Comprehensive treatment of lung cancer, including surgery, radiotherapy and chemotherapy, immunization and treatment of Chinese medicine treatment. But treatment is not simply to increase by several means of treatment in a patient, but on the basis of the pathological type and stage, physical condition, and so do comprehensive analysis of the situation, select the most suitable treatment programmes, in order to get the best Treatment.
Which of the treatment should be «in which the main treatment, which supplemented» after the completion of each phase of the next step should be how do «the need to continue to do treatment» what to do »what to do»
These issues require professional and technical personnel to do comprehensive analysis and judgement to choose.
For non-small cell lung cancer (squamous cell carcinoma, adenocarcinoma, etc.), usually the preferred treatment for surgery, particularly for patients with early radical surgery, radiotherapy and chemotherapy after supplemented by, and in line with immunization, such as Chinese medicine treatment, To prevent recurrence, transfer, enhance survival.
And small-cell lung cancer because of its unique biological characteristics, grade, the early transfer of the body may have, the more the current first choice does not advocate surgery, but mainly systemic chemotherapy, supplemented by radiotherapy. Intermittent during radiotherapy and chemotherapy, Chinese medicine can consolidate and immune therapy treatment.
And advanced lung cancer patients, the body has been transferred, surgery, radiation therapy has not as a local tumor control purposes, it should be the main choice of chemotherapy. To ease local pressure, bleeding, pain and other symptoms, can also be an appropriate choice of palliative surgery and radiotherapy. At this point in Chinese medicine treatment because of side effects and immune low toxicity, do not damage the body functions do not add to failure, but also for many of the optional, relieve pain, improve the quality of life, the role of extended life.
In short, the combination therapy is lung cancer surgery, radiotherapy and chemotherapy, immunization, Chinese medicine treatment of organic synthesis, rather than simply stacking, the formulation of comprehensive treatment programme should be specialized technical personnel in accordance with the different circumstances of each patient made.
2008-07-13
Chinese medicine treatment of lung cancer!
Primary Lung Cancer (hereinafter referred to lung cancer) is one of common malignancies, particularly in major cities in China, the incidence rate ranks first in various types of cancer, but the incidence is still rising. At present, most of the treatment of the disease by surgery, radiotherapy and chemotherapy, Chinese medicine, and other comprehensive measures. In recent years, Chinese medicine treatment of lung cancer has been noteworthy effect in alleviating symptoms and extended survival period has played a very good role. Early treatment of the disease preferred surgical resection, but for various reasons, medical treatment, most patients have advanced to the loss of the surgical treatment opportunities, and more characteristics of Chinese medicine treatment, especially for in advanced lung cancer, is by means other treatment Irreplaceable. Now clinical treatment summarized as follows:
1. Differential Treatment
General since the beginning of this disease for more than Xiedu phlegm and blood stasis pool in the lungs, focusing on evidence, not imaginary as weight, body upright Shangqiang through Treating, the condition can be improved. If not controlled, are Xiedu injury, pulmonary Spleen-Qi Deficiency, suppressed evil lack of power, Xiedu lung rumored to be further changed, or flow in the subcutaneous skin, or streamer on the viscera compartment, or in Zhijie bones, sex pulp loss Bone, on the nuisance or Xiedu-obsessed, and even fool-obsessed. Xusun increased consumption of gas blood injury, Shang Yin and Yang, if cut to meet Xingshou, "made from meat" Xusun failure of the disease, often indicates that patients have access to critical condition stage. As part of recurrence of lung cancer patients, can occur by the then Yang Qi, also graded for-blood deficiency, can show clinical lung splenorenal three of the dirty Qiyin the witness of the two injured, many indicate an extremely serious disease potential, poor treatment . In addition, "Tanreqing" often for lung cancer pathology evolution of the one aspect, the mechanism is more a result of heat caused by phlegm and blood stasis. Phlegm and blood stasis of the direct cause of heat is the result of Aikuai bronchial obstruction, resulting in poor drainage sputum, because of a secondary infection. If this transformation, clinical treatment, the cut-off approach must be taken, in order to achieve thermal control as quickly, to stop the rapid deterioration of the condition. Now at different stages of different clinical syndromes of treating as follows:
1. Evil plot of drug -
Cough more drama, Katan not easy, blood or sputum, Xiongxie pain, dark purple Shezhi, Moss thick veins string. This is the accumulation of Xiedu, phlegm and blood stasis gas stagnation. Zhiyi Ruanjiansanjie, detoxification Quxie. To use: Scutellaria barbata, Maozhao grass, the Health Committee with the theory 30 g, law Banxia, Melon, Prunella, cellular, Sunburn pangolins, Yang Shu-chuen, the 10 g, Sunburn Biejia 20 g. Xiedu Shing: Canada dry Toad clams Paper 6 g, Long Kwai grass, Sophora subprostrata, Selaginella, iron leaves the 10 g, partial heat: Canada bezoar 3 g, Hedyotis diffusa, see-through, Hibiscus leaves 20 g, partial Yinhan: Canadian Health Fuzi Health Radix Aconiti, the Health and Southern Star to 10 g.
