Introduction
Clinical manifestations of the cancer are complex and changeable because the primary site of nasopharyngeal cancer is the nasopharyngeal cavity. The cancer invades the skull base upward, involving the left and right sides of the pharynx, metastasizing to the neck downward and metastasizing to the bone, liver, lungs, and other distant organs. The common clinical symptoms are nasal congestion, blood in nasal discharge, sensation of ear fullness and blocking, hearing loss, diplopia and headache, and so on. The World Health Organization (WHO) has divided it into three types: type I is keratinized squamous cell carcinoma, type II nonkeratinized squamous cell carcinoma, and type III poorly differentiated carcinoma or undifferentiated carcinoma. Cervical lymph node metastasis is the most common in nasopharyngeal carcinoma. The occurrence sites of distant metastasis are bone, liver, and lung.
Treatments
1.Surgery
The anatomical structure of the location of primary nasopharyngeal carcinoma is complex, being closely linked with important nerves, blood vessels, and other tissues and organs around the base of the skull. Also, nasopharyngeal carcinoma has a strong aggressive nature and easily involves the surrounding tissue structure, as well as having a higher lymph node metastasis rate, and the site lacks a cutting edge necessary for surgery. As a result, surgery is difficult for complete eradication. Surgery is mainly used for patients with local lesions that are residual or recurrent, cervical lymph nodes that are residual or recurrent, and so on after radiotherapy.
2.Radiotherapy
Because the vast majority of nasopharyngeal carcinomas are poorly differentiated squamous cell carcinomas that are relatively sensitive to radiotherapy, radiotherapy is the preferred treatment for nasopharyngeal carcinomas. Radiotherapy should be preferred for the primary treatment of nasopharyngeal carcinoma. In general, radiotherapy can cure nasopharyngeal carcinoma, and the 5-year survival rate can reach 50%–70%. Even for recurrent nasopharyngeal carcinoma, a 10%–20% 5-year survival rate can be achieved after a reasonable reprocess treatment. Radiotherapy alone is conducted for early-stage nasopharyngeal carcinoma, including external exposure or external exposure plus intracavitary afterloading therapy.
Comprehensive chemoradiotherapy can be selected for medium-advanced cases, including concurrent chemoradiotherapy, induction chemotherapy, or adjuvant chemotherapy. For cases with distant metastasis, adopt mainly chemotherapy, supplemented by radiotherapy. For nasopharyngeal carcinoma patients with recurrence, radiation or an integrative treatment program should be developed, depending on the time and site of recurrence after radiotherapy.
3.Chemotherapy
The majority of nasopharyngeal carcinomas are poorly differentiated squamous cell carcinomas, prone to distant metastases, and are medium sensitive to chemotherapy. Chemotherapy, as an adjuvant therapy for medium-advanced cases, may improve the local control rate and reduce the incidence of distant metastasis. For widely distant metastasis that has occurred in advanced nasopharyngeal carcinoma, chemotherapy can achieve good palliative effect and can be combined with radiotherapy for comprehensive use or concurrent chemoradiotherapy. Commonly used combination methods are induction chemotherapy, concurrent radiotherapy, adjuvant chemotherapy, and so on.
4.Hyperthermia
Hyperthermia is also a clinically feasible means for radiosensitization in addition to having anticancer and local immune functions. The existing clinical results suggest that the effect of hyperthermia combined with radiotherapy or integrative treatments of hyperthermia, radiotherapy, and chemotherapy for nasopharyngeal carcinoma cervical lymph node metastases is better than the effect of radiotherapy alone. And, hyperthermia applied to the primary cancer has the potential to bring therapeutic gain for cervical lymph node metastases. Also, clinical studies have shown that whole-body hyperthermia combined with chemotherapy for nasopharyngeal carcinoma multiple bone metastases has a better palliative treatment effect.
5.Chelation Detoxification Therapy
Chelating detoxification therapy can effectively remove toxins from the body; the vitamins contained within can reduce the side effects induced by radiotherapy and isotope therapy. Simultaneously conducting hyperthermia and chelation detoxification has a synergistic enhancement effect. The timing of chelation detoxification therapy in the treatment of advanced nasopharyngeal carcinoma is particularly important. Chelation detoxification therapy should be conducted as early as possible after the diagnosis to ensure early enough full dose for the entire process, combined with hyperthermia and other therapies.
