Multimodality treatment of pancreatic cancer with liver metastases using chemotherapy, radiation therapy, and/or Chinese herbal medicine.

OBJECTIVE: To explore the utility of multidisciplinary approaches in the treatment of patients with pancreatic cancer with liver metastases (PCLM). METHODS: From 2002 to 2007, a total of 164 consecutive patients with PCLM treated with chemotherapy, radiation therapy, and/or Chinese herbal medicine were included in this study. Clinical parameters, treatments received, and survival time from initial diagnosis were analyzed. RESULTS: Of the 164 patients, 113 (69%) were men and 51 (31%) were women, with median age of 58 years. One hundred thirty-two patients (80%) had synchronous liver metastases, and 57 patients (35%) had extrahepatic metastases. Overall median survival time of the 164 patients was 4.7 months; 23 (14%) were alive at least 12 months after initial diagnosis of liver metastases. Karnofsky performance status of less than 80, weight loss (>10% within 6 months), ascites, and carbohydrate antigen 19-9 of 1000 U/mL or greater were the most relevant predictors of poor survival. Multivariate analysis showed that chemotherapy and Chinese herbal medicine were protective factors. CONCLUSIONS: Multimodality treatment is well tolerated by patients with PCLM and may be effective in prolonging their survival. Awareness of the implications of these prognostic factors may assist in evaluating the survival potential of patients and selecting the most appropriate treatments.

Effects of Qingyi Huaji decoction on serum levels of interleukin-6, interleukin-8 and tumor necrosis factor-alpha in nude mice bearing pancreatic tumors.

OBJECTIVE: To investigate the effects of Qingyi Huaji (QYHJ) decoction, a compound traditional Chinese herbal medicine, on tumor inhibition rate and serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) in nude mice with transplanted tumors of human pancreatic cancer. METHODS: The tumor-bearing mice model was established by subcutaneously inoculating with xenografts of pancreatic cancer into the right armpit of 40 BALB/c nude mice. After successful modeling, the mice were randomly divided into untreated group (Arabic gum), capecitabine group, low-dose QYHJ decoction group (36 g/kg) and high-dose QYHJ decoction group (72 g/kg), with 10 mice in each group. Citrate buffer solution (containing 5% Arabic gum), capecitabine suspension and QYHJ decoction were administered to four groups by gavage respectively. After 5-week treatment, the concentrations of serum IL-6, IL-8 and TNF-alpha were examined by enzyme-linked immunosorbent assay (ELISA) using blood sample from eye socket. Then the mice were euthanized by cervical dislocation. Tumor weight and the tumor inhibition rate were calculated. RESULTS: Tumor weight in the low-dose QYHJ decoction group decreased significantly as compared with the untreated group (P<0.05). Serum levels of IL-6 and TNF-alpha in low- and high-dose QYHJ groups were extremely significantly lower than those in the untreated group (P<0.01). Serum level of IL-8 in the low-dose QYHJ group was significantly lower than that in the untreated group (P<0.05). Correlation analysis showed that transplanted tumor weight of the mice was linearly positively correlated with serum levels of IL-6, IL-8 or TNF-alpha (P<0.01). CONCLUSION: Conventional dose of QYHJ decoction is effective in suppressing pancreatic carcinoma in nude mice. The mechanism may be related to down-regulation of serum cytokines such as IL-6, IL-8 and TNF-alpha.

Comparison between chemoembolization combined with radiotherapy and chemoembolization alone for large hepatocellular carcinoma.

AIM: To investigate the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiotherapy for unresectable large hepatocellular carcinoma (HCC). METHODS: From June 1994 to June 1999, a total of 76 patients with large unresectable HCC were treated with TACE followed by external-beam irradiation. 89 patients with large HCC, who underwent TACE alone during the same period, served as the control group. Clinical features, therapeutic modalities, acute effects and survival rates were analyzed and compared between TACE plus irradiation group and TACE alone group. A multivariate analysis of nine clinical variables and one treatment variable (irradiation) was performed by the Cox proportional hazards model. RESULTS: The clinical features and therapeutic modalities except irradiation between the two groups were comparable (P>0.05). The objective response rate (RR) in TACE plus irradiation group was higher than that in TACE alone group (47.4 % vs 28.1 %, P<0.05). The overall survival rates in TACE plus irradiation group (64.0 %, 28.6 %, and 19.3 % at 1, 3, 5 years, respectively) were significantly higher than those in TACE alone group (39.9 %, 9.5 %, and 7.2 %, respectively, P=0.0001). Cox proportional hazards model analysis showed that tumor extension and Child grade were significant and were independent negative predictors of survival, while irradiation was an independent positive predictor of survival. CONCLUSION: TACE combined with radiotherapy is more effective than TACE alone, and is a promising treatment for unresectable large HCC.

The long-term efficacy of combined chemoembolization and local irradiation in the treatment of patients with large hepatocellular carcinoma.

BACKGROUND/AIMS: To investigate the effects and toxicity of combined transcatheter arterial chemoembolization and local radiotherapy for patients with unresectable hepatocellular carcinoma. METHODOLOGY: From June 1994 to June 1999, 28 patients with unresectable hepatocellular carcinoma (the largest dimension of tumor ranged from 3 to 10 cm) were treated with transcatheter arterial chemoembolization followed by local irradiation. Response was assessed by computed tomography scan and ultrasound, together with serum alpha-fetoprotein level in cases with increased baseline values. Complications associated with treatment were monitored. Cumulative survival was determined by Kaplan-Meier method from the first day of treatment. RESULTS: An objective response (reduction of tumor area greater than 50%) was achieved in 57.0% of the cases. In 63.0% of the cases with increased alpha-fetoprotein values, alpha-fetoprotein level underwent a marked reduction (more than 50%). The cumulative survival rates at 1, 3, and 5 years were 81.9%, 42.4%, and 21.2%, respectively (median survival, 31 months, 95% CI: 27.8-34.2 months). The combination therapy was generally well tolerated. CONCLUSIONS: The results suggest that combined transcatheter arterial chemoembolization with local radiotherapy is an effective and safe treatment for unresectable hepatocellular carcinoma. Further study is required to compare the therapeutic efficacy of this regimen to transcatheter arterial chemoembolization or radiotherapy alone.

Large primary liver cancer treated by chemoembolization combined with radiotherapy successfully.

For unresectable primary liver cancer, transcatheter arterial chemoembolization is the most effective method in reducing the size of tumor and become the most popular forms in Asia, but, it is not a curative approach and additional therapy is needed to kill the residual tumor cells. In this paper, we report a case in which a patient with a single very large liver cancer has been successfully treated by chemoembolization combined with radiotherapy. The results suggest that this is a very promising therapeutic approach for single large primary liver cancer.

[Restoring the harmony and order of the body: treatment of cancer patients according to syndrome differentiation].

By reviewing the clinical work of the past 40 years and combining with the theories of traditional Chinese medicine, the author proposed that the spleen plays a key role in treating liver cancer according to syndrome differentiation. Based on the clinical and experimental research work, the author advanced a theory that the goal of the treatment of cancer according to syndrome differentiation is to restore the harmony and order of the body. Further research into this theory will be conducive to establishing a new theoretical system of integrative medicine on cancer treatment.