An Integrated Chinese-Western Medical Treatment of Non-small Cell Lung Cancer

Keywords: Chinese medicine, Chinese herbal medicine, oncology, non-small cell lung cancer (NSCLC), radiation

Lung cancer is the leading cancer killer in both men and women in the United States, and smoking is the number one cause of lung cancer. Approximately 169,400 new cases of lung cancer and 154,900 deaths from lung cancer occured in the US in 2002.¹ There are two major types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Non-small cell lung cancer is the more common of the two, affecting up to 80% of those with lung cancer. This type of lung cancer usually metastasizes to different parts of the body more slowly than does small cell lung cancer.

Non-small cell lung cancer is further subdivided into squamous cell carcinoma, adenocarcinoma, and large cell carcinoma, and its progression is divided into occult NSCLC and stages 0-IV NSCLC. Stage I means that the tumor is totally contained within one lung. Stage Ia means that tumor has not started to invade local structures in the lung, whereas a Ib tumor has. Stage II generally means that there is local lymph node spread of the tumor. 'Local' lymph nodes refer to lymph nodes on the same side of the chest as the affected lung. As above, stage IIa refers to a tumor that has not invaded local structures in the lung, whereas an IIb tumor has invaded local structures or has spread to the chest wall, diaphragm, and other chest cavity structures. Stage III tumors have lymph node involvement either in the mediastinum (the area between the two lungs) or in the lymph nodes of the opposite lung. Stage IIIb generally refers to a tumor that has lymph node involvement in the opposite lung or in which the tumor has directly spread to the structures in the mediastinum, such as the esophagus, heart, or blood vessels. Stage IV refers to a tumor that has spread to another organ, such as the liver or adrenal gland, or to another part of the lung.

Standard Western medical treatment of this type of lung cancer typically involves some combination of surgery, radiation, and chemotherapy. In general, the five-year survival rate in Western medicine for stage I SNCLC is 70%. The five-year survival rate of stage II, IIa, and IIb is 40%. For stage III, the five-year survival rate is between 10-30%, and, for stage IV, there is a one-year survival rate of 30% and a two-year survival rate of 10%.²

In China, it is currently believed that either Western or Chinese medicine alone is not adequate for the treatment of cancer. While Western medicine is very focused and powerful, its heroic treatments often have unacceptable levels of side effects and adverse reactions. On the other hand, Chinese medicine is more holistic and gentler, with few or no side effects, but it is too slow-acting to effectively treat most malignancies. Therefore, in China, the integration of Chinese and Western medicine has become routine and even standard for the treatment of cancer. As the following clinical trial suggests, the integration of Chinese and Western medicine in the treatment of cancer gets better therapeutic effects than Western medicine alone and with fewer side effect. In issue #11, 2003 of the Hu Nan Zhong Yi Za Zhi (Hunan Journal of Chinese Medicine), Wo An-jun of the Shaoyang Municipal Central Hospital published an article titled, 'A Summary of Treating 46 Cases of Non-small Cell Lung Cancer with Integrated Chinese-Western Medicine.' This article appeared on page 2 of that journal, and a summary of its main points is presented below.

Cohort description
There were a total of 92 cases of NSCLC enrolled in this comparative study. These 92 patients were randomly divided into two groups, a treatment group which received integrated Chinese-Western medicine and a comparison group which only received Western medicine. In the treatment group, there were 28 males and 18 females with an average age of 56 years. The were four cases who were stage IIa, 10 cases who were stage IIb, 20 cases who were stage IIIa, and 12 cases who were IIIb. In the comparison group, there were 27 males and 19 females with an average age of 57. In this group, there were five cases who were stage IIa, nine cases who were stage IIb, 19 cases who were stage IIIa, and 13 cases who were stage IIIb. Therefore, in terms of sex, age, and staging, there were no statistically significant differences between these two groups. Further, all 92 cases were seen as in-patients in the same hospital between June 1994 and August 1998. All were diagnosed with SNCLC via biopsy, and a combination of chest X-ray, CT scan, MRI, and ultasonography ruled out any other serious internal medical condition. All the patients were 70 years old or less and had a Karnovsky Scale rating of 70 points or more. None had a prior history of any other cancer.