2. Tanreqing Yu-lung
Impeded coughing, bloody sputum, chest tightness Xiongxie pain or shortness of breath, dry lips dry mouth, constipation big knot, or Anhong She Zhi-hong, Moss yellow, thin veins string or string. The permit for Ben Yu Lung-Qi, blood stasis Tanyong. Zhiyi Xuanfei Qi, Chu Tan Huayu. The use of gold Modified reed stems. Prescription: reed stems 30 g, Taoren, the Health coixenolide, Fuling, wax gourd-jen, Scrophulariaceae, trichosanthin, Shu-chuen, sheep, Zihuadeding, Sophora subprostrata, fleas off the 15 g, Zhejiang Fritillaria, Houttuynia, dandelion, wild Chrysanthemum, Hedyotis diffusa all 20 g, mulberry leaves, March 7, Cortex Lycii, Wan Chi, Kuan Donghua all 10 g, Shougong 5 g, law Banxia 12 g, Citrus, licorice all 6 g.
3, Qi Tan Shi -
Tanduo coughing, chest tightness short-and less-lazy statement, Nadai suffering from weight loss, abdominal distention it Tang. An Shezhi short or Danhong, a tooth-printed, Moss Baini, pulse Wenru or Waterloo. Lung-Qi is certified weak, and the mother of disease, loss of spleen-Yun, Tan Shi internal resistance. Air Jianpi Zhiyi, Chutan Sanjie. Side with the Senate Baishu Powder addition and subtraction. Prescription: Dangshen, the Health coixenolide all 20 g, Fuling, white tricks, Zhejiang Fritillaria, white lentils, fried pangolins (Xian Jian), the Senate too, Gynostemma, Ganoderma lucidum, astragalus, dangshen, white tricks, the 15 g Schisandra Yam 25 g, Hawthorn Coke, Coke Divine Comedy, Amomum villosum (after), the law Banxia all 10 g, Cordyceps sinensis, Citrus, bellflower, licorice all 6 g.
4, Yin-Tanreqing
Less cough sputum, or dry cough, Yangan discomfort, or Katan with Blood-streaked phlegm, chest full short breath, hot flashes night sweats, dizziness tinnitus, upset dry mouth, yellow urine, feces stem end. She Zhi-hong Jiang, moss-stripping or tongue-no moss, unable to clock a few strings. The permit for lung and kidney yin vacuity, guitar Tanreqing each other, Zhiyi Zishen Qingfei, Chutan heat. Prescription: Cortex Mori, Shengde Huang, Zhimu, Ophiopogon japonicus, Zhejiang Fritillaria, Biejia (Xian Jian), the Health coixenolide, Houttuynia, Nansha Senate and North Shashen, Yao Dong, Huang Jing, 100, Lily , Yuzhu, Houttuynia, Hill conch, Ligustrum lucidum, Lin dry grass, Huaishan medicine, Agrimony, trichosanthin, Ejiao, Zhimu, Cortex Lycii all 15 g, the Health and oysters 20 g, Sichuan Fritillaria, licorice 6 g.
5, Qiyinliangxu type of
Stem expectoration less Kesheng low, less blood or sputum, weight loss Shenjuan, dry mouth short gas, Mu Ming Mei loss, irritability palpitation, lack of Nacha, Shehong dry or Nenhong, moss or dry white moss, pulse - Fine. Feipi deficiency is certified, Shenyin exhausted. Zhiyi Yiqi Yin, Fuzheng addition plot. Shengmaisan side with a Liuweidihuang Decoction. Prescription: the Senate too, Gynostemma, Ganoderma lucidum, astragalus, dangshen, white tricks, Schisandra, Agrimony all 15 g, Ophiopogon japonicus, Fuling, Shude Huang, Cornel, Chinese wolfberry son, Huang Jing, Yuzhu, lily of the 15 g, Sheng-yi, Chinese yam, the Health and oysters all 25 g, bellflower, Cordyceps sinensis, and Sichuan Fritillaria, licorice all 6 g.
6, deficiency of yin and yang
Thinner dry mouth, Shenpi burnout, cold-Pa Leng, short-lazy statement, looking Wu Hua, short dark tongue, white or less moss Moss, Shen Fine veins. That this is bad virtual, and more from falling into Feiyin loss, and Yang Yin Sun, caused by deficiency of yin and yang. Yin and yang and to fill. Prescription: ginseng, psoralen, Curculigoside, Epimedium, meat from Chengdu, Cynomorium, Fuzi-all 10 g, astragalus, Schisandra, Chinese wolfberry son, jujube (to nuclear), Shude Huang, Cornel, Huang Jing, Yu - Bamboo, lily of the 15 g, Sheng-yi, Chinese yam, the Health and oysters all 25 g, licorice 6 g
Second, identify disease addition and subtraction
1, brain metastases: Canada centipede three defensive Palace, the Scorpion 6 g, Koto 20 g.
2, pleural effusion: Application Qingfei promoting blood circulation and Water Treatment: If Drabanemerosa hebecarpa-Ting, Cortex Mori, hirudin, stay-line, the Zeeland 10 g.
3, metastasis: Jia Kunbu, algae, Hill arrowhead,
4, bone metastases: Jiachuan Wu, Rhodojaponin, tetrandrine, swelling of the wind section 10 g, Scorpion 6 g.
5, cancer pain: Canadian Xu Changqing, Fuzi Health, the Health and Radix Aconiti 10 g.
6, cancer fever:, a combination安宫牛黄丸day two.
Third, for the prevention and perturbation
Although the disease can be no precise method of prevention, but to strengthen training and enhance capacity of the body resistance, to avoid carcinogenic factors to stimulate the long-term, it can reduce the incidence rate, has acknowledged smoking caused lung cancer is a more important factor Therefore, should actively publicize the dangers of smoking, promote smoking cessation. Tar, coal tar, chromium, which are caused by lung cancer, should avoid or reduce exposure. Ionizing radiation caused by lung cancer is also a factor, it should take certain protective measures. Pingsu to as much as possible so that patients feel cheerful, sometimes daily, maintaining indoor air fresh, warm attention to cold, Waixie prevent the passage of the lungs caused by lung secondary infection. Nianni diet to eat, the stimulation of spicy, eat more mushrooms, coixenolide, kelp, and other food.
