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1、QYHJ Formula-based Integrated Herbs and Western medicine Therapy in Elderly Patients with Pancreatic Cancer,Luming Liu Department of Integrative Oncology Fudan University Cancer Hospital Shanghai China,Stage
2、distribution at diagnosis and 5-year relative survival rate among patients with pancreatic cancer US,1996-2003,5-year relative survival rate,Stage distribution at diagnosis,From Jemal, A. et al. CA Cancer J Clin 2008;5
3、8:71-96.,The 4th leading cause of cancer-related mortality in U.S.A.,Edwards BK et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden.
4、 Cancer, 2002,,,,41%pancreatic cancer occurs over 75 years old,71%pancreatic cancer occurs over 65 years old,Standardized Incidence of cancer in Shanghai City,Incidence of pancreatic cancer from1972-1999 increased 72.
5、2% in male and 56.2% in female,2% or so increase every year.,A rapidly increasing trend in the incidence for PC:the 8th and 9th for men and women in Shanghai,LIU Jusi,et al. Tumor 2004,24(1)11-15,,,ca,Characteristics
6、160;in Elderly Patients with Cancers,Ageing and sickly;Cancer progression relatively slow;Cancer metastasis probably less;Multiple primary carcinoma increasing; Poor tolerance to Chem & RT(because of its los
7、ing physiological function in elderly patients),A retrospective study on advanced pancreatic cancer treated by TCM Herbs --- An analysis of 56 casesLiu LM, Wu LC, Lin SY,et al. Therapeutic Evaluation on Advanced
8、 Pancreatic Cancer Treated by Integrative Chinese and Western Medicine - Clinical Analysis of 56 Cases.,Chin J Integrative Med, 2003, 9(1): 39-43.,56 cases with advanced pancreatic cancer treated by chemotherapy alone or
9、 chemotherapy combined with TCM decoctionThe TCM+CHEMO group had a better survival over the CHEMO group (P=0.04)There was a superiority of chemotherapy combined with TCM to chemotherapy in objective response (p=0.049)
10、and in improvement of symptoms (P=0.002),,Case 1 67y, F. Symptoms before operation: Jaundice, upper abdominal pain;Tumor size: 8?9cmOperation time: Oct.8,1997 ,Tumor unresected,1999,FENG Erbao Nov 2004 7-
11、year birthday,Follow up in xinhua(新華 ) Hospital Hangzhou in March 18,2006,1,1,1,232 cases from May 1, 2002-Dec. 31, 2005 were reviewed, and 134 cases with advanced pancreatic cancer had pathological diagnosis we
12、re included in this analysis (94 no prior treatment, 40 had treatment).We excluded 98 cases (no pathology 64, not-proven by pathology 16, neuroendocrine carcinoma 2,no mass after pancreatic operation 7;clinical data in
13、complete 4;herbs treatment < 1month 5, stage II 10 例、 stage III 15、 stage IV 109 with remote M).,A Retrospective Study on Advanced Pancreatic Cancer Treated with Integrated Western Medicine and Traditional Chinese h
14、erbs: Analysis of 134 Cases 2002-2005Shen Ye-hua, Liu Lu-ming, Meng Zhi-qiang, Chen Zhen, Lin Jun-hua, Zhou Zhen-hua, Chen Hao, Wang Kun, Fu Jie, Yu Er-xinDepartment of Integrated Oncology,F(xiàn)udanUniversity Cancer Hospi
15、tal,,Survival,,Median Survival 5.7monsHalf yr survival 47.0%1-yr survival 17.5%2-yr survival 8.7%3-yr survival 7.2%,QYHJ Herbs P<0.001,,mons,QYHJ Herbs,Others Herbs,,2006,2
16、004,2005,2007,2008,Case 2,Before Treatment 2002-7-25,After Treatment2003-6-6,Case 3 Xing xx; 18/07/2002 Admission,2010.1.1. Follow-up,Case 3,2011,Case 4 Wu Jianping xx,F,44yrs, Jiangsu nativeDiagnosed data: May
