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大肠直肠癌多年来一直高居台湾癌症死亡率前三名，近年来治疗大肠直肠癌有许多进展，合并使用5-fluororuracil (5-FU) 及oxaliplatin 或irinotecan使得存活率增加，但化学治疗的副作用仍是无法避免，而且因为剂量的累积和治疗时间的拉长，副作用影响层面只会越来越广，若我们可以先期掌握目前大肠直肠癌主流的化疗方式与其副作用之特性，从中医药的角度解释副作用产生的原因，结合临床研究的文献与我们的临床的观察分析，进一步讨论化疗药物的寒热偏性，以先期掌握每位大肠癌患者的化疗常见副作用并能够更准确地介入对应治疗。
针对回顾性文献主要从四点论述：第一点讨论晚期大肠直肠癌之化学治疗发展。第二点比较FOLFOX (FOLinic acid, 5-FU, OXaliplatin) 和FOLFIRI(FOLinic acid, 5-FU, IRInotecan) 两种化疗模式异同。第三点和第四点我们分别探讨oxaliplatin 的神经毒性和irinotecan 的腹泻副作用，与其中医治疗的概念及临床研究。最後讨论本院临床观察到的大肠癌患者化疗副作用特性，并尝试归纳其寒热证型，分析化疗药物属性，进一步利用寒者热之，热者寒之概念给予治疗，期望藉此模式未来可以提升中医改善各种化疗副作用的准确性，强化中西医结合的价值。
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Ching-Chun Huang1 Jhong-Yuan Chen1*
1Department of Traditional Chinese Medicine, Kaohsiung Medical University Chung-Ho
Memorial Hospital, Kaohsiung, Taiwan
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Colorectal cancer is the third leading cause of Taiwan malignancy death for many years. In recent years, there is a lot of progress in the treatment of colorectal cancer. Combination therapy of 5-fluororuracil (5-FU) and oxaliplatin or irinotecan increased survival rate of colorectal cancer patient. However, the side effects of chemotherapy are still unavoidable, and because of the cumulative dose of chemotherapeutic agents and the duration of treatment, the side effects will become more and more extensive. If we can understand the current mainstream chemotherapy of colorectal cancer as well as the characteristics of side effects, explain the causes of side effects by the perspective of Traditional Chinese Medicine (TCM), review the clinical research literature, combine our clinical observations to differentiation of cold and heat syndrome, and presume the cold and heat properties of chemotherapeutic agents in order to predict the side effects of chemotherapy in each patient, and intervene the TCM treatment more accurately after chemotherapy.
The discussion of this retrospective literature can be divided into four parts. First, we discuss the development of chemotherapy for advanced colorectal cancer. Second, we compare the similarities and differences between FOLFOX (FOLinic acid, 5-FU, OXaliplatin) and FOLFIRI (FOLinic acid, 5-FU, IRInotecan). Third and fourth, we respectively discuss the neurotoxicity of oxaliplatin, the diarrhea side effects of irinotecan, and related clinical study of TCM. Finally, we discuss the side effects of chemotherapy in patients with colorectal cancer by our clinical observation, summarize the cold and heat syndrome of the side effects from chemotherapy, analyze the characteristics of chemotherapeutic agents, and then use the concept of TCM that the cold syndrome should be treated with medications of warm or hot nature, and vice versa to relieve the side effects of chemotherapy. We hope that this model can improve the accuracy of TCM treatment for relieving various side effects of chemotherapy and strengthen the value of integration of traditional and western medicine.
Keywords：Advanced colorectal cancer chemotherapy, Side effects of chemotherapy TCM treatment, literature review
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221.8 晚期大肠直肠癌化疗副作用之中医治疗回顾性文献探讨及临床观察
