頭頸部癌症放射線療法後副作用之中醫觀點與相關實證研究進展

Irradiation - induced mucositis in Patients with Head and Neck Cancer from the TCM Perspective and the Related Evidence-based Research Progress

頭頸部腫瘤是國人常見的癌症之一，其中鼻咽癌更是台灣特有的疾病。由於放射線療法為目前的標準治療之一，面對該療法產生之諸多副作用，特別是口腔毒性（orotoxicity），不僅危害生活品質，甚至降低腫瘤控制率與存活率。估計所有接受放射線照射口腔的患者，皆會產生程度不等的放射性口炎症狀，而此為中醫藥可以介入的病症。古代文獻對於放射性口炎約與「嗌痛」、「痞塞」、「口疳」、「口瘡」、「舌疔」等相類似。臨床表現上，包括感染、疼痛、口乾、吞嚥困難等，依據世界衛生組織的定義，分為五個等級。中醫認為頭頸部腫瘤與上焦熱毒熾盛、痰濕蘊結、氣血凝聚有關，而放射線療法則為外加之火邪熱毒。基礎醫學的研究發現，放射線在局部產生自由基、破壞表皮細胞，促使細胞凋亡並產生發炎因子訊號的傳遞與放大，破壞黏膜完整性，進一步造成感染、潰瘍，與疼痛。中醫的治療上需以養陰益氣扶正為主，活血化瘀、清熱解毒祛邪為輔，實證醫學證實有效的方法包括中藥複方口服與針灸。整體而言，中醫藥在治療放射性口炎有其一定的療效，我們希望可以設計更為嚴謹的隨機雙盲臨床對照實驗，探討中醫藥治療的臨床療效與機轉。

Head and neck tumor, especially nasopharyngeal cancer (NPC), is one of the most common cancers in Taiwan. As the standard treatment of NPC, radiotherapy (RT) may induce orotoxicity, which traditional Chinese medicine (TCM) could deal with, of variable levels in nearly all patients who receive this regimen. Common clinical manifestation of orotoxicity include: infection, soreness, dry mouth, and difficult swallowing, and was ranked into 5 grades by world health organization (WHO). According to the theory of TCM, head and neck tumors are related to repletion heat in the upper burner, phlegm-damp, and qi stagnation with blood stasis. RT is though defined as external fire and heat. According to basic medical studies, radiation would generate free radicals locally, damage epithelial cells, induce apoptosis and signal transduction of inflammation, compromise the integrity of mucus membrane, and therefore cause infection, ulceration, and pain. The regimen of TCM is primarily enriching yin and boosting qi, associated with quickening the blood and transforming stasis, clearing heat and resolving toxin. Evidence based medicine (EBM) has proved TCM formula and acupuncture to be effective. Overall, TCM has proved to be effective in treating radiation mucositis, and we truly hope that there will be more formal randomized, double blind, clinical controlled studies in the future to investigate the mechanism and effectiveness of TCM.