․교신저자:Chang-gueSon East-WestCancerCenter DunsanOrientalHospitalofDaejeon University, 1136Dunsan-Dong,Seo-Gu,Daejeon,Korea TEL:82-42-4709481
E-mail:[email protected]
A Cl i ni c a lObs e rva t i o no fOri e nt a lMe di c i ne - Ba s e dLo ngCa ref o r Te rmi na lRe c t a lCa nc e rPa t i e ntwi t hMul t i pl eMe t as t a s i s
Sun-hwiBang,Chang-gueSon
East-WestCancerCenter,CollegeinDaejeonUniversity
ACl i ni calObser vat i onofOr i ent alMedi ci ne- BasedLongCar ef orTer mi nalRect al CancerPat i entwi t hMul t i pl eMet ast asi s
Sun-hwiBang,Chang-gueSon
East-WestCancerCenter,CollegeinDaejeonUniversity
ABSTRACT
Canc e ri snow t hel e adi ngf at aldi s e as ei ne ve r yde ve l ope d c ount r y.Duet ove r yl ow e f f i c i e nc y ofc onve nt i onalc anc e r t he r ape ut i c sandi mpor t antas pe c tofqual i t yofl i f e(QOL),c ompl e me nt ar y/al t e r nat i veme di c i ne(CAM)hasbe e nac c e pt e d wor l dwi de ,e s pe c i al l ybyl at e - s t age dc anc e rpat i e nt s .Or i e nt alme di c i net r adi t i onal l yhass t r e s s e dnotonl yt het umori t s e l fbut t hebodyhavi ngc anc e r ,i mpr ovi ngc anc e r - r e l at e di mmuni t yande xt e ndi ngs ur vi valpe r i od.He r e i n,wer e por tonec as eofa t e r mi nals t age dr e c t alc anc e rpat i e nthavi ngs pr e ad- me t as t as i sbuts howi ngame ani ngf ulc l i ni c alc our s eofar oundf ourye ar s wi t h Or i e nt alme di c i net he r api e s .Thi ss t udy ai me d t or e por tt hec l i ni c alc apac i t y ofOr i e nt alme di c i nef orpat i e nt swi t h c anc e r ousdi s e as e ,t ohe l pde ve l opme ntofOr i e nt alme di c i ne - de r i ve dant i c anc e rt r e at me nt s .
Keywords:
Canc e r ,Or i e nt alme di c i ne ,QOL,CAM,Col or e c t alc anc e r .
Ⅰ.I n t r oduc t i on
I n s pi t e of r api d advanc e s of pr e ve nt i on, de t e c t i on and t r e at me ntme t hods ,c anc e ri s t he f i r s tc aus eofde at hi ne ve r yde ve l ope dc ount r i e s . Among t hos e , c ol or e c t al c anc e r (CRC) i s t he s e c ond mos t c ommon c aus e of c anc e r - r e l at e d de at h.Wor l dwi de ,ar ound 35% ofCRC pat i e nt s haves t ageⅣ (M1,me t as t at i c ) att het i meof di agnos i s ,and20-50% ofCRC pat i e nt swi t hs t age
Ⅱ or Ⅲ pr ogr e s s t o s t age Ⅳ.The f i ve - ye ar s ur vi valr at ef ors t ageⅣ di s e as eove r al lr e mai ns appr oxi mat e l y10%
1.
Ont heot he rhands ,t hes t at usofl ow e f f i c i e nc y
buthi ghs i de - e f f e c t sbr i ngst hei nc r e as i ngus er at e
ofc ompl e me nt ar y/al t e r nat i veme di c i ne(CAM)i n
c anc e rpat i e nt s
2-3.Or i e nt alme di c i ne t r adi t i onal l y
has pr ac t i c e d t he me di c alt he or i e s and c l i ni c al
t r e at me nt s as s t r e s s i ng on body i ns t e ad of
di s or de r si t s e l fs uc hast umorr e gi ons .So,CAM or
Or i e nt alme di c i nehasbe e nac c e pt e dbye s pe c i al l y
l at e -s t age d c anc e rpat i e nt swor l dwi debe c aus ei t
hasbe e n be l i e ve d t os uppor tqual i t y ofl i f eand
gai nofs ur vi valpe r i od.
Wer e por tonec as eoft e r mi nals t age d r e c t al c anc e r pat i e nt havi ng s pr e ad- me t as t as i s but s howi nggood c l i ni c alc our s eove rt hr e eye ar sby Or i e nt alme di c i net he r api e s .
