DOI 10.3966/181020932017121504006 Case Report The Role of Herbal Medication in Poor TACE Response Hepatocellular Carcinoma: Case Report Chao-Hua Fang 1, Chin-Chuan Tsai 1,2, Chien-Lin Chen 3, Jiann-Hwa Chen 4, Cheng-Yi Chan 5,* ABSTRACT On principle, the treatment for hepatocellular carcinoma (HCC) generally involves surgeries. However, if patients are unfit or unwilling to undergo surgeries, medical personnel assess whether radiofrequency ablation is a viable option. If both of the aforementioned curative therapies are unsuitable, transarterial chemoembolization (TACE) may be considered. We report a patient who had undergone TACE and whose computed tomography (CT) scan during the 1-month follow-up showed unfavorable results, resulting in the patient deciding to withdraw from the treatment. After a discussion with the patient, 3 months of traditional Chinese medicine-based treatment were recommended. A follow-up CT scan indicated that the size of the tumor was reduced considerably, and that the application of TACE following the traditional Chinese medicine-based treatment yielded remarkable results. Thus, a combination of the two methods may be an option for patients whose liver cancer condition fails to improve after TACE. Keywords: Chinese medicine-based treatment, Hepatocellular carcinoma (HCC), Transarterial chemoembolization (TACE) 1 The School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan 2 Department of Chinese Medicine, E-Da Hospital, Kaohsiung, Taiwan 3 Department of Chinese Medicine, Taipei Tzu Chi Hospital, New Taipei, Taiwan 4 Department of Gastroenterology, Taipei Tzu Chi Hospital, New Taipei, Taiwan 5 Department of Medical Imaging, Taipei Tzu Chi Hospital, New Taipei, Taiwan * Corresponding author: Dr. Cheng-Yi Chan Department of Medical Imaging, Taipei Tzu Chi Hospital, the Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan No. 289, Jian-Guo Road, Xindian, New Taipei 231, Taiwan E-mail: ccy983998@gmail.com 輔仁醫學期刊第 15 卷第 4 期 2017 215
Chao-Hua Fang Chin-Chuan Tsai Chien-Lin Chen Jiann-Hwa Chen Cheng-Yi Chan INTRODUCTION Cancer has remained the top cause of death in Taiwan for 34 consecutive years. Of the top 10 cancers, hepatocellular carcinoma (HCC) currently ranks third and second in incidence and mortality rates, respectively. The main cause of HCC is the hepatitis virus, particularly hepatitis B and C, and surgery and radiofrequency ablation (RFA) are the most popular methods of treatment [1, 2], followed by transarterial chemoembolization (TACE), radiotherapy, and chemotherapy [3-5]. Alternative treatments include hepatic arterial infusion chemotherapy (HAIC) and yttrium-90 (Y-90) embolization therapy [6, 7]. In mainland China, traditional Chinese medicine is regularly employed to treat HCC, but seldom used in Taiwan [8-10]. This study surveyed a patient who had undergone TACE and whose treatment displayed unfavorable results, resulting in the patient deciding to withdraw from the treatment. The patient subsequently received traditional Chinese medicine-based treatment. A follow-up computed tomography (CT) scan revealed a considerable reduction in the size of the tumor, and that the application of TACE following the traditional Chinese medicine-based treatment had yielded favorable results. CASE REPORT The patient was male and 61 years of age. He had hepatitis B for 23 years but did not follow up regularly on his medical condition. He visited the hospital for treatment because of an abdominal pain he was experiencing; abdominal ultrasound and CT scan revealed multiple tumors on both sides of his liver (Figure 1). A surgical biopsy were subsequently performed, confirming that the patient had HCC. Because the patient was unfit for surgery and radiofrequency ablation, TACE was used. A CT scan during the 1-month follow-up showed unfa- Figure 1. Arterial phase of dynamic liver CT shows a HCC (3.6cm) in S5 of liver Figure 2. Post-TACE one month latter follow-up study shows only minimal lipiodol retention in the tumor and no definite interval change of tumor size 216 Fu-Jen Journal of Medicine Vol.15 No.4 2017
The role of herbal medication in hepatocellular carcinoma vorable results (Figure 2), resulting in the patient deciding to withdraw from the treatment. After careful discussion with the patient, this study recommended that the patient undergo 3 months of traditional Chinese medicine-based treatment, to which he agreed. The treatment included scutellaria baicalensis, tanshinone IIA, tetrandrine, andrographolide, and cornus officinalis. A follow-up CT scan indicated a considerable reduction in the size of the tumor (to 1.0 cm) (Figure 3), and that the application of TACE following the traditional Chinese medicine-based treatment yielded remarkable results (Figure 4). DISCUSSION Cancer has remained the number one cause of death in Taiwan for 34 consecutive years. Of the top 10 cancers, hepatocellular carcinoma currently ranks third in incidence rate (after colorectal cancer and