A Case Study: TCM Adjuvant Therapy for Chemotherapy in a Child with Neuroblastoma

The child, a certain Zhang, aged 2, from Shandong Province, was diagnosed with neuroblastoma in that province in August 2020, and later treated at the Shanghai Children's Medical Center (patient no. 64709985). The child's parents first contacted me on December 27, 2020, seeking my help.

By then the child was already receiving pre-surgical chemotherapy at the Shanghai Children's Medical Center, and the family had also found a TCM doctor in Shanghai to prescribe herbs; this TCM doctor strongly opposed the child's surgery and chemotherapy, but his treatment had no obvious effect. The child's parents, introduced by someone, sought my help.

The child's abdominal plain-and-contrast MRI showed a solid mass in the lower abdomen-pelvis, anterior to the spine, appearing as multiple nodules of varying sizes fused into a mass, measuring about 107.1 x 66 x 103.8 mm; the borders were locally somewhat ill-defined, the shape irregular; T1WI was mainly uneven low signal with scattered punctate high signal, T2WI mainly uneven high signal with scattered low signal; DWI showed restricted diffusion; after contrast the enhancement was uneven. Around the L5 level the mass was seen extending through an enlarged intervertebral foramen into the spinal canal, reaching about one-third of the way across the right side of the spinal canal, compressing the thecal sac and pushing it to the left.

The child received four courses of pre-surgical chemotherapy, and the tumor had shrunk to 94.2 x 65.6 x 40.7 mm, showing a clear chemotherapeutic effect. But the parents were terrified of surgery and continued chemotherapy and, under the influence of other TCM doctors, were firmly determined to abandon Western treatment. After communicating with me, I believed that treating such a huge tumor with TCM alone had a very low success rate, so I recommended surgery first, then continuing the original effective chemotherapy regimen; during surgery and chemotherapy, I would take charge of resolving any side effects. After the standardized treatment was completed, TCM would then address the problems that surgery and chemoradiation could not solve; this approach would have a higher success rate.

After this work of persuasion, on December 29 the child underwent cytoreductive surgery at the Shanghai Children's