ANALYSIS OF CLINICAL EFFECTS OF ELECTROCHEMJCAL Therapy ON 211 CASES WITH MIDDLE AND LATE STAGE LUNG CANCER Xin Yu-Ling China-Japan Friendship Hospital, Beijing (100029)

ABSTRACT The clinical efficacy obtained from 211 cases of middle and late stage Jung cancer treated by electrochemical therapy (ECT) were summarised. The responses are divided into CR, PR, NR, PD according to the international standard of four grades. The short term effectiveness~ within one year was: CR (29.4%) and PR (40.3%) which were assessed as the total effective rate being 69.7%. while NR (13.3%) and PD (17.1%) were assessed as ineffective. The efficacy of traditional Chinese medicine (TCM) group was 54.3%; that of ECT group was 70.4%; while that of TCM combined with Western medicine group (ECT + TCM) was 84.3%. The efficacy of ECT + TCM group was superior to the former two groups (P<0.5). The 5 years long term effectiveness of ECT group was 31.0%, TCM group 15.7%, ECT + TCM group 40.0%. Clinical analysis showed that the effect of ECT + TCM group was the best. KEY WORDS Jung cancer, electrochemical therapy, traditional Chinese medicine.

Two hundred eleven patients of middle and late stage Jung cancer were treated from Oct. 1987 to Oct. 1991. Among them, 71 cases were treated by electrochemical therapy (ECT), 70 cases by traditional Chinese medicine (TCM), and the other 70 cases were treated by ECT + TCM. In order to discover the role of the ECT + TCM method in treatment of the Jung cancer, the therapeutic effectiveness of the three groups was reviewed.

 METHODS

1.1 Clinical Data
Among the 211 cases, 159 cases were male, 52 cases were female. The ratio of male to female was 3:1. Age ranged 32 —. 78 with an average of 56. 119 cases were not ever treated with other therapy; the other 92 cases were treated by exploration thoracotomy (38 cases), chemotherapy (28 cases) and radiotherapy (26 cases), but these therapy were all ineffective.

The location of Jung cancer was that: In 131 cases the cancers were in right lung, among which 75 were in upper-right lobe and 56 in lower-right lobe. In 80 cases the cancers were in the left lung, among which 49 were in upper-left lobe and 31 in lower-left lobe. There were 156 patients of peripheral type, 55 cases of central type. The pathological type of these lung cancer was shown in table 1.

Table I. The Histopathologic Type of 211 Cases of Lung Cancer

According to TNM stage statistical method of UICC, there no case in TI stage, 62 in T2, 105 in T3, 44 in T4. Table 2 showed the distribution of the different stages.

From table 2, it was shown that most cases were middle and late stage lung cancer. 149 cases (70.6%) were at T3 T4 stage. 44 cases ofT4 stage lung cancer with remote metastasis, among them, 8 with chest metastasis, 15 with neck Lymph node metastasis, 13 with bone metastasis, and 8 with liver metastasis. Such cases were treated only with palliative method in order to reduce the sufferings of the patients.

Size costumer was measured according to X - ray films, they were from 3.7cm to 13.5cm in diameter, most of them ware >5 cm (65.87%). lt was shown in Table 3, in ECT group, 67.6% of patients had the tumor size of more than 5 cm in diameter, that in TCM group and ECT + TCM group was 60.0% and 70.0 % respectively.

Table 3 Diameter of Tumour (cm)

1.2    Treatment 1.2.1   ECT group

ECT was invented by the famous Swedish radiologist, Professor B. EW Nordenström. lt was introduced into our country in 1987. Using the ECT instrument and platinum (Pt) needle electrodes made by ourselves, in our hospital successful performances have been conducted.

Operation Procedure: Let the patient lay comfortably on the operation table and sedatives was given in advance, strict aseptic manipulation was conducted. Under monitoring with X-ray or CT, or wider direct vision in thoracotomy, the electrode needles were inserted accurately into the tumour mass. The destroyed area around each inserted needle was about 3 cm. i.e., a tumour with 3 cm in diameter, two needles should be inserted (one anode and the other cathode). If it reached 5-6 cm, one anode. needle should be inserted into the center, other three cathode needles into the margin area of the tumour. For giant tumour, the numbers should be calculated according to the diameter of tumour, i.e. every 3 centimetre needs one needle.