6.Medical Ozone Therapy
For early-stage nasopharyngeal carcinoma, EBOO is mostly applied. Patients in poor condition or with active bleeding are subject to medical ozone saline infusion; medical ozone autohemotherapy or medical ozone acupoint injection. Medical ozone saline can effectively alleviate radiotherapy-induced stomatitis, ulcers, pharyngitis, and so on. Medical ozone olive oil is used for the treatment of radiotherapy-induced skin damage, all kinds of wounds, and skin rashes and is applied to the affected areas. Medical ozone saline atomizing inhalation is for radioactive inflammation of the mouth and nasopharynx. Medical ozone saline can also be applied to rinse the nasal cavity, paranasal sinuses, maxillary sinus, and other parts. For medium-advanced nasopharyngeal carcinoma, EBOO is still the first choice. If the patient is excessively weak with abnormal coagulation function, major autohemotherapy or medical ozone saline intravenous injection can be chosen. Rinse the cancer area directly with medical ozone saline through conchoscope. It can achieve hemostasis and reduce edema, and so on; also, it can achieve the effect of cancer reduction.
7.Traditional Chinese Medicine
Modified Qingjin Huatan Pill is given for the syndrome of lung-heat and phlegm coagulation. Modified Xiaolei Pill is given for the syndrome of qi stagnation and phlegm and blood stasis. Longdan Xiegan Decoction is given for the syndrome of fire toxicity and internal resistance. Shengmai Powder with Jiawei Zengye Decoction is given for the syndrome of deficiency of both qi and yin. Commonly used Chinese for- mulated products are Biyanlin tablets, Biyanqingdu granules, and Xiaojin pellets.
8.Acupuncture
8.1 Early nasopharyngeal carcinoma
Because the syndrome is mainly lung heat, the therapeutic principle should focus on clearing away heat and removing throat dampness.
8.2 Medium-advanced nasopharyngeal carcinoma
Because the syndrome is mainly toxic heat stagnating in the body, the therapeutic principle should focus on clearing away heat and toxic substances as well as removing swelling and lumps.
9.Medicated Diet, Nutrition, and so on
Early nutrition is mainly through medicated diet conditioning for nasopharyngeal carcinoma. For patients with radiation esophagitis and dysphagia, indwell gastric tube or conduct fistulization for nutritious meal injection. It is to be combined with qigong practice, adequate exercise, music therapy, and other therapies, as well as psychological counseling to adjust the patient’s attitude to fight against tumors with optimism and confidence. For patients with medium-advanced cancers who can eat, nutrition is provided mainly through medicated diet conditioning, supplementing enough amino acids, vitamins, digestive enzymes, and so on. If digestive tract obstruction occurs, total parenteral nutrition may be considered. At the same time, combine qigong, sports, music therapy, and so on, as well as psychological counseling adjustment to enhance the patient’s confidence and self-healing powers.
10.Others
Because bleeding, ear infections, headaches, and other complications that seriously affect the quality of life are commonly seen due to the nasopharyngeal condition itself or after radiotherapy, nontoxic integrative treatments or targeted western medicines must be applied in a timely manner during the course of treatment to quickly alleviate these complications. For example, use thrombin, mannitol, and other drugs to relieve the suffering of patients in the shortest possible time.
Typical Case
39 year old male patient, was admitted on Jan 4, 2007 to Clifford Hospital “for nasopharyngeal carcinoma after chemotherapy over 2 years ago”. Patient had left submandibular tumor and neck lymph nodes in October 2004, and was diagnosed with nasopharyngeal poorly-differentiated squamous cell carcinoma and bone metastases at clinical stage 4. He underwent radical radiotherapy and six courses of chemotherapy. On admission, patient experienced headache, thirst, dry mouth and throat, swelling and aching of gums, swelling pain in cheeks, hearing loss, mental fatigue, and anorexia.
Physical examination: His weight was 46kg, in poor general health. He was thin. Superficial lymph nodes were not enlarged. Heart, lung, liver and spleen were normal. Auxiliary examinations: His neck skin was coarse from radiation damage. He had decreased acuity in hearing to left ear, tongue was red with less fur, pulse was thready and rapid. The KPS was 70.