1. Differential Treatment
General since the beginning of this disease for more than Xiedu phlegm and blood stasis pool in the lungs, focusing on evidence, not imaginary as weight, body upright Shangqiang through Treating, the condition can be improved. If not controlled, are Xiedu injury, pulmonary Spleen-Qi Deficiency, suppressed evil lack of power, Xiedu lung rumored to be further changed, or flow in the subcutaneous skin, or streamer on the viscera compartment, or in Zhijie bones, sex pulp loss Bone, on the nuisance or Xiedu-obsessed, and even fool-obsessed. Xusun increased consumption of gas blood injury, Shang Yin and Yang, if cut to meet Xingshou, "made from meat" Xusun failure of the disease, often indicates that patients have access to critical condition stage. As part of recurrence of lung cancer patients, can occur by the then Yang Qi, also graded for-blood deficiency, can show clinical lung splenorenal three of the dirty Qiyin the witness of the two injured, many indicate an extremely serious disease potential, poor treatment . In addition, "Tanreqing" often for lung cancer pathology evolution of the one aspect, the mechanism is more a result of heat caused by phlegm and blood stasis. Phlegm and blood stasis of the direct cause of heat is the result of Aikuai bronchial obstruction, resulting in poor drainage sputum, because of a secondary infection. If this transformation, clinical treatment, the cut-off approach must be taken, in order to achieve thermal control as quickly, to stop the rapid deterioration of the condition. Now at different stages of different clinical syndromes of treating as follows:
1. Evil plot of drug -
Cough more drama, Katan not easy, blood or sputum, Xiongxie pain, dark purple Shezhi, Moss thick veins string. This is the accumulation of Xiedu, phlegm and blood stasis gas stagnation. Zhiyi Ruanjiansanjie, detoxification Quxie. To use: Scutellaria barbata, Maozhao grass, the Health Committee with the theory 30 g, law Banxia, Melon, Prunella, cellular, Sunburn pangolins, Yang Shu-chuen, the 10 g, Sunburn Biejia 20 g. Xiedu Shing: Canada dry Toad clams Paper 6 g, Long Kwai grass, Sophora subprostrata, Selaginella, iron leaves the 10 g, partial heat: Canada bezoar 3 g, Hedyotis diffusa, see-through, Hibiscus leaves 20 g, partial Yinhan: Canadian Health Fuzi Health Radix Aconiti, the Health and Southern Star to 10 g.
2. Tanreqing Yu-lung
Impeded coughing, bloody sputum, chest tightness Xiongxie pain or shortness of breath, dry lips dry mouth, constipation big knot, or Anhong She Zhi-hong, Moss yellow, thin veins string or string. The permit for Ben Yu Lung-Qi, blood stasis Tanyong. Zhiyi Xuanfei Qi, Chu Tan Huayu. The use of gold Modified reed stems. Prescription: reed stems 30 g, Taoren, the Health coixenolide, Fuling, wax gourd-jen, Scrophulariaceae, trichosanthin, Shu-chuen, sheep, Zihuadeding, Sophora subprostrata, fleas off the 15 g, Zhejiang Fritillaria, Houttuynia, dandelion, wild Chrysanthemum, Hedyotis diffusa all 20 g, mulberry leaves, March 7, Cortex Lycii, Wan Chi, Kuan Donghua all 10 g, Shougong 5 g, law Banxia 12 g, Citrus, licorice all 6 g.
3, Qi Tan Shi -
Tanduo coughing, chest tightness short-and less-lazy statement, Nadai suffering from weight loss, abdominal distention it Tang. An Shezhi short or Danhong, a tooth-printed, Moss Baini, pulse Wenru or Waterloo. Lung-Qi is certified weak, and the mother of disease, loss of spleen-Yun, Tan Shi internal resistance. Air Jianpi Zhiyi, Chutan Sanjie. Side with the Senate Baishu Powder addition and subtraction. Prescription: Dangshen, the Health coixenolide all 20 g, Fuling, white tricks, Zhejiang Fritillaria, white lentils, fried pangolins (Xian Jian), the Senate too, Gynostemma, Ganoderma lucidum, astragalus, dangshen, white tricks, the 15 g Schisandra Yam 25 g, Hawthorn Coke, Coke Divine Comedy, Amomum villosum (after), the law Banxia all 10 g, Cordyceps sinensis, Citrus, bellflower, licorice all 6 g.
4, Yin-Tanreqing
Less cough sputum, or dry cough, Yangan discomfort, or Katan with Blood-streaked phlegm, chest full short breath, hot flashes night sweats, dizziness tinnitus, upset dry mouth, yellow urine, feces stem end. She Zhi-hong Jiang, moss-stripping or tongue-no moss, unable to clock a few strings. The permit for lung and kidney yin vacuity, guitar Tanreqing each other, Zhiyi Zishen Qingfei, Chutan heat. Prescription: Cortex Mori, Shengde Huang, Zhimu, Ophiopogon japonicus, Zhejiang Fritillaria, Biejia (Xian Jian), the Health coixenolide, Houttuynia, Nansha Senate and North Shashen, Yao Dong, Huang Jing, 100, Lily , Yuzhu, Houttuynia, Hill conch, Ligustrum lucidum, Lin dry grass, Huaishan medicine, Agrimony, trichosanthin, Ejiao, Zhimu, Cortex Lycii all 15 g, the Health and oysters 20 g, Sichuan Fritillaria, licorice 6 g.