Ⅱ.Re por toft hec a s e
1.Char act er soft hepat i entanddi agnosi s A 46ol dwomanwasdi agnos e dasr e c t alc anc e r wi t hs t ageⅢ andhadMi l e s 'ope r at i on
4t or e c t al
c ar c i noi d t umori n Apr i l2004.Shedoe s n' thave any ot he rpas thi s t or y e xc e ptappe nde c t omy i n 1975.Shegotl i ve rme t as t as i si n De c e mbe r2002 t he n r e c e i ve d 6c yc l e sofc he mot he r apy.I n June 2003,he rt umorpr ogr e s s e dasmul t i pl emat as t as i s atbr ai n and bone .Thet r e at me ntofanot he r6 c yc l e s ofc he mot he r apy and r adi ot he r apy di dn' t ame l i or at et hes t at usbuti nduc e d s e ve r ege ne r al we akne s s .Shes t ar t e dt obet r e at e dwi t hOr i e nt al me di c i nef r om Nove mbe r2004.
Fi g.1.Radi ol ogi calf i ndi ngsoft hepat i ent .
A.MultipleBonemetastasisinwholebodybone-scan(July2006);B.Multiplelivermetastasisandlymphadenopathy incomputedtomography(Jan.2006);C.Multiplebrainmetastasisinmagneticresonanceimaging(Dec.2006).
2.Or i ent almedi ci nesandt r eat ment
Moxi bus t i on was dai l y pe r f or me d t o i nc r e as e vi t al i t y on mai nl y Kwanwon (關元 CV4) and Yo ng c he o n( 涌泉 KI 1 ) .Ac upunc t ur e ,phar ma c o punc t ur e and ot he rOr i e nt alt r e at me nt swe r epr ovi de d t o t he pat i e nt s ac c or di ng t o t he c ompl ai ns or s ympt oms . The mai n he r bal pr e s c r i pt i ons was Tongkyuwhal whe ol -t ang (TKHWT,通竅活血湯), Chunggan e xt r ac t(CGX)
5-6,Gongj i n- dan (GJD, 供辰丹)
7andMye l ophi l
8(Tabl e1).
3.Cour se ofsympt oms,l ab exami nat i on and r adi ol ogi calf i ndi ng
Whe nt hepat i e ntvi s i t e dourc l i ni catf i r s tt i me , he r c ompl ai nt s we r e t he s e ve r l os e of e ne r gy i nc l udi ngmi l d f l ank pai n,bot h l owe rl i mb pai n, pe r i ne um pai n, f ac i al s pas m and r i ght opht hal mos t as i s .He rge ne r all i f epe r f or manc ewas r e s t r i c t e d i ns i de hous e and vi s i t i ng hos pi t al ,as (ECOG 2~3).Fr om Januar y 2006,t he pat i e nt f r e que nt l y was hos pi t al i z e d f orc ar e ofmul t i pl e pai n(e s pe c i al l ype l vi cpai n)andr i ghtf ac i alpal s y c aus e dbymul t i pl eme t as t as i sonboneandbr ai n.
Shehasbe e nc apabl eofonl yl i mi t e ds e l f - c ar e ,
c onf i ne dt obe dmor et han50% ofwaki nghour s
f r om Januar y2006t onow (May2008)byj udgi ng
ECOG pe r f or manc es t at us(ECOG 3).He rbody we i ghthasbe e n i n s l i ghtde c r e as i ngphas e .The pat i e nt has ke pt r e l at i ve l y s t abl e c ondi t i on i n
c our s e of s ympt oms de s pi t e of t e r mi nalr e c t al c anc e rwi t hmul t i pl eme t as t as i s (Tabl e2).