During the treatment, the voltage applied should be raised gradualiy. lt was raised to 2 V at After. After adaptation, then the voltage increased to 4V, 6V, 8V even 10V in succession, if it was tolerated well. Usually ‚ it was maintained at 7-8V, 50-70 mA. The amount of electricity was calculated as 100 Coulombs for 1 cm of tumour diameter, lasting for 20 minutes. The principle of ECT is the electrolytic action of direct current causes a series of chemical changes in tumour so as to induce necrosis and death of tumour cells after a certain time.

1.2.2  TCM group

In this group, a recipe called AC785 1 (Anti-Cancer 7851) was used, which has been prepared and studied in recent years in our hospital. The main components of this recipe were: Moschus, Radix Astragali, Cortex Phellodendri, Radix Salviae Miltiorrhizae, Fructus Aurantii Immaturus, Rhizoma Cyperi, etc. as well as trace element copper and iron. The dosage were 6 tablets each time, three times a day, two months as one treatment course. All the 70 patients in this group have taken this medicine for two months.

1.2.3  ECT + TCM group

In this group, combination of ECT and TCM has been used. The medication of ECT and TCM were the same as mentioned above.

1.3  Selection of Indication and Prevention of Complication

1.3.1  Indication of ECT

Lung cancer patients, who was unsuitable to surgical Operation or patients with tumour relapse after surgical operation and was irresponsive to chemo- or radio-therapy or unsuitable to chemo- or radiotherapy again, were indicated for ECT. But the tumour should be solitary with no remote metastasis, the optimal tumour size was less than 10 cm. Too weak or cachexia were the contraindications of ECT. Lung cancer of peripheral type was treated directly under the guidance of X ray and the effect was good. For that of central type, thoracotomy would facilitate the needle insertion accurately and safely.

Indication should be kept strictly to ensure the efficacy of treatment. Traumatic pneumothorax was the frequently met complication of ECT for treating lung cancer. If the possibility of pneumothorax was predicated before or during the operation, a chest dram should be put in advance or immediately to expel the gas to warrant the therapy carry on smoothly. In addition, arrhythmia was also a complication, caused by interference of the direct current to the heart, but not damaging myocardium. Electrocardiogram was used to supervise the heart rhythm during Operation. Once the arrhythmia happened, stopped Operation, and the heart rhythm would turn to normal at once. This complication often occurred in central type of lung cancer, it was possibly due to influence of electrode needle which located next to the heart. To avoid the interference of the direct current to the heart rhythm, electrode should be placed over 2-3 cm apart from the heart.

1.3.2  Indication of TCM

Most patients in this group were old asthenics or with cardiopulmonary dysfunction. The tumours were multiple and the diameter was less than 5 cm. Our previous studies has shown that the giant tumour (diameter> 7 cm) was difficult to be controlled by TCM. But to relieve the symptoms and prolong the life span so as to reach the effect of palliative treatment could be expected.

1.3.3  Indication of ECT + TCM

The giant tumour (diameter> 7 cm) was difficult to be treated by TCM alone, while it was also difficult for ECT to treat those weak patient. In such cases ECT + TCM was the best choice to achieve better efficacy.

2 RESULTS

2.1   Standard for Therapeutic Efficiency

FR ( partial remission ) - the tumour reduced in size for more than ‘/~ ‚ cancer cells were positive or negative in residual lesion biopsy, symptoms alleviated markedly, with self-care of life for more than half year.

NR ( no remission, stable ) tumour reduced in size by 1/3 or so, cancer cells were positive in biopsy, symptoms slightly improved with partial self-care of life and was stable for around three months.

PD (progressive disease ) - tumour was aggravated or with remote metastasis, not wider control completely, patients could not take care of himself.

2.2   Therapeutic Effect The therapeutic efficacy was evaluated as short term effectiveness ( one year )‘ and long term effectiveness ( one to five year).

2.2.1 Short term effectiveness

In all 211 cases, 28 cases died and 6 lost after treatment within one year, these cases were taken as ineffective. For one year curative effect: 62 cases were CR (29.3%), 85 cases PR (40.2%), 28 cases NC (13.2 %)‚ 36 cases PD (17.0 %). The sum of FR and CR were 147 cases, assessed as effective, while that of NR and PD were 64 cases, assessed as ineffective (Table 4).

