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Traditional Medicine-2015 Birmingham, UK August 03 – 05, 2015 Yongling Gong Therapeutic Value of Chinese Herbal Decotion in Radiation Pneumonia of Oesophageal Carcinoma -------a retrospective observational clinical case report Yongling Gong, MD Department of Oncology Nanjing 1st Hospital Nanjing Medical University Nanjing 210006 China 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. Background Chinese 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. Background Chinese 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 presentation A A 56-year-old 56-year-old male male underwent underwent surgery surgery for for cancer cancer of of the the uper uper easophagus easophagus (T3N2M0) (T3N2M0) in in Aug. Aug. 2014. 2014. Case presentation Pathology 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 presentation Two months later, severe pneumonia had been found by Chest X-ray Diffuse patchy shadows / ground glass appearance Case presentation The end of 2014 •Complaint dry cough, chest pain, dyspnea palpitations , headedness weakness and fatigue, etc Dec, 2014 •Hospitalized in the oncological depatment Case presentation Accompanied 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 presentation Treatment of hormone and antibiotic. Hydroprednisone Injection Fluconazole Injection Cefminox Sodium for Injection 60mg qd ivgtt 0.1 qd ivgtt 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. Case presentation Objection Get far better bebefits and tolerability. Chinese herbal medicine Run Fei Decoction mixed a variety of effective herbal components 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 Discussion Abnormal activation and infiltration of tumour cell are leading causes of patient death. Therefore, clearing about the pathogenesis and seeking effective treatments are quite significant. Discussion 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 unsatisfactory. the curative effect of radiotherapy are squemous cell arcinoma is sensitive Glandular cell arcinoma is moderately sensitive other 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. Consent Written informed consent was obtained from the patient for presentation of this case report and any accompanying images. Summary Our RP patient reported is completely cured we chose the other way and selected a CTM participation in clinical anti-RP treatment Further Chinese traditional treatment decoction /powder We managed to have prolonged PFS (Progression-Free-Survival) TTP(Time-to-Progression 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. Discussion Clincal 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. Discussion The 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 Acknowledgements At 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) Collaborators Xudong Xia, Chinese medicine specialist, Wuxi, Jiangsu Qiang Wang, Prof , Dept of ICU, Tiantan Hospital , Beijing Yuanxing Xiong, Prof, Provical Traditional Hospital ,Nanjing Ping Li, Prof, Dept of Gastroenterology , Changhai Hospita l, Shanghai Funding Ministry of Health and Welfare of Nanjing Award ZKX-13013 Jiangsu Provincal Traditional Medical Foundation〔YB2015071〕 Meet the eminent gathering once again at Traditional Medicine-2016 London, UK October 03-05, 2016 Traditional Medicine-2016 Website: http://traditionalmedicine.conferenceseries.com/