Liu Shao-Yong, Hu Liu-Ling, Wang Shi-Jun, Liao Zhong-Li
Traditional Chinese Medicine Cancer Treatment Center, Chongqing University Cancer Hospital, Chongqing 400030, China.
The Center for Gastroenterology, Diagnosis and Minimally Invasive Treatment of Early Gastrointestinal Cancer, Chongqing University Cancer Hospital, Chongqing 400030, China.
World J Clin Cases. 2023 Feb 16;11(5):1129-1136. doi: 10.12998/wjcc.v11.i5.1129.
Hemorrhagic chronic radiation proctitis (CRP) is a common late complication of irradiation of the pelvis and seriously impairs life quality. There is no standard treatment for hemorrhagic CRP. Medical treatment, interventional treatment, and surgery are available, but they are limited in their applications due to nondefinite efficacy or side effects. Chinese herbal medicine (CHM), as a complementary or alternative therapy, may provide another option for hemorrhagic CRP treatment.
A 51-year-old woman with cervical cancer received intensity-modulated radiation therapy and brachytherapy with a total dose of 93 Gy fifteen days after hysterectomy and bilateral adnexectomy. She received six additional cycles of chemotherapy with carboplatin and paclitaxel. Nine months after radiotherapy treatment, she mainly complained of 5-6 times diarrhea daily and bloody purulent stools for over 10 d. After colonoscopy examinations, she was diagnosed with hemorrhagic CRP with a giant ulcer. After assessment, she received CHM treatment. The specific regimen was 150 mL of modified Gegen Qinlian decoction (GQD) used as a retention enema for 1 mo, followed by replacement with oral administration of 150 mL of modified GQD three times per day for 5 mo. After the whole treatment, her diarrhea reduced to 1-2 times a day. Her rectal tenesmus and mild pain in lower abdomen disappeared. Both colonoscopy and magnetic resonance imaging confirmed its significant improvement. During treatment, there were no side effects, such as liver and renal function damage.
Modified GQD may be another effective and safe option for hemorrhagic CRP patients with giant ulcers.
出血性慢性放射性直肠炎（CRP）是盆腔放疗常见的晚期并发症，严重影响生活质量。目前尚无针对出血性CRP的标准治疗方法。虽有药物治疗、介入治疗和手术治疗，但因疗效不确切或存在副作用，其应用受限。中药作为一种补充或替代疗法，可能为出血性CRP的治疗提供另一种选择。
一名51岁宫颈癌女性患者，在子宫切除及双侧附件切除术后15天接受调强放疗和近距离放疗，总剂量93 Gy。她又接受了6个周期的卡铂和紫杉醇化疗。放疗9个月后，她主要诉每日腹泻5 - 6次，脓血便持续10余天。经结肠镜检查，诊断为伴有巨大溃疡的出血性CRP。评估后，她接受了中药治疗。具体方案为150 mL加味葛根芩连汤（GQD）保留灌肠1个月，之后改为口服150 mL加味GQD，每日3次，持续5个月。整个治疗后，她的腹泻次数减至每日1 - 2次。直肠坠胀感及下腹部轻度疼痛消失。结肠镜和磁共振成像均证实病情有显著改善。治疗期间，未出现肝肾功能损害等副作用。
加味GQD可能是治疗伴有巨大溃疡的出血性CRP患者的另一种安全有效的选择。