17、 2003CT:PC Mass 10cm,two lober liver multimasses ,biggest one is 9cm;,Case 4,Liver biopsy:metastasis poor differentiated adenocarcinoma;,Treatment : May 28,2003: Gemcitabine (1.4g/m2), Oxalipatin (150mg/m2) , THP60mg +
18、 Lipiodol 13ml in 1st cycle TAI for liver metastasis;June 25,2003~July 23,2003 3DCRT 6MV X-ray 3160 cGy/20Fx for PC; Aug 11,2003: Gemcitabine 1.4g, Oxalipatin 200mg,THP 60mg + LP 10ml in 2nd cycle TAI; Herbs treatmen
19、t,July 31,2003-7-31 After treatment —— intrahepatic metastasis masses regression,and mass not clear,May 22,2003 Before Treatment,,,,,,,,,,,May 2003 PC MassBefore treatment,,,,,,,Oct. 2003 PC mass not clear,,,,,,July
20、 2003 after treatment PC mass regression,Case 5 Yang xxlong survival with cancer,before(13/10/2004),after(17/04/2008),,,,,,,F,43y, Shanghai nativeDiagnosed data: 31/08/2004Diagnosis:Pancreatic Ca with LM(09/2004),
21、both lung M(09/2004), post-peritoneum LNm(09/2004), multi-bone (11/2006);Cytology: denocarcinomaFollow-up:31/12/2009Survives 86 mons,Case 5,Multimodality Treatment of Pancreatic Cancer With LiverMetastases Using Chemo
22、therapy, Radiation Therapy,and/or Chinese Herbal Medicine --- Analysis of 164 Cases,Huaqiang Ouyang, Peng Wang, MD,Zhiqiang Meng, MD,Zhen Chen, Er’xin Yu, Huan Jin, David Z. Chang, Zhongxing Liao, Lorenzo Cohen, PhD, an
23、d Luming Liu,Pancreas, 2011;40(1) : 120~126, IF:2.607,RESULTS,,From 2002 to 2007, 164 cases of pancreatic cancer patients with liver metastasis diagnosed by pathologyQYHJ Formula is independent prognostic factors,Qing
24、yihuaji Formula(QYHJ),Liu et al. Chin J Integr Med. 2005Shen et al. Tradit Chin Med. 2006 Shen et al. CJBMTCM. 2006Shen et al. China Oncology. 2006,Clinical & experimental study showed that:QYHJ is of the effects
25、 on anti-pancreatic cancer.,A prospective randomized controlled Phase II clinical trialIntegrative therapy of QYHJ+Gemcitabine- based chemotherapy or with 3DCRT for advanced pancreatic cancer Shen Yehua, Liu Luming
26、, Chen Zhen, Meng Zhiqiang, Lin Junhua, Zhou Zhenhua, Cheng Wenwu, Yu Erxin, Jiang Guoliang.Integrative Medicine Program of Liver,Gallbladder and Pancreatic Cancer, Fudan University Cancer Hospital,Journal of Tradition
27、al Chinese Medicine 2010,51(12) :1093-1097,Study Design,Primary Objective :Response, Median Survival, Overall SurvivalSecondary objective:Clinical Benefits, Adverse Effects,R,,,GEM d1 + 3DCRT d15 + QYHJ herbs for 4
28、 mons,,,GEM d1 + 3DCRT d15 + Placebo for 4 mons,TAI: Gem 1.0g/m2, Oxaplatin 135mg/m2 or Cisplatin 40mg/m23DCRT:6MV Xray,36~40Gy / 1.8~2Gy,Advanced PC,Research subjects (participants),83 cases were enrolled into this st
29、udy during March, 2004~2009;1 pathologic diagnosis changed;2 no treatment:1 (QYHJ) obstructive jaundice;1(Control) bowel obstruction;80 received treatment and included in the study: QYHJ 41 cases,control 39.,Compa
30、rison of Control and QYHJ Group,Comparison of Control and QYHJ Group,Response,,Of 80, 72 is valuable assesment.5 cases are PR in QYHJ group,no CR or PR in control.,Survival,,Lastest follow-up: no lost on Dec. 1, 2009;
31、 3 cases (all in QYHJ) still survive .,P=0.046,GroupControlQYHJ,Adverse Effects,P >0.05,GI bleeding,Vomit,Norsea,3-4. Thrompenia,3-4. Leucopenia,ALP,AKP,,,Control,Prognostic analysis of 190 elderly patients wit