Above statistics showed that ECT + TCM group had the best effect (CR + PR = 84.2%), the next was ECT group (CR + FR = 70.4%) and then TCM group (CR + PR = 54.2%). There were significant differences between the three groups (P<0.05). The therapeutic effect was closely related with TNM stages, it decreased with the increase of stage (Table 5). Table 5 Relationship between TNM Stages and Therapeutic Effectiveness

Table 5. Relationship between TNM Stages and  Therapeutic Effectiveness

Table 5 showed that in 62 cases ofT2 stage, 57 cases were effective (CR + PR), the effective rate was 92.0%. In 105 cases ofT3 stage, it was 79 cases and 75.3%, whereas in 44 cases ofT4 stage, 11 cases and 25.0%. Between every pair of groups the difference was significant (P<0.01).

Therapeutic effect was also correlated with location of the lung cancer, in peripheral type, the effective rate of CR + PR was 82.4%, while in central type it was only 28.5%, the difference was significant (P<0.0l).

Between cancer in the left and that in the right lobe, there was no significant difference in therapeutic efficacy ( the therapeutic efficacy was 83.6% and 81.2% respectively, P>0.05).

The therapeutic effect was related to the pathological type of the cancer. In squamous cell carcinoma the effective rate (CR + PR) was 85.0%, in adenocarcinoma 77.3%, in undifferentiated type 47.8%, in small cell carcinoma 20.6% only. The difference was significant between them (P<0.0l) (Table 6).

Table 6. Relationship between pathological types and Therapeutic Effectiveness

The therapeutic effect was closely related with the tumour size. When the tumour diameter was 3-5 cm, 5.1-7 cm, 7.1-9cm and 9.1-13 cm, the effective rate (CR + PR) was 96.0%, 67.0%, 41.1 % and 2.3 %‚ respectively. The differences was significant between them (P<0.0 1) (Table 7)

Table 7. Relationship between Therapeutic Effect and Tumour Sizes

2.2.2   Long Term Effectiveness

Among the 211 cases of lung cancer, 28 died, 6 cases were lost within one year. Among the remaining 177 cases, 18 cases were lost after 1.5 years, and assumed as died. Therefore only 159 cases were taken into the count of the long term effect within 1-5 years, the survival rate was 89.8%. If the total (177 case:.~) were taken into account, it was 75.3%. Among 211 cases, 1-5 years survival rate was 79.6%, 75.0~, 60.6%, 46.4% and 28.4%, respectively. The survival rate 1-5 years ofECT + TCM group was the best of the three groups. (Table 8)

The long term survival rate was closely related to TNM stage (Table 9). All 44 cases of T4 stage had remote metastases were died within 1-2 years (the median survival time was 16 months). The survival time of the 105 cases ofT3 stage ( including central type lung cancer) was 2—2.5 years (median survival time was 23.5 months). The majority of T2 stage patients survival more than 3 years (median survival time was 38.9 months).

Table 9. Relationship between TNM Stages and Long term Survival Rat

Long term effect was also relevant to pathological type, the survival time of small cell carcinoma (the median survival time was 10.8 months) was shorter than that of adenocarcinoma (25.5 months) and squamous cell carcinoma (25.6 months). The generalised metastasis and relapse of the lung cancer lesion were die main cause of death. There was significant difference both in short or long term therapeutic effect between them mutually. ECT + TCM group was better than die other two groups.

DISCUSSION

lt is well known that die treatment of middle and late stage lung cancer is difficult, most of the patients lost die chance of operation. Chemo- or radiotherapy are also not easy to get expected effect. The new method ofECT which has just been invented, combined with TCM was applied to elevate die therapeutic effect for middle and late stage lung cancer. In recent years, combined therapy was unanimously agreed to be taken to treat die middle and late stage lung cancer. The therapeutic effect of such patients treated by us had also showed that die combination of Chinese traditional and Western medicine (ECT + TCM) was die best choice. Among die 211 cases, die effectiveness of ECT for giant tumour (diameter >7 cm) was definite. This therapeutic method was easy, effective, safe, less traumatic and suitable for aged and asthenics, who was unable or failed to receive chemo- and radiotherapy. lt has been proved by dilnical practice that TCM could improve die immune function of lung cancer patients, reduce dieir sufferings and prolong their survival time. The aim for us to set U~ ECT + TCM group was using ECT to destroy lung cancer body, using TCM to elevate die body‘s anti-tumour capacity, to reduce die relapse and metastasis and improve patient‘s quality of life. This study had confirmed that it was an effective way to treat middle and late stage lung cancer by using ECT + TCM therapy. Because of limited number of cases, die results was preliminary and further study is needed.

REFERENCE: 1.    Nordenström BEW. Biologically Closed Eleciric Circuits. AJR 1985; 145-147.