5, Qiyinliangxu type of
Stem expectoration less Kesheng low, less blood or sputum, weight loss Shenjuan, dry mouth short gas, Mu Ming Mei loss, irritability palpitation, lack of Nacha, Shehong dry or Nenhong, moss or dry white moss, pulse - Fine. Feipi deficiency is certified, Shenyin exhausted. Zhiyi Yiqi Yin, Fuzheng addition plot. Shengmaisan side with a Liuweidihuang Decoction. Prescription: the Senate too, Gynostemma, Ganoderma lucidum, astragalus, dangshen, white tricks, Schisandra, Agrimony all 15 g, Ophiopogon japonicus, Fuling, Shude Huang, Cornel, Chinese wolfberry son, Huang Jing, Yuzhu, lily of the 15 g, Sheng-yi, Chinese yam, the Health and oysters all 25 g, bellflower, Cordyceps sinensis, and Sichuan Fritillaria, licorice all 6 g.
6, deficiency of yin and yang
Thinner dry mouth, Shenpi burnout, cold-Pa Leng, short-lazy statement, looking Wu Hua, short dark tongue, white or less moss Moss, Shen Fine veins. That this is bad virtual, and more from falling into Feiyin loss, and Yang Yin Sun, caused by deficiency of yin and yang. Yin and yang and to fill. Prescription: ginseng, psoralen, Curculigoside, Epimedium, meat from Chengdu, Cynomorium, Fuzi-all 10 g, astragalus, Schisandra, Chinese wolfberry son, jujube (to nuclear), Shude Huang, Cornel, Huang Jing, Yu - Bamboo, lily of the 15 g, Sheng-yi, Chinese yam, the Health and oysters all 25 g, licorice 6 g
Second, identify disease addition and subtraction
1, brain metastases: Canada centipede three defensive Palace, the Scorpion 6 g, Koto 20 g.
2, pleural effusion: Application Qingfei promoting blood circulation and Water Treatment: If Drabanemerosa hebecarpa-Ting, Cortex Mori, hirudin, stay-line, the Zeeland 10 g.
3, metastasis: Jia Kunbu, algae, Hill arrowhead,
4, bone metastases: Jiachuan Wu, Rhodojaponin, tetrandrine, swelling of the wind section 10 g, Scorpion 6 g.
5, cancer pain: Canadian Xu Changqing, Fuzi Health, the Health and Radix Aconiti 10 g.
6, cancer fever:, a combination安宫牛黄丸day two.
Third, for the prevention and perturbation
Although the disease can be no precise method of prevention, but to strengthen training and enhance capacity of the body resistance, to avoid carcinogenic factors to stimulate the long-term, it can reduce the incidence rate, has acknowledged smoking caused lung cancer is a more important factor Therefore, should actively publicize the dangers of smoking, promote smoking cessation. Tar, coal tar, chromium, which are caused by lung cancer, should avoid or reduce exposure. Ionizing radiation caused by lung cancer is also a factor, it should take certain protective measures. Pingsu to as much as possible so that patients feel cheerful, sometimes daily, maintaining indoor air fresh, warm attention to cold, Waixie prevent the passage of the lungs caused by lung secondary infection. Nianni diet to eat, the stimulation of spicy, eat more mushrooms, coixenolide, kelp, and other food.
The latest lung cancer therapy
The triple therapy for the treatment of lung cancer: (A), internal medicine: Self Qingfei Decoction: prescription: ginseng, Panax quinquefolium, bellflower, winter days, Zhimu, Lily, seven towers more than 30 kinds of Chinese herbal medicine, and other components. The author of lung cancer will be for the five-dialectic: the Spleen-Qi Deficiency-lung, lung-kidney yin deficiency, Qiyinliangxu-, gas-Lag Xueyu, heat-drug Chi Sheng. According to clinical performance, the person dialectical treatment of illness, respectively, to Oxfam, refused to Yidao points. (2), plaster, paste: a hard-paste type of Traditional Chinese Medicine paste treated - Huichun Ling plaster. The director of medical experience and learn from the best experts and scholars today, through repeated exploration and research developed from. Hui Chun Ling plaster to Health Radix Aconiti, such as Qingrejiedu of the tower. Kennedy swelling of soft-line pain medication. Supported Shanjia, safflower Relieving Blood Stasis, such as promoting blood circulation and to borneol musk, and other radio-channeling to Reply to drugs to infiltrate into the surface of tumor blood vessels in the tumor tissue to improve circulation. Dissolved and destruction of tumor tissue around the tumor and fiber lectin protein, tumor remission in patients with the party on the chemical nerve stimulation or physical oppression, to ease the pain, tumors can be dispersed. Plaster paste, the characteristics of drug absorbed through the skin, the nearest role in patients with locally to avoid the effect of oral drugs to be brought into full play. (C), injection drug targeting: The non-toxic effects without the side effects of drug injection in particular targeted way, it is to use the mechanism in place of meridians of the drug into specific points on the play and efficacy, acupuncture double , To reach Fuzheng evil, the active-purposes.
Individual treatment of lung cancer
21 of lung cancer treatment, are moving towards standardized, individual direction of the rapid advance of evidence-based medicine. The so-called individual treatment of lung cancer, which is developed by the special treatment strategy for a certain lung cancer patients. An individual's lung cancer treatment strategy, we must rely on clinical factors, but also to rely on functional genomics and functional proteomics factors.