Blood routine: Hb 102g/L，RBC：3.2×1012/L，WBC：3.1×109/L，PLT：194×109/L; ECT examination showed nasopharyngeal carcinoma with skull metastasis.
Diagnosis: nasopharyngeal carcinoma recurrence and bone metastases after chemoradiotherapy.
Integrative treatment prescription: patient received intravenous nutrition, acupuncture and TCM, once daily after admission. Medical ozone and other integrative treatments were prescribed as well as local hyperthermia, once every other day. After 1 week, his symptoms of headaches, mental fatigue and anorexia improved. First, TP program for 2 courses of chemotherapy was implemented. One session of whole body medium-low temperature hyperthermia was prescribed for each course of chemotherapy. Local hyperthermia was stopped 3 days before and after whole body hyperthermia. For the rest of the time, local hyperthermia was conducted once every other day. After two courses of chemotherapy, radiotherapy (a total of 35 times) + local hyperthermia (once every other day for a total of 21 times) was given. After radiotherapy, four courses of chemotherapy of TP program + whole body hyperthermia + local hyperthermia treatments were implemented. Chinese medicine and acupuncture treatments accompanied chemoradiotherapy throughout the process. Because patient was with red tongue, less fur, thready and rapid pulse. It was concluded patient was deficient of both Qi and Yin. TCM treatment was to supplement Qi and nourish Yin as well as drain toxins and eliminating stagnation.
Medications: prescription was for supplemental Shengmai Powder. Decocted oral medication ingredients were as follows: Radix Pseudostellariae 15g, Ophiopogon Japonicus 15g, Schisandra Chinensis 12g, Rhizoma Pinelliae Praeparatum 12g, Bile Arisaema 12g, Cremastra Appendiculata 15g, Agrimonia Pilosa Ledeb 30g, Selaginella Doederleinii 12g, Cortex Moutan 10g, Gardenia Jasminoides Ellis 10g, Fructus Xanthii 15g, and Flos Magnoliae Liliflorae 10g, one dose a day.
Acupuncture Treatment: The principle of acupuncture was to drain toxins and eliminating stagnation.
Acupuncture on acupoints: Hegu, Quchi, Zusanli, Dazui, Baihui, Yingxiang, Tinghui, Taixi, Feishu and Waisanguan. Methods: Even reinforcing-reducing method was used for acupuncture. Retained the needle for 20 minutes, once a day. Stop 2 days after 5 sessions of acupuncture.
Moxibustion on acupoints: Zusanli, Guanyuan, Dazui, Pishu, Shenque and Shenshu. Methods: Took 2 points each time. Using the moxa stick, moxibustion was performed at 10 minutes per point, once per day. Stop 2 days after 5 sessions of moxibustion.
Auricular acupoints: Internal Nose, External Nose, Throat, Jiaogan, Forehead, Temporal Bone, Adrenal Gland and Lung. Method: Adhere cowherb seed to auricular points. Patient was asked to press those points 3 to 5 times daily for a duration of 3 to 5 minutes, twice a week, alternating ears.
Treatment outcome: patient received 6 months of treatment (intermittent hospitalization). Because patient was in poor general condition, with poor appetite, headaches, mental fatigue and other symptoms when he was admitted to hospital, treatment was focused on relieving the symptoms and to boost nutrition. Small doses or base quantum of medical ozone, chelation and detoxification therapy were used. The therapeutic dose was gradually increased after relieving symptoms of headache, and mental fatigue. Treatment was formulated based on both its root cause and symptoms. While applying chemoradiotherapy for cancer treatment, we combine TCM, chelation and detoxification therapy, medical ozone, whole body hyperthermia, local hyperthermia and other treatments, to eradicate the tumor and to reduce chemotherapy side effects. After 2 months of treatment, the symptoms of dry mouth, swelling and painful gums disappeared. His hearing was slightly restored and a weight gain of 3 kg. Karnofsky performance score was 90. After discharge, he persisted with herbal medicines and returned to hospital to received green therapy 3 days every 2 weeks, which was adjusted to 3 days treatment per month after 3 months. After 7 months, CT lesions disappeared. ECT showed the skull metastasis of nasopharyngeal carcinoma with no significant change compared with the previous scan. With no new metastases. Patient continued with regular hospital visits. Her condition remained stable and no recurrence or new metastases have been evident.
