腫瘤患者放射性皮膚炎中藥治療療效評估

Study the Efficacy of the Topical Chinese Medicine, Angelica Aloe Vera Gel, on the Treatment of Radiation Dermatitis

放射線治療為治療頭頸部腫瘤與鼻咽癌的主要方法，急性放射性皮膚炎仍是放射治療中的重要議題，目前對於放射性皮膚炎的治療和預防並無統一的準則，外用類固醇已被證實對放射性皮膚炎有效，但有許多的副作用被報導。本研究以長庚醫院放射腫科門診，頭頸部腫瘤接受放射線治療的患者為收案對象，總計共中藥組31 人及西藥組32 人，放射治療期間中藥組使用「白芷蘆薈凝膠」，每日放射線治療後及睡前塗抹中藥白芷蘆薈凝膠，每日兩次，西藥組使用類固醇藥膏，早晚各一次塗抹患處。研究結果發現，以美國國家癌症研究所公布之常見不良事件評價標準來評估皮膚損傷程度，中藥組（N=31）皮膚情況較西藥組（N=32）好，且有統計上顯著差異（P=0.012）。生活品質問卷結果顯示，病人治療中對痛、癢、緊繃、舒適度、脫皮程度主觀症狀的改善程度評分中，兩組並無顯著差異，但是如果比較放射治療54 格雷以後的變化，中藥組脫皮程度較緩。研究結論，中藥外用複方「白芷蘆薈凝膠」治療放射線皮膚炎的效果不亞於傳統類固醇。Radiotherapy is the main method for the treatment of head and neck cancer; however, patients suffer from substantial side effects of radiation dermatitis that may affect the course of treatment. There is no consistent medical treatment program for the management of radiation dermatitis. Nonetheless, topical steroids have proved effective in the treatment of radiation dermatitis; however, several side effects from steroid use have been reported. This study proposes using the Chinese herbal medicine “Angelica aloe vera gel” as a possible alternative treatment for radiation dermatitis. In this study, 70 patients were enrolled and randomly divided into 2 groups of 35 patients each. The 35 patients in the first group used Western medicine as the treatment for radiation dermatitis, whereas the patients in the second group used Chinese herbal medicine as the treatment. Seven patients dropped out of the study because of personal reasons 3 from the group using Western medicine and 4 from the group using Chinese medicine. During the study, patients were evaluated using the Criteria for Adverse Events Version 4.0 (CTCAE v4) of the National Cancer Institute Common Terminology, and skin symptom including pain, itching, tightness, comfort, peeling, and quality of life were evaluated. The study findings showed that CTCAE results from the group of patients using Chinese medicine compared to the group of patients using Western medicine were significant (P = 0.012). Further comparison of the skin symptoms using 54 Grays to 68 Grays of radiotherapy showed a lower rate of desquamation in the group of patients using Chinese medicine with a significant difference compared to the group of patients using Western medicine. In conclusion, using Chinese medicine is not inferior to using topical steroids in the treatment of radiation dermatitis.