Based on the clinical factors of individual treatment of lung cancer
Stages of lung cancer is one of the most important indicators of prognosis, it is also extremely important predictor of treatment. Based on the phased development of lung cancer treatment strategy is now recognized individual one of the basic standards of treatment. The end of 2005 "published by the Chinese lung cancer diagnosis and treatment guidelines" and the United States Comprehensive Cancer Network (NCCN) guidelines lung cancer, the most commendable and most of the best part is that the principle of phased treatment and staging of the implementation details: Ⅰ, Ⅱ preferred surgical treatment of lung cancer, Ⅲ lung cancer need a multidisciplinary organic arrangements, Ⅳ lung cancer while systemic treatment such as chemical treatment or mainly targeted therapy.
In recent years carried out a large-scale clinical trial has clearly some clinical factors as predictors of prognosis. The easiest targets are in the physical state (PS) index and weight loss. If the PS> 2 or weight loss index> 5%, chemotherapy or radiation therapy greatly reduced, or even counterproductive.
A very interesting study, the United States, such as the U.S. eastern Hoang tumor Cooperation Group (ECOG) of the two large randomized controlled study ECOG1594 and ECOG5592 the establishment of clinical prediction model. 1436 cases of third-generation chemotherapy for non-small cell lung cancer (NSCLC) patients entered the study, to screen a total of six independent prognostic factors: transfer of the skin, low PS, reduce appetite, liver metastases, four places and had not transferred the history of surgery . According to the researchers this six clinical factors predict the early establishment of governance in patients with NSCLC 1 to 2-year survival rate of model (Figure 1). Can be seen from the plan, six if there are negative factors, total as much as 216 points, corresponding to the one-year survival rate of only 0.6 percent. If only a transfer of the skin, compared with its integral 66 points, corresponding to the 1-year survival rate around 30 percent, 2-year survival rate of less than 10 percent. From this we can determine what the basic needs of patients with active anti-cancer therapy, which only patients with active support treatment.
Based on the clinical factors of individual treatment of lung cancer, although based on experience than simply the treatment has been a major step forward, but it is still not the real significance of the individual treatment. For example, Ⅰ lung cancer is a rather large groups, based on the principle of phased treatment groups use the same treatment strategy, there are still 20 percent to 30 percent of patients fail to survive more than five years, some patients actually receive the Is not the individual treatment.
Based on functional genomics and proteomics individual treatment of lung cancer
Each individual unique, because of its unique gene spectrum. Therefore, based on functional genomics and proteomics individual treatment of lung cancer, it is possible for us to tailor each of lung cancer patients, designed a unique, the best effect and minimum side effects of treatment.
Based on the molecular characteristics of tumors anti-cancer drug choice
Hailed as the past five years in the lung cancer study found that one of the most important thing is to determine the tyrosine kinase inhibitors gefitinib the target population for the East-smoking crowd in patients with adenocarcinoma. Our research suggests that China's human lung adenocarcinoma of the EGFR mutation rate was 34.1 percent, far higher than other types of lung cancer 5.7% (P <0.05). In fact, the Oriental people, women, non-smoking and adenocarcinoma of the four factors of EGFR mutations can be attributed to the molecular biology of this unique characteristics. Therefore, in accordance with EGFR mutation in the choice of suitable patients with lung cancer and gefitinib treatment of lung cancer is expected to make more individualized treatment.
Based on biological markers of chemotherapy options.
"Tailor" has been frequently and "chemotherapy" with the use. Tailor chemotherapy foundation, is based on biological markers of chemotherapy options. In the field of lung cancer, interesting is the ERCC1 and cisplatin, RRM1 and gemcitabine, β-tublin taxane drugs and the relationship between. In 2005 the American Society of Clinical Oncology (ASCO) annual meeting, Rosell report the first molecular markers based on the type of chemotherapy choice of prospective randomized controlled clinical study, ERCC1 with low expression of the two drugs cisplatin programme 56.6 percent have the highest response rate is very regrettable that, ERCC1 expression of non-platinum group only 37.7 percent of the programme is efficient, effective and do not show the results.
One of our adjuvant chemotherapy for stage Ⅲ randomized controlled clinical experiments (CSLC0201), on the β-tublin Ⅲ NSCLC in the forecast of adjuvant chemotherapy in value. Patients are complete with NSCLC, after supplemented with docetaxel Jiaka Platinum 4 cycle of chemotherapy. The results showed that the median time in the non-recurrence of β-tublin Ⅲ positive group only six months, the negative group was 26 months (P = 0.006); chemotherapy invalid group 66.7 percent of patients with β-tubulin Ⅲ positive, significantly higher than that Adjuvant chemotherapy effective group of 14.3% (P = 0.063).
In addition, RRM1 polymorphism also decided to gemcitabine resistance of the problem. Multi-drug resistance gene MDR-1 over-expression means that the doxorubicin and paclitaxel resistance.
Trap or a way out »
Functional genomics research people dazzling. Do we have reason to believe that the individual treatment of cancer era about to come »In fact, laboratory, clinical small sample of the findings and clinical application still exist between the great divide, to straddle this divide is not easy. Therefore, under the present circumstances, it is not appropriate to have a preliminary understanding easily applied to clinical practice. It can be said that the individual treatment of cancer, there are traps everywhere, there is a way out, the key lies in how the laboratory and clinical practice to fill the gap between.
