晚期大腸直腸癌化療副作用之中醫治療回顧性文獻探討及臨床觀察

Traditional Chinese Medicine Treatments on Side Effects of Chemotherapy for Advanced Colorectal Cancer: Literature Review and Clinical Observation

大腸直腸癌多年來一直高居台灣癌症死亡率前三名，近年來治療大腸直腸癌有許多進展，合併使用5-fluororuracil（5-FU）及oxaliplatin或irinotecan使得存活率增加，但化學治療的副作用仍是無法避免，而且因為劑量的累積和治療時間的拉長，副作用影響層面只會越來越廣，若我們可以先期掌握目前大腸直腸癌主流的化療方式與其副作用之特性，從中醫藥的角度解釋副作用產生的原因，結合臨床研究的文獻與我們的臨床的觀察分析，進一步討論化療藥物的寒熱偏性，以先期掌握每位大腸癌患者的化療常見副作用並能夠更準確地介入對應治療。針對回顧性文獻主要從四點論述：第一點討論晚期大腸直腸癌之化學治療發展。第二點比較FOLFOX（FOLinic acid, 5-FU, OXaliplatin）和FOLFIRI（FOLinic acid, 5-FU, IRInotecan）兩種化療模式異同。第三點和第四點我們分別探討oxaliplatin的神經毒性和irinotecan的腹瀉副作用，與其中醫治療的概念及臨床研究。最後討論本院臨床觀察到的大腸癌患者化療副作用特性，並嘗試歸納其寒熱證型，分析化療藥物屬性，進一步利用寒者熱之，熱者寒之概念給予治療，期望藉此模式未來可以提升中醫改善各種化療副作用的準確性，強化中西醫結合的價值。 Colorectal cancer is the third leading cause of Taiwan malignancy death for many years. In recent years, there is a lot of progress in the treatment of colorectal cancer. Combination therapy of 5-fluororuracil (5-FU) and oxaliplatin or irinotecan increased survival rate of colorectal cancer patient. However, the side effects of chemotherapy are still unavoidable, and because of the cumulative dose of chemotherapeutic agents and the duration of treatment, the side effects will become more and more extensive. If we can understand the current mainstream chemotherapy of colorectal cancer as well as the characteristics of side effects, explain the causes of side effects by the perspective of Traditional Chinese Medicine (TCM), review the clinical research literature, combine our clinical observations to differentiation of cold and heat syndrome, and presume the cold and heat properties of chemotherapeutic agents in order to predict the side effects of chemotherapy in each patient, and intervene the TCM treatment more accurately after chemotherapy. The discussion of this retrospective literature can be divided into four parts. First, we discuss the development of chemotherapy for advanced colorectal cancer. Second, we compare the similarities and differences between FOLFOX (FOLinic acid, 5-FU, OXaliplatin) and FOLFIRI (FOLinic acid, 5-FU, IRInotecan). Third and fourth, we respectively discuss the neurotoxicity of oxaliplatin, the diarrhea side effects of irinotecan, and related clinical study of TCM. Finally, we discuss the side effects of chemotherapy in patients with colorectal cancer by our clinical observation, summarize the cold and heat syndrome of the side effects from chemotherapy, analyze the characteristics of chemotherapeutic agents, and then use the concept of TCM that the 'cold' syndrome should be treated with medications of 'warm or hot' nature, and vice versa to relieve the side effects of chemotherapy. We hope that this model can improve the accuracy of TCM treatment for relieving various side effects of chemotherapy and strengthen the value of integration of traditional and western medicine.