and commonality. Most postoperative colorectal cancer patients' differentiation typing is mainly characterized by deficiency, which is the commonality. For the spleen deficiency-dampness accumulation type, treatment focuses on strengthening the spleen and invigorating qi, regulating qi and resolving dampness; for the qi-blood dual-deficiency type, treatment focuses on replenishing qi and nourishing blood; for the spleen-kidney yang deficiency type, treatment focuses on warming and tonifying the spleen and kidney; for the liver-kidney yin deficiency type, treatment focuses on nourishing the liver and kidney. All cases exhibited spleen deficiency. Other types of patients besides spleen deficiency-dampness accumulation also show changes in spleen deficiency. Postoperative colorectal cancer severely damages the spleen-stomach qi, and the application of chemotherapeutic drugs makes the spleen-stomach qi even weaker. Emphasizing the simultaneous application of surgery and chemotherapy with TCM differentiation and treatment, focusing on replenishing the spleen and invigorating qi, has significant importance in improving the quality of life of patients and alleviating discomfort symptoms during chemotherapy. However, currently, there is a lack of theoretical and systematic research in the clinical application of TCM alone for treating colorectal cancer. Research in this field needs to be strengthened in both basic and clinical aspects. Additionally, the pharmacological research on TCM is still insufficient, and future efforts should strengthen experimental studies on the anti-cancer mechanisms of TCM and apply modern medical examination and experimental methods to the research and development of TCM.