Based on the clinical factors of individual treatment of lung cancer
Stages of lung cancer is one of the most important indicators of prognosis, it is also extremely important predictor of treatment. Based on the phased development of lung cancer treatment strategy is now recognized individual one of the basic standards of treatment. The end of 2005 "published by the Chinese lung cancer diagnosis and treatment guidelines" and the United States Comprehensive Cancer Network (NCCN) guidelines lung cancer, the most commendable and most of the best part is that the principle of phased treatment and staging of the implementation details: Ⅰ, Ⅱ preferred surgical treatment of lung cancer, Ⅲ lung cancer need a multidisciplinary organic arrangements, Ⅳ lung cancer while systemic treatment such as chemical treatment or mainly targeted therapy.
In recent years carried out a large-scale clinical trial has clearly some clinical factors as predictors of prognosis. The easiest targets are in the physical state (PS) index and weight loss. If the PS> 2 or weight loss index> 5%, chemotherapy or radiation therapy greatly reduced, or even counterproductive.
A very interesting study, the United States, such as the U.S. eastern Hoang tumor Cooperation Group (ECOG) of the two large randomized controlled study ECOG1594 and ECOG5592 the establishment of clinical prediction model. 1436 cases of third-generation chemotherapy for non-small cell lung cancer (NSCLC) patients entered the study, to screen a total of six independent prognostic factors: transfer of the skin, low PS, reduce appetite, liver metastases, four places and had not transferred the history of surgery . According to the researchers this six clinical factors predict the early establishment of governance in patients with NSCLC 1 to 2-year survival rate of model (Figure 1). Can be seen from the plan, six if there are negative factors, total as much as 216 points, corresponding to the one-year survival rate of only 0.6 percent. If only a transfer of the skin, compared with its integral 66 points, corresponding to the 1-year survival rate around 30 percent, 2-year survival rate of less than 10 percent. From this we can determine what the basic needs of patients with active anti-cancer therapy, which only patients with active support treatment.
Based on the clinical factors of individual treatment of lung cancer, although based on experience than simply the treatment has been a major step forward, but it is still not the real significance of the individual treatment. For example, Ⅰ lung cancer is a rather large groups, based on the principle of phased treatment groups use the same treatment strategy, there are still 20 percent to 30 percent of patients fail to survive more than five years, some patients actually receive the Is not the individual treatment.
Based on functional genomics and proteomics individual treatment of lung cancer
Each individual unique, because of its unique gene spectrum. Therefore, based on functional genomics and proteomics individual treatment of lung cancer, it is possible for us to tailor each of lung cancer patients, designed a unique, the best effect and minimum side effects of treatment.
Based on the molecular characteristics of tumors anti-cancer drug choice
Hailed as the past five years in the lung cancer study found that one of the most important thing is to determine the tyrosine kinase inhibitors gefitinib the target population for the East-smoking crowd in patients with adenocarcinoma. Our research suggests that China's human lung adenocarcinoma of the EGFR mutation rate was 34.1 percent, far higher than other types of lung cancer 5.7% (P <0.05). In fact, the Oriental people, women, non-smoking and adenocarcinoma of the four factors of EGFR mutations can be attributed to the molecular biology of this unique characteristics. Therefore, in accordance with EGFR mutation in the choice of suitable patients with lung cancer and gefitinib treatment of lung cancer is expected to make more individualized treatment.
Based on biological markers of chemotherapy options.
"Tailor" has been frequently and "chemotherapy" with the use. Tailor chemotherapy foundation, is based on biological markers of chemotherapy options. In the field of lung cancer, interesting is the ERCC1 and cisplatin, RRM1 and gemcitabine, β-tublin taxane drugs and the relationship between. In 2005 the American Society of Clinical Oncology (ASCO) annual meeting, Rosell report the first molecular markers based on the type of chemotherapy choice of prospective randomized controlled clinical study, ERCC1 with low expression of the two drugs cisplatin programme 56.6 percent have the highest response rate is very regrettable that, ERCC1 expression of non-platinum group only 37.7 percent of the programme is efficient, effective and do not show the results.
One of our adjuvant chemotherapy for stage Ⅲ randomized controlled clinical experiments (CSLC0201), on the β-tublin Ⅲ NSCLC in the forecast of adjuvant chemotherapy in value. Patients are complete with NSCLC, after supplemented with docetaxel Jiaka Platinum 4 cycle of chemotherapy. The results showed that the median time in the non-recurrence of β-tublin Ⅲ positive group only six months, the negative group was 26 months (P = 0.006); chemotherapy invalid group 66.7 percent of patients with β-tubulin Ⅲ positive, significantly higher than that Adjuvant chemotherapy effective group of 14.3% (P = 0.063).
In addition, RRM1 polymorphism also decided to gemcitabine resistance of the problem. Multi-drug resistance gene MDR-1 over-expression means that the doxorubicin and paclitaxel resistance.
Trap or a way out »
Functional genomics research people dazzling. Do we have reason to believe that the individual treatment of cancer era about to come »In fact, laboratory, clinical small sample of the findings and clinical application still exist between the great divide, to straddle this divide is not easy. Therefore, under the present circumstances, it is not appropriate to have a preliminary understanding easily applied to clinical practice. It can be said that the individual treatment of cancer, there are traps everywhere, there is a way out, the key lies in how the laboratory and clinical practice to fill the gap between.
2008-07-12
The treatment of liver cancer bleeding
Bleeding primary liver cancer, liver cancer patients is a serious and deadly complications, the rate of about 5.46% -19.8% of patients with liver cancer is the leading cause of death of liver cancer death of the 9 % -10% In liver cancer in the cause of death for the first four. As the disease of a sudden, sharp, shock and frequently, the difficulties of their treatment, prognosis is poor, if not positive where most of the patients died quickly.