32、h Pancreatic cancer treated by integrated Herbs and Western medicinePan Y, Liu LM, Chen Z, Meng ZQ, Lin JH, Chen H, Wang K, Shen YH, Zhu XYChinese J. Clin Hepatol. 2014, (30)4: 330~333,190 elderly pancreatic cancer
33、 patients treated by integrated Herbs and Western medicine during Jan. ,2002~Dec., 2008 . Proved by histopathology 63; cytology 127; Female:126,male:64,average age: 67.93±5.54(60~83ys); UICC stage Ⅲ: 52(27.4%
34、), stage Ⅳ 138 (72.6%)。 distant metastasis 132 ( 69.5%),survival time of QYHJ formula to TNM-III Pancreatic cancer in elderly patientswith non-surgery,,survival time of QYHJ formula to TNM-IV Pancreatic cancer in
35、elderly patients with non-surgery,Conclusion,For elderly patients with advance pancreatic cancer, it is best to choose QYHJ-based formula without others.,F,41y,Anhui 和縣 native;Diagnosis data: 01/04/2005;Diagnosis: Pan
36、c Ca(CT:02/2005) with liver metastasis(liver boispy:04/2005);Cytology: Adenocarcinoma,6,Case 6,Treatment 21/02/2005 CT:Cancer in pancreatic tail with liver M;11/03/2005 CT:Cancer in pancreatic tail with liver multi-
37、M;04/04/2005 Liver boipsy:Adenocarcinoma;05/04/2005 1th liver TACE;28/04/2005 PC ERT+QYHJ;03/08/2005 MRI: No mass in pancreas; liver multi-M;10/08/2005 2th liver TACE;14/11/2006 3th TACE;07/07/2007 CT: PR i
38、n liver multi-M.31/12/2009 Survives 59 mons.,MRI——MR after treatment,Before,After Treatment,Case 7 Chen xx,M,62y,Helongjiang大慶 native.Diagnosis data:21/03/2003Diagnosis:Pancreatic cancer resected(09/1999), Pat
39、hology: Adenocarcinoma with liver MLiver biopsy(12/2002):metastatic poor differentiated AdenocarcinomaStomach Ca resected(09/1999), Pathology: Adenocarcinoma,Treatment,09/1999: Pancreatic cancer resected & Stomach
40、Ca resected;12/2002: liver M;12/2002: Liver biopsy:metastatic poor differentiated Adenocarcinoma;03/2003: TACE;04/2003: Oxplatin+5-Fu+CF;04/2003; TACE;05/2003: Liver ERT;12/31/2009: Survives 6-year more.,200
41、3.4.15,Case 8 Lin,M,53y,Zhejiang 瑞安 RuiAn nativeDiagnosis data: 21/03/2005Diagnosis : Panc Ca(CT:03/2005) with liver metastasis(liver boispy:05/2005);Cytology: Liver biopsy (28/03/2005) poor differentiated carcinoma,
42、long survival with cancer,(March, 2005~ now). Dec. 30, 2009: Survives 58 mons,Treatment 31/03/2005 1th liver TACE19/07/2005 3th liver TACE;28/07/2005 HIFU for pancreatic mass; 12/06/2008 11th liver TACE;,8,Case 10
43、 Zhang xx,F,51y,Shanghai Native1st Diagnosis:08/10/2004CT:mass in pancreatic head with liver metastasis Liver biopsy:AdenocarcinomaFollow up: 16/01/2010. Survival time:63 mons.,Jan.,2010,08/10/2004~16/01/2010,10,F
44、ewer side-effects and toxicity than western medicine;Tolerated well for extended periods of time;Inexpensive.It is a suitable therapy for Elderly Pancreatic Cancer patients.,SummaryAdvantages of QYHJ-based integrati
45、ve treatment in Elderly patients with Pancreatic Cancer,Acknowledgement,Dr. Luming LiuDr. Zhiqiang MengDr. Zhen ChenDr. Hao ChenDr. Yehua Shen Dr. Peng WangDr. Junhua Lin,R21 (CA108084, NIH/NCI-2003)U19 (CA1215
46、3031, NIH/NCI-2005)R01 (CA14870701, NIH/NCI-2011)The Ministry of Technology and Science, China(2005)Shanghai Nature Science Foundation (2006, 2008)National Science Funds of China( 2010,2011,2013),Dr. Lorenzo CohenDr
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