TKHWT: Hipparion species(16),Ostrea gigas Thunb.(8),Angelica gigas Nakai(8),Salvia miltiorrhiza Bunge(8), ZizyphusjujubaMill(8),UncariasinensisOliv.Havil(12),Paeonia lactifloraPall(6),Prunuspersica(L.)Batsch(4), CarthamustinctoriusL.(4),Ligusticum chuanxiong Hort(4),Angelica dahurica Benth.etHookerf.(4),Pheretima aspergillum (4),PolygalatenuifoliaWilld.(2),Chrysanthemum morifolium Ramat.(4)
CGX: Artemisia capillaris Herba(5), Trionycis Carapax(5), Raphani Semen(5), Atractylodis Macrocephalae Rhizoma(3), Poria cocos(3), Alismatis Rhizoma(3), Atractylodis Rhizoma(3), Salvia Miltiorrhizae Radix(3), Polyporus(2),AmomiFructus(2),PonciriFructus(2),GlycyrrhizaeRadix(1),HeleniiRadix(1)
GJD: CornusofficinalisSieb.etZucc.(2),Angelica gigasNakai(2),Cervusalbirostris Przewalski(0.25),Moschus moschiferusL.(0.25)
Myelophil:SalviamiltiorrhizaBunge(2),AstragalusmembranaceusBunge(2)
Numbersinblankrepresentthepropositionalgram ofherbalcompositionforeachformulae.
Tabl e1.Pr escr i pt i onandComposi t i onalVol umeofOr i ent alMedi ci nes
Date Diagnosis Treatment QOL&Pain (ECOG/NRS*)
Body
Weight Orientalmedicinetreatments Apr.
2002 RevtalCa. Miles'operation Nov.
2002 LiverMeta. Ctx.6cycle Jun.
2003
BrainMeta. Ctx.6cycle BoneMeta Rtx.5cycle (BoneMeta) Nov.
2004
3/2
OutpatientTx CGX Jan.
2006
Rtx.20cycle
(BoneMeta) 3/2 51kg
50kg Acupuncture
Moxibustion Apr.
2007
Rtx.10cycle
(BoneMeta) 3/2 53kg TKHWT 51kg InpatientTx
GJD Apr.
2008 3/2 49kg
May.
2008
47kg Myelophil
*Eas t e r nCoope r at i veOnc ol og yGr oupPe r f or manc es t at us ;0:Ful l yac t i ve ,1 :Re s t r i c t e di nphys i c al l ys t r e nuousac t i vi t y,2:
Upandaboutmor et han50 % ofwaki nghour s ,3 :Conf i ne dt obe dorc hai rmor et han5 0 % ofwaki nghour s ,4 :Tot al l y c onf i ne dt obe dorc hai r ,5 :De ad.*Nume r i c alRat i ngSc al ef orpai nme as ur e me nt ;0me ansnopai nand1 0me anst hewor s t pai npos s i bl e .
Tabl e2.Summar yoft r eat ment s,sympt omsanddi seasepr ogr ess
Panc yt ope ni a i nduc e d by mul t i pl e bone me t as t as i shaveappe ar e d many t i me s ,s ohe r bal pr e s c r i pt i on (Mye l ophi l ) as we l l as bl ood t r ans f us i on (r e d bl ood c e l l and pl at e l e t ) was gi ve n.Se r um l e ve lofal kal i nephos phat as e(ALP), gamma- gl ut amylt r ans f e r as e(GGT),and l ac t at e de hydr oge nas e (LDH) have ke pt i n hi ghl y
abnor malt i l lnow.Se r um l e ve lofc r e at i ni ne ,bl ood ur e a ni t r oge n(BUN) we r e i n nomal r ange . Er yt hr oc yt e s e di me nt at i on r at e (ESR) we r e i n s omef l uc t uat i ons .Shehaske ptr e l at i ve l y s t abl e r e nalandhe pat i cf unc t i onde s pi t eofl i ve rmul t i pl e me t as t as i s and he mat ur i a i n l abor at or y e xami nat i ons (Tabl e3).
Labresult Sep.
2005
Jan.
2006
July 2006
Jan.
2007
May 2007
Sep.
2007
Jan.
2008
March 2008
GOT (IU/L) 28 39 27 38 35 28 19 40
GTP(IU/L) 15 20 19 18 19 11 13 16
ALP(U/L) 124 107 187 179 165 128 170 296 GGT (IU/L) 37 33 83 127 120 114 81 142 LDH (U/l) 205 200 289 589 339 450 400 460 Creatinine(mg/dl) 0.8 0.9 0.7 0.7 0.8 1.0 0.7 0.6 BUN (mg/dl) 14.0 11.6 12.1 17.9 16.6 13.8 12.2 11.7 WBC (103/mm3) 5.04 2.83 3.25 2.25 2.55 2.47 3.46 2.06 Hemoglobin(g/이) 12.4 11.5 10.7 8.4 9.0 7.0 9.4 8.0
Platelet(104/㎕) 21.8 18.9 23.0 4.4 10.6 6.9 10.6 5.9
ESR (mm/hr) 21 28 34 8 18 25 37 34
PT (sec) 11.0 10.7 12.7 12.1 12.6 12.0 12.6 PTT (sec) 30.7 29.3 34.5 31.7 34.5 37.9 32.3 CEA (ng/ml) 1.4 1.1 0.9 0.9 1.4
Hematuria ++ + ++ ++ + +++ ++
Tabl e3.Labor at or yExami nat i on
Ⅲ.Di s cus s i on
Af t e rge t t i ngdi agnos i sofCRC ofs t ageⅢ,t hi s pat i e nt had r e c e i ve d r out i ne c onve nt i onal t r e at me nt s ;o pe r at i o n,c he mot he r apyandr adi o t he r apy.