First, the mechanism
Bleeding more common in liver cancer nodules and massive hepatocellular carcinoma, particularly those associated with liver cirrhosis, liver cancer rare diffuse. HCC bleeding There are two types: a hemorrhage of the liver capsule, the capsule into a person for abdominal perforation, the rapid progress in the latter condition, the high mortality rate.
1, liver in the process of growth due to expansion of growth, the higher the pressure within the tumor, and because of the rapid tumor growth,
Blood for a relative shortage of ischemia and hypoxia, tumor necrosis central liquefaction, corrosion vessels in tumors congestion, pressure is high and on the basis of necrosis, in deep breaths, stand up, shock, severe coughing, defecation or physical force, such as increased intra-abdominal pressure The circumstances, the pressure of the surrounding capsule breakthrough in cancer or normal liver tissue breakdown of the weak, resulting in intra-abdominal bleeding.
2, liver cirrhosis portal hypertension is the peripheral venous system tumor blood supply, and the portal and hepatic veins are traffic-related.
When the portal pressure increased, arteries and veins, the pressure increased, so that gradually thinning vessel walls, leading to bleeding. Bleeding in patients with liver cancer often associated with cirrhosis, with rates as high as 90 percent, less bleeding liver cancer patients with high rate of liver cirrhosis.
3, tumor necrosis of tumor growth after the liquefied erosion damage blood vessels rupture of the liver cancer is also an important factor.
4, liver accompanied cirrhosis, liver damage, abnormal clotting mechanisms, liver cancer is one of the reasons for bleeding.
Second, clinical performance
(A) the general performance of liver cancer
Hepatomegaly, liver pain. Abdominal wall varicose veins, weight loss, fever, jaundice, such as elevated serum AFP, some suffering from liver cancer before the bleeding before the diagnosis of liver cancer, or are receiving treatment, some with less bleeding as the first symptom.
(B) performance of bleeding
Subcapsular liver bleeding, showed sudden liver pain, right upper quadrant mass rapid increase. Liver tenderness and tension, North Korea, such as fertilizer, can be associated with nausea, vomiting, looking pale and a cold sweat, dizziness, palpitations, to speed up the pulse, blood pressure, such as blood volume declined less than the performance of smaller rupture if liver cancer, bleeding slowly, Blood volume can be no shortage of performance, or only minor pain liver limitations, 3-5 days to ease; liver cancer were broken into the abdominal perforation capsule, showed sudden abdominal pain, and then reduce the pain And spread to the entire abdomen, accompanied by acute peritonitis and the performance of bleeding, such as abdominal pain, abdominal distention, nausea, vomiting, looking pale and a cold sweat, to speed up the pulse, abdominal tension, mobility Zhuoyin positive, the patient quickly into shock状态. Severe abdominal pain rate was 54% -100%, the shock rate was 17% -100%, peritoneal irritation sign up to 92 percent.
Third, the diagnosis
The diagnosis of the disease in general it is not difficult, especially liver cancer diagnosis has been clear and the greater amount of bleeding. If less amount of bleeding, the diagnosis more difficult, have a history of liver cancer in patients with cirrhosis, or forced suddenly appeared after the right upper quadrant pain or hemorrhagic shock and diffuse peritonitis performance, should guard against the possibility of this disease. Diagnosis of abdominal wear, CT, B Chaodeng inspection, in particular the diagnosis of abdominal wear on the larger significance of the diagnosis, therefore, for unknown reasons the abdominal pain, abdominal distention, peritoneal irritation sign, should the diagnosis of abdominal wear line . The diagnosis of liver cancer patients have not yet clear, the sudden onset of abdominal distention, abdominal pain associated with peritoneal irritation sign and shock performance, should be held B-abdomen, CT, diagnostic angiography and abdominal wear such as checks to clear availability of liver Of liver cancer lesions and bleeding. The diagnosis of the disease may refer to the following diagnostic criteria:
1, a serious liver damage performance, AFP positive.
2, abdominal not out of the blood coagulation, the positive rate of 100 percent, AFP abdominal puncture of bile analysis of amylase, or check positive performance of cancer cells.
3, hemoglobin level of decline, often in the 90 g / L below.
4, B-chao, CT hepatic artery was performed and found that tumors can rupture, abdominal bleeding.
4, treatment
Neoplasms bleeding often sharp, dangerous, the need for immediate rescue, or stable condition after the liver should be actively considered for the treatment of primary lesions.
(A) non-surgical treatment
1, emergency handling lesser amount of bleeding. Should rest sits flat, restrictions on activities, Fudai compression bandaging, the amount of bleeding, failed bloody cycle of failure around the time the patient should be in blood pressure, pulse, breathing, heart rate and consciousness conducted intensive care and anti-shock therapy.
2, added a smaller blood volume bleeding can only add to the liquid crystal, the amount of bleeding, lose blood circulation around the failure of patients to be timely infusion of new blood or blood components.
(B) surgical treatment
The condition of dangerous, high mortality, all with surgical operation indications should be treated immediately.
Surgical indications:
(1) of the general situation is good, the age of 60 years;
(2) expressly for liver cancer bleeding, with shock, short-term hemoglobin rapidly declining;
(3) can not rule out other causes bleeding, or other acute abdomen need surgical exploration;
(4) compensatory liver function is good, especially hepatic encephalopathy. Massive ascites, or other important organ dysfunction, it is estimated that tumors can be removed or other effective treatment.
(B) TCM treatment
The disease Jizhou, dangerous conditions and high mortality, the use of Chinese medicine treatment is still rare.
