針刺治療伊文氏肉瘤併多重器官轉移之頑固性疼痛和惡病質病例報告

Acupuncture Improve Refractory Pain and Cachexia of Ewing's Sarcoma Patients with Multiple Organs Metastasis: A Case Report

伊文氏肉瘤（Ewing's sarcoma）是好發於兒童和年輕人的中高度侵襲性和轉移性骨肉瘤，多因基因轉位並形成融合基因所引發，患者於發病時常有全身性症狀如發熱、盜汗、疲勞、無食慾及體重下降等。腫瘤是否有轉移影響其預後，治療多以化學療法為主，並視情況配合手術、放射線治療，然而這些療法多伴隨著嚴重的副作用，其中又以頑固性疼痛和惡病質最為難纏。本病例為30歲男性患者，六年前因反覆腰背痛而診斷出伊文氏肉瘤，雖經手術但腫瘤仍轉移至薦骨、肺、橫膈、腎上腺，住院期間因患者腹脹痛伴隨腰背牽引痛而無法有效控制，故會診中醫協助治療，四次針灸治療後疼痛大減，成功脫離嗎啡，改善腸胃症狀，增進食慾和進食，出院後追蹤發現疼痛控制穩定，不須服用止痛藥，體重亦隨之增加。因此我們認為針灸具有穩定、長效的止痛作用，並可改善患者的腸胃功能、食慾和營養攝取，進而提升癌症患者的生活品質。

Ewing's sarcoma is a highly invasive and metastatic osteosarcoma usually occurs in children and teenagers. It is mostly caused by gene trans-location and fusion. Patients with Ewing's sarcoma often have systemic symptoms such as fever, night sweats, fatigue, loss of appetite, and weight loss. The prognosis of Ewing's sarcoma is determined by whether the tumor has metastasized or not. The treatment plan of Ewing's sarcoma is mainly based on chemotherapy usually combined with surgery and radiation treatment as appropriate. However, these treatments are often accompanied by serious side effects, of which refractory pain and cachexia are the most difficult to deal with. This case is a 30-year-old male patient who was diagnosed with Ewing's sarcoma six years ago attributing to repeated low back pain. Although the surgery had completed, the tumor still metastasized to sacrum, lung, diaphragm, and adrenal glands. During the hospitalization, the patient was suffered from abdominal pain accompanied with uncontrollably low back referred dragging pain so he consulted Chinese medicine doctor for help. The pain was greatly reduced after four sessions of acupuncture treatments, hence morphine was successfully discontinued. In addition, the gastrointestinal symptoms, appetite and intake were also improved. After discharged on stable status, the patient reported the reduced dosage of painkillers and increased body weight during the follow-up in the outpatient clinic. Therefore, we believe that acupuncture may exert beneficial effect to the analgesia, gastrointestinal function, appetite and intake, thereby improving the quality of life.