Treatment method
The members of the comparison group all received radiation therapy one time per day for five days per week, for a total of 6-7 weeks. The members of the treatment group received the same radiation regimen along with the following basic Chinese medicinal formula: Radix Codonopsitis Pilosulae (Dang Shen), 20g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 15g, Sclerotium Poriae Cocos (Fu Ling), 10, Radix Glycyrrhizae Uralensis (Gan Cao), 6g, Caulis Milletiae Seu Spatholobi (Ji Xue Teng), 30g, Radix Angelicae Sinensis (Dang Gui), 12g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, Fructus Crataegi (Shan Zha), 10g, Rhizoma Curcumae Zedoariae (E Zhu), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, Buthus Martensis (Quan Xie), 3g, Scolopendra Subspinipes (Wu Gong), 3 strips, Herba Houttuyniae Cordatae Cum Radice (Yu Xing Cao), 20g, Herba Scutellariae Barbatae (Ban Zhi Lian), 15g, Radix Paridis Polyphyllae (Yi Zhi Hua), 15g, Radix Astragali Membranacei (Huang Qi), 15g, and powdered Radix Pseudoginseng (San Qi), 3g. If there was phlegm dampness, Rhizoma Pinelliae Ternatae (Ban Xia), Bulbus Fritillariae Thunbergii (Zhe Bei Mu), Fructus Trichosanthis Kirlowii (Gua Lou), and Pericarpium Citri Reticulatae (Chen Pi) were added. If there was phlegm heat, Radix Scutellariae Baicalensis (Huang Qin) and Cortex Radicis Mori Albi (Sang Bai Pi) were added. If there was hemoptysis, Herba Agrimoniae Pilosae (Xian He Cao), Rhizoma Imperatae Cylindricae (Bai Mao Gen), and Radix Rubiae Cordifoliae (Qian Cao Gen) were added. If there was yin vacuity with a dry thorat and constipation, Bulbus Lilii (Bai He), Radix Glehniae Littoralis (Sha Shen), Tuber Asparagi Cochinensis (Tian Men Dong), Tuber Ophiopogonis Japonici (Mai Men Dong), and Radix Trichosanthis Kirlowii (Tian Hua Fen) were added. If there was blood astasis, Nidus Vespae (Lu Feng Fang) and Carapax Amydae Sinensis (Bie Jia) were added. One packet of these medicinals was decocted in water and administered hot orally in three divided doses per day, morning, noon, and night.

Study outcomes
Complete remission of symptoms was defined as complete disappearance of the cancer. Partial remission meant that the cancer decreased in size by 50% or more. No remission meant that the cancer receded less than 50% in size or grew by 25%. Progression of disease meant that the cancer grew by more than 25% or arose some place else. Based on these criteria, in the treatment group, 11 cases (23.9%) experienced complete remission, 30 cases (65.2%) achieved a partial remission, and five cases (10.9%) experienced either no remission or progression of disease. Therefore, the total percentage of patients in the treatment group who achieved either complete or partial remission was 89.1%. In the comparison group, seven cases (15.2%) achieved complete remission, 26 (65.5&) experienced partial remission, and 13 (28.3) experienced no remission or progression of the disease. That meant that 71.1% of the comparison group experienced either complete or partial remission. Further, two-year survival rate, three-year survival rate, and local control rate were 52.2%, 28.3%, 47.8%, and 37% respectively in the treatment group but only 23.9%, 13%, 26.7%, and 8.7% respectively in the comparison group. And finally, the rates of radiation-induced esophagitis, bronchitis, and pneumonitis were markedly lower in the treatment group than the comparison group. Based on these findings, it was the author's conclusion that treatment with Chinese medicinals based on pattern discrimination along with standard radiation therapy can achieve significantly better short-term survival rates and better local control of tumors with less side effects than radiation alone.

Discussion
According to Dr. Wo, lung cancer is due to a righteous qi insufficiency with qi and blood depletion and vacuity plus the external invasion of evils prompting the accumulation of phlegm, dampness, toxins, and stasis within the lungs. Therefore, the qi mechanism's upbearing and downbearing loses its regulation, diffusion and depuration lose their duty, and the water passageways are no longer freely flowing. The vessels and network vessels become obstructed by blood stasis, and static blood and phlegm bind together to form the accumulation lumps. Dr. Wo also says that radiation therapy easily causes damage and detriment to fluids and humors. Thus, he believes that the general principle for treating lung cancer with Chinese medicine should be to support the righteous and combat the cancer by boosting the qi and nourishing the blood at the same time as dispelling stasis and resolving toxins, softening the hard and scattering binding, engendering fluids and moistening dryness, and using medicinals for these purposes which are empirically known to combat cancer. Examples of specifically anti-cancer medicinals within the above protocol include Herba Houttuyniae Cordatae Cum Radice (Yu Xing Cao), Herba Scutellariae Barbatae (Ban Zhi Lian), and Radix Paridis Polyphyllae (Yi Zhi Hua).

While using radiation alone as the Western medical treatment of stage II NSCLC is not considered standard in North America,³ I nevertheless believe that the above study can serve as a model for the integration of these two medicines in the treatment of lung cancer. Similar published protocols exist for combining Chinese herbal medicine with surgery and chemotherapy. Therefore, an integrated Chinese-Western medical treatment plan based on previous clinical research can be crafted for virtually all patients with lung cancer.

Copyright © Blue Poppy Press, 2004. All rights reserved.

References
1. www.lungusa.org/diseases/lungcanc.html
2. www.healthtalk.com/otherconditions/talks/edition39/page02.cfm
(Now: http://www.everydayhealth.com/health-center/lung-cancer-survival-rates-info.aspx)
3. Radiation therapy may be used to treat stage II patients who cannot have surgery because they have other medical problems. Stage III patients may be treated with radiation alone or with surgery and radiation, chemotherapy and radiation, or chemotherapy alone.

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