Ne ve r t he l e s s ,he rc anc e rhad s pr e adt ol i ve rj us t af t e rs i xmont hs ,t he n had me t as t as i z e d t obone and br ai n atf our t e e n mont hsofdi agnos i s .Thi s aggr avat i on pat t e r n i s not muc h di f f e r e ntwi t h ot he r s .Ge ne r al l y,20- 50% ofCRC wi t hs t ageⅡ or Ⅲ pr ogr e s s t o s t age Ⅳ and i t s f i ve -ye ar s ur vi valr at e i s known as ar ound 10%
1.The
pat i e nts t ar t e d t o us ehe r baldr ugsaf t e rge t t i ng s i dee f f e c t ss uc h asl os eofe ne r gy,anor e xi a and di s c omf or t i n di ge s t i ve s ys t e m c aus e d by r e - t r e at me nt swi t hc he mot he r apyandr adi ot he r apy agai ns t me t as t as i s on bone and br ai n s i nc e Nove mbe r2004.Eve n t hough s he gotr andoml y we s t e r n t r e at me nt s by Apr i l 2004, he r mai n me di c al c ar e s we r e Or i e nt al me di c i ne -bas e d t he r api e s .Se ve r alhe r baldr ugs we r e pr e s c r i be d;
CGX f ori mpr ovi ng l i ve rf unc t i on,TKHWT f or
r e duc i ng br ai n t umor -as s oc i at e d s ympt oms ,GJD
f or i nc r e as i ng vi t ale ne r gy,and Mye l ophi lf or
ame l i or at i ng bone mar r ow s uppr e s s i on-c aus e d bl ooddi s or de r s .
Abovedr ugspar t i al l y haves c i e nt i f i ce vi de nc e s s uppor t i ng t he i r e f f i c ac i e s he l pi ng c anc e r - r e l at e d s ympt oms or QOL of c anc e r pat i e nt s
5-8. I n par t i c ul ar ,CGX,modi f i e dhe r baldr ugbas e dona t r adi t i onalChi ne s ehe pat ot he r ape ut i cf or mul a,has t he r ape ut i cpr ope r t i e sf orc hr oni cl i ve rdi s e as e si n c l i ni c alt e s t sand ani malmode l s
9-11.Thi spat i e nt has mul t i pl e l ar ge l i ve r me t as t as i s ,but has n' t s hown de s t r uc t i on of he pat i c c e l l s r api dl y wor s e ni nghe rc l i ni c alc our s e .
The oc c ur r e nc e of unde s i r e d e f f e c t s f r om c onve nt i onal c he mot he r apy or r adi ot he r apy f or c anc e ri si ne vi t abl e .Mye l ophi lwasde ve l ope d t o r e duc e c anc e r t he r apy-as s oc i at e d adve r s e e f f e c t s and t oi mpr oveQOL ofc anc e rpat i e nt s .I n t hi s pat i e ntc as e ,c l as s i c almode ofmye l os uppr e s s i on (ane mi a, l e ukope ni a and t hr omboc yt ope ni a) appe ar e d,and be c ame s l owl y wor s e wi t h t i me f l ow.Thi s pat i e nt may be c aus e d f r om many t i me s r adi o/c he mot he r apy and mul t i pl e bone me t as t as i s t oge t he r . Howe ve r , i t i s s t r ongl y ant i c i pat e d t hatMye l ophi land ot he r smi ghtbe he l pf ult oame l i or at et hes e ve r i t yi nc ons i de r at i on ofl ongmai nt ai ni ngt hemode r at es t at e .