lung cancer) and second in mortality rate (after lung cancer). The main cause of liver cancer is hepatitis virus, particularly Hepatitis B and C. Hepatocellular carcinoma treatment generally involves performing surgeries, which include tumor resection or liver transplantation [1]. However, for patients who are unfit or unwilling to undergo surgeries, assessments will be made to determine whether radiofrequency ablation serves as a viable option [2]. Nevertheless, radiofrequency ablation is unsuitable for treating tumors that are excessively small, large, or in large numbers. When this occurs, transarterial chemoembolization (TACE) may be considered [3]. Patients with malignant portal vein thrombosis may consider receiving radiotherapy [4], whereas those with extrahepatic metastasis may consider undergoing chemotherapy [5]. Other alternative treatments include hepatic arterial infusion chemotherapy and yttrium-90 embolization therapy [6, 7]. The use of traditional Chinese medicine to Figure 3. Post-herbal treatment three months latter follow-up study shows marked regression of the tumor Figure 4. Post-2 nd TACE (after herbal treatment) one month latter follow-up study shows marked lipiodol retention in the tumor 輔仁醫學期刊第 15 卷第 4 期 2017 217
Chao-Hua Fang Chin-Chuan Tsai Chien-Lin Chen Jiann-Hwa Chen Cheng-Yi Chan treat cancer is a common practice in mainland China [8-10]. However, such a method of treatment is considered unorthodox in Taiwan. Ironically, Taiwanese people tend to use folk prescriptions, to an extent that surpasses their use of orthodox treatment. The patient surveyed in this study was a perfect example of this assertion: he initially decided to withdraw from the treatment when he discovered that TACE failed to improve his medical condition. However, after discussing with us, he decided to accept the traditional Chinese medicinebased treatment. The treatment changed the tumor properties, allowing the second TACE to produce outstanding results. Although the use of traditional Chinese medicine-based treatment substantially improved this patient s liver cancer, the mechanism by which the treatment cures hepatocellular carcinoma remains unknown, as does whether this treatment will produce the same results for all patients. The result of this single case study cannot serve as a generalized conclusion. In addition, the mechanism by which the traditional Chinese medicine-based treatment elevates the effectiveness of TACE must be investigated in further case studies. Overall, the use of traditional Chinese medicine to treat HCC is an uncommon practice in Taiwan and the benefits of said medicine remain unclear. Additional case studies may be used to determine the possibility of utilizing it to treat HCC. REFERENCES [1]. elghiti J, Kianmanesh R. Surgical treatment of hepatocellular carcinoma. HPB 2005; 7: 42-49. [2]. au WY, Lai EC. The current role of radiofrequency ablation in management of hepatocellular carcinoma: a systematic review. Ann Surg 2009; 249: 20-25. [3]. encioni R, Petruzzi P, Crocetti L. Chemoembolization of hepatocellular carcinoma. Semin Intervent Radiol 2013; 30: 3-11. [4]. alogeridi MA, Zygogianni A, Kyrgias G, et al. Role of radiotherapy in the management of hepatocellular carcinoma: a systematic review. World J Hepatol 2015; 7: 101-112. [5]. ao H, Phan H, Yang LX. Improved chemotherapy for hepatocellular carcinoma. Anticancer Res 2012; 32: 1379-1386. [6]. suqa K, Murakami T, Nakata S, et al. Hepatic arterial infusion chemotherapy (HAIC) hepatocellular carcinoma. Gan To Kagaku Ryoho 2004; 31: 2114-2117. [7]. l-kalbani A, Kamel Y. Y-90 microspheres in treatment of unresectable hepatocellular carcinoma. Saudi J Gastroenterol 2008; 14: 90-2. [8]. asool M, Rashid S, Arooj M, et al. New possibilities in hepatocellular carcinoma treatment. Anticancer Res 2014; 34: 1563-1572. [9]. ing CT, Li WC, Chen CY, et al. Preventive and therapeutic role of traditional Chinese herbal medicine in hepatocellular carcinoma. J Chin Med Assoc 2015; 78: 139-144. [10]. ang X, Wang N, Cheung F, et al. Chinese medicine for prevention and treatment of human hepatocellular carcinoma: current progress on pharmacological actions and mechanisms. J Integr Med 2015; 13: 142-164. 218 Fu-Jen Journal of Medicine Vol.15 No.4 2017
The role of herbal medication in hepatocellular carcinoma 中藥在肝動脈栓塞治療效果不佳患者治療上的角色 : 病例報告 方昭華 1, 蔡金川 1,2, 陳建霖 3, 陳建華 4, 詹正義 5,* 中文摘要 肝癌治療的原則, 若適合開刀的患者仍是以開刀治療為主, 若不適合開刀或不願意開刀的患者, 則評估是否適合施行射頻燒灼術 若以上兩種痊癒性治療皆不適合, 則考慮經動脈腫瘤栓塞治療 我們報告一個接受一次經動脈腫瘤栓塞治療的患者, 一個月後追蹤電腦斷層發現效果不佳 病患想完全放棄治療, 但與患者討論後建議先以中藥治療三個月, 追蹤電腦斷層發現腫瘤明顯縮小, 且再施行動脈腫瘤栓塞治療的效果奇佳 因此合併中藥治療對於一些經動脈腫瘤栓塞治療效果不佳的患者可能是可考慮的方法之一 關鍵字 : 中藥治療 肝癌 經動脈栓塞 義守大學學士後中醫學系義大醫院中醫部佛教慈濟醫療財團法人台北慈濟醫院中醫部佛教慈濟醫療財團法人台北慈濟醫院胃腸肝膽科佛教慈濟醫療財團法人台北慈濟醫院影像醫學部收稿日期 :2017 年 7 月 19 日 1 2 3 4 5 接受日期 :2017 年 10 月 17 日 * 通訊作者 : 詹正義電子信箱 :ccy983998@gmail.com 輔仁醫學期刊第 15 卷第 4 期 2017 219
Chao-Hua Fang Chin-Chuan Tsai Chien-Lin Chen Jiann-Hwa Chen Cheng-Yi Chan 220 Fu-Jen Journal of Medicine Vol.15 No.4 2017