Potential of non-Western medicines in chemoradiotherapy for cervical cancer

Abstract

This editorial explores the potential integration of non-Western medicine into radiotherapy for cervical cancer. While radiotherapy remains a radical treatment for cervical cancer, its associated toxicity and decline in quality of life can significantly impact patients’ lives. Currently, most treatments are supportive, with no specific treatment options available in Western medicine. Non-Western medicine, often less toxic and easier to administer, has shown promising results when used alongside radiotherapy for cervical cancer. Despite these potential benefits, challenges such as limited evidence and restricted application areas persist. While non-Western medicines may offer potential improvements in chemoradiotherapy outcomes for cervical cancer, further research is necessary to substantiate these benefits.

Key Words: Cervical cancer; Radiotherapy; Non-Western medicine; Kampo; Herbal medicine

Core Tip: There is currently no specific Western medical treatment for managing the toxicity associated with radiotherapy in cervical cancer, making treatment challenging. Non-Western medicines may be less toxic and more effective than Western medicines. However, further evidence is required to substantiate these benefits.

INTRODUCTION

Cervical cancer is the fourth most common cancer among women in terms of both incidence and mortality, with an estimated 660000 new cases and 350000 deaths in 2022. Human papillomavirus infection is a leading cause of cervical cancer. A vaccine has recently been developed, and its incidence rate is expected to decrease as it becomes more widespread[1]. However, vaccination coverage remains limited in some areas, and the disease is often asymptomatic nature in its early stages, and many cases are diagnosed only after disease progression[2].

Chemoradiotherapy (CRT) is a major treatment for cervical cancer, especially for equal or stage IIB or worse disease, depending on local access to radiotherapy services. For patients with stage IIB cervical cancer or worse, surgery is also the treatment of choice; however, surgery is unlikely to be curative on its own. Therefore, adjuvant treatments, including CRT, are necessary to prevent disease recurrence. The combination of radical surgery and CRT has a high risk of toxicity[2].

While radiotherapy alone may be appropriate, combining it with chemotherapy is often preferred when possible. The absolute survival benefit of CRT compared with radiotherapy alone is 6% at 5 years. Additionally, CRT offers absolute locoregional disease-free survival and metastasis-free survival benefits of 9% and 7% at 5 years, respectively[3]. However, increasing treatment intensity also increases the likelihood of toxicity, with a 14.6% incidence of grade 3 or higher toxicity reported in a large-scale multicenter cohort study by Pötter et al[4]. Addressing these toxicities adequately with Western medicine alone can be challenging.

This editorial focused on the potential role of non-Western medicine in enhancing the effectiveness of radiotherapy for cervical cancer.

PROBLEM OF RADIOTHERAPY FOR CERVICAL CANCER

Radiation-induced enteritis is one of the most troublesome conditions associated with radiotherapy, significantly affecting treatment outcomes. This condition, along with other toxicities, including fatigue, myelosuppression, and urogenital complications, directly impacts patient well-being. Radiation-induced enteritis usually presents with abdominal pain, loss of appetite, nausea, and diarrhea during the treatment period[5]. Moreover, radiation-induced enteritis can exacerbate treatment-related complications and negatively affect overall treatment efficacy. Song et al[6] reported a higher incidence of grade 3 or higher toxicity in patients with longer treatment periods (11%) compared to those with shorter periods (2%) (P = 0.05), although this difference was not statistically significant. Additionally, they found that radiotherapy exceeding 56 days was associated with increased pelvic failure. Chatani et al[7] also reported that delays in completing radiotherapy lead to poorer prognosis. Although a systematic review has highlighted the potential benefits of nutritional therapy[8], most treatments for radiotherapy-induced toxicity remain supportive, with no specific treatment established within Western medicine[5].

NON-WESTERN MEDICINE IN CRT FOR CERVICAL CANCER

Reports on the toxicity of CRT for cervical cancer in non-Western settings are limited. Although some studies have highlighted the effectiveness of traditional Chinese medicine (TCM) in treating various cancers and there are meta-analyses on TCM injections for cervical cancer with expectation of health-strengthening and pathogen-eliminating[9,10], the evidence remains sparse. In contrast, Murai et al[11] conducted a phase 2 study using TJ-14 for patients undergoing whole pelvic irradiation. This study found that TJ-14 effectively alleviated acute radiation-induced enteritis symptoms in 77% of cases. Additionally, Pesee et al[12] reported the effectiveness of a Thai herbal tonic solution(Vilac Plus G716/45) as a supportive remedy for treating cervical cancer with radiotherapy. While basic research on the effects of non-Western drugs is incomplete, some studies, such as those on TJ-14, suggest that these treatments may reduce enteritis by suppressing neutrophils and cyclooxygenase-2 in animal models[13]. Although the mechanisms of treatment are not fully understood, it is generally observed that the additional administration of these medicines results in minimal toxicity, with any adverse effects being mild[9-12]. However, a major limitation is that these treatments are not universally applicable.

CONCLUSION

Non-Western medicine may positively influence the outcomes of CRT for cervical cancer; however, further evidence is needed to substantiate these benefits.