Thei mpor t anc eofke e pi ngQOL ande nhanc i ng i mmuni t y has be e n we l l unde r s t ood i n c anc e r t r e at me nt .Ac c or di ngl yOr i e nt alme di c i neorCAM hasbe e nac c e pt e dbye s pe c i al l yl at e - s t age dc anc e r pat i e nt s
12-13.I naddi t i on,duet ol ow e f f i c i e nc yand hi gh t oxi c i t y ofc onve nt i onalc anc e rt he r ape ut i c s , r e duc i ng adve r s e e f f e c t s i s a c r i t i c ali s s ue f or pat i e nt s and doc t or s ,gi ve n t he i mpor t anc e of qual i t y ofl i f e ,aswe l lass ur vi valgai n
14-16.We
al s ohavec ar e d t hepat i e ntwi t h moxi bus t i on at CV4 and KI 1,phamac opunc t ur e at CV4,and ac upunc t ur et os uppor the rvi t ale ne r gyaswe l las t ode c r e as ehe rdi s c omf or t s .Asac upunc t ur ei sone ofmaj ort he r ape ut i c si nOr i e nt alme di c i ne ,i thas be e n us e d t o c ont r ol t he par t i c ul ar l y var i ous pai n- r e l at e ddi s or de r si nc l udi ngne ur ophat hi cpai n i n c anc e r pat i e nt s
17-19. Many c ompl ai ns or c ompl i c at i ons f r om t he mul t i - r e gi onal t umor mas s e swe r emode r at e l y r e l i e ve d by ac upunc t ur e i nt hi spat i e nt .Webe l i e vet hatac upunc t ur ec an be an us e f ult ooli n c anc e r manage me nt .For e xampl e ,s uppr e s s i on ofgas t r oi nt e s t i nalmobi l i t y af t e rpai n- ki l l e rus eorr adi at i on- i nduc e dxe r os t omi a c oul dbes ome whati mpr ove dbyac upunc t ur e
20-22.
Thepat i e nthasbe e n al i veke e pi ng r e l at i ve l y we l lt ol e r at e d pe r f or manc eby Or i e nt alt he r api e s f orar ound f ourye ar saf t e rdi agnos i sofmul t i pl e me t as t as i s . I t i s pr opos e d t hat Or i e nt al t he r ape ut i c se nhanc e dt hei mmuni t yofbodyand he l pe d s us t ai ni ng QOL i n t hi s pat i e nt ,and we hopet hatt he r at i onal e c oul d bege ne r al i z e d t o ot he r c anc e r pat i e nt s .We want t hi s s t udy t o pr e s e ntt hepos s i bi l i t yofde ve l opme ntofOr i e nt al me di c i ne - de r i ve dant i c anc e rt r e at me nt svi ar e por t i ng ac as eoft e r mi nalr e c t alc anc e rpat i e nts uc c e s s f ul l y c ar e df orbyOr i e nt alme di c i ne .
Ac k n owl e dge me nt
Thi ss t udywass uppor t e dbyagr antf r om t he
Or i e nt al Me di c i ne R&D Pr oj e c t (B070031),
Mi ni s t r y of He al t h and We l f ar e , Re publ i c of
Kor e a.
ACl i ni calObser vat i onofOr i ent alMedi ci ne- BasedLongCar ef orTer mi nalRect al CancerPat i entwi t hMul t i pl eMet ast asi s
방선휘,손창규
대전대학교 둔산한방병원 동서암센터
ABSTRACT
암은 현대의 모든 선진국에서 가장 주요한 사망의 원인이다.통상적인 암 치료의 낮은 효율과 삶의 질의 중요성의 측면에 서,보완대체의학은 말기의 암 환자들에게 전 세계적으로 널리 수용되어지고 있다.한의학은 전통적으로 종양 자체뿐만 아니라 암을 지닌 몸 전체를 함께 강조해 왔으며,그로 인하여 종양면역을 개선시키고 환자의 삶의 질을 개선시키며 생존기간을 연장 하는데 일조한다고 여겨진다.저자는 여기에서 전신에 전이가 이루어진 말기의 직장암 환자가 한방치료를 4년 정도 받으면서 양호한 임상경과를 보여 온 환자를 보고하는 바이다.본 연구가 암성 질환에 있어 한의학의 임상적 효용성의 예를 통하여 한의 학 기반의 암 치료법의 개발과 발전에 일조하길 희망한다.
핵심단어 :