中文 » 英语 翻译
First, the mechanism
Bleeding more common in liver cancer nodules and massive hepatocellular carcinoma, particularly those associated with liver cirrhosis, liver cancer rare diffuse. HCC bleeding There are two types: a hemorrhage of the liver capsule, the capsule into a person for abdominal perforation, the rapid progress in the latter condition, the high mortality rate.
1, liver in the process of growth due to expansion of growth, the higher the pressure within the tumor, and because of the rapid tumor growth,
Blood for a relative shortage of ischemia and hypoxia, tumor necrosis central liquefaction, corrosion vessels in tumors congestion, pressure is high and on the basis of necrosis, in deep breaths, stand up, shock, severe coughing, defecation or physical force, such as increased intra-abdominal pressure The circumstances, the pressure of the surrounding capsule breakthrough in cancer or normal liver tissue breakdown of the weak, resulting in intra-abdominal bleeding.
2, liver cirrhosis portal hypertension is the peripheral venous system tumor blood supply, and the portal and hepatic veins are traffic-related.
When the portal pressure increased, arteries and veins, the pressure increased, so that gradually thinning vessel walls, leading to bleeding. Bleeding in patients with liver cancer often associated with cirrhosis, with rates as high as 90 percent, less bleeding liver cancer patients with high rate of liver cirrhosis.
3, tumor necrosis of tumor growth after the liquefied erosion damage blood vessels rupture of the liver cancer is also an important factor.
4, liver accompanied cirrhosis, liver damage, abnormal clotting mechanisms, liver cancer is one of the reasons for bleeding.
Second, clinical performance
(A) the general performance of liver cancer
Hepatomegaly, liver pain. Abdominal wall varicose veins, weight loss, fever, jaundice, such as elevated serum AFP, some suffering from liver cancer before the bleeding before the diagnosis of liver cancer, or are receiving treatment, some with less bleeding as the first symptom.
(B) performance of bleeding
Subcapsular liver bleeding, showed sudden liver pain, right upper quadrant mass rapid increase. Liver tenderness and tension, North Korea, such as fertilizer, can be associated with nausea, vomiting, looking pale and a cold sweat, dizziness, palpitations, to speed up the pulse, blood pressure, such as blood volume declined less than the performance of smaller rupture if liver cancer, bleeding slowly, Blood volume can be no shortage of performance, or only minor pain liver limitations, 3-5 days to ease; liver cancer were broken into the abdominal perforation capsule, showed sudden abdominal pain, and then reduce the pain And spread to the entire abdomen, accompanied by acute peritonitis and the performance of bleeding, such as abdominal pain, abdominal distention, nausea, vomiting, looking pale and a cold sweat, to speed up the pulse, abdominal tension, mobility Zhuoyin positive, the patient quickly into shock状态. Severe abdominal pain rate was 54% -100%, the shock rate was 17% -100%, peritoneal irritation sign up to 92 percent.
Third, the diagnosis
The diagnosis of the disease in general it is not difficult, especially liver cancer diagnosis has been clear and the greater amount of bleeding. If less amount of bleeding, the diagnosis more difficult, have a history of liver cancer in patients with cirrhosis, or forced suddenly appeared after the right upper quadrant pain or hemorrhagic shock and diffuse peritonitis performance, should guard against the possibility of this disease. Diagnosis of abdominal wear, CT, B Chaodeng inspection, in particular the diagnosis of abdominal wear on the larger significance of the diagnosis, therefore, for unknown reasons the abdominal pain, abdominal distention, peritoneal irritation sign, should the diagnosis of abdominal wear line . The diagnosis of liver cancer patients have not yet clear, the sudden onset of abdominal distention, abdominal pain associated with peritoneal irritation sign and shock performance, should be held B-abdomen, CT, diagnostic angiography and abdominal wear such as checks to clear availability of liver Of liver cancer lesions and bleeding. The diagnosis of the disease may refer to the following diagnostic criteria:
1, a serious liver damage performance, AFP positive.
2, abdominal not out of the blood coagulation, the positive rate of 100 percent, AFP abdominal puncture of bile analysis of amylase, or check positive performance of cancer cells.
3, hemoglobin level of decline, often in the 90 g / L below.
4, B-chao, CT hepatic artery was performed and found that tumors can rupture, abdominal bleeding.
4, treatment
Neoplasms bleeding often sharp, dangerous, the need for immediate rescue, or stable condition after the liver should be actively considered for the treatment of primary lesions.
(A) non-surgical treatment
1, emergency handling lesser amount of bleeding. Should rest sits flat, restrictions on activities, Fudai compression bandaging, the amount of bleeding, failed bloody cycle of failure around the time the patient should be in blood pressure, pulse, breathing, heart rate and consciousness conducted intensive care and anti-shock therapy.
2, added a smaller blood volume bleeding can only add to the liquid crystal, the amount of bleeding, lose blood circulation around the failure of patients to be timely infusion of new blood or blood components.
(B) surgical treatment
The condition of dangerous, high mortality, all with surgical operation indications should be treated immediately.
Surgical indications:
(1) of the general situation is good, the age of 60 years;
(2) expressly for liver cancer bleeding, with shock, short-term hemoglobin rapidly declining;
(3) can not rule out other causes bleeding, or other acute abdomen need surgical exploration;
(4) compensatory liver function is good, especially hepatic encephalopathy. Massive ascites, or other important organ dysfunction, it is estimated that tumors can be removed or other effective treatment.
(B) TCM treatment
The disease Jizhou, dangerous conditions and high mortality, the use of Chinese medicine treatment is still rare.
中文 » 英语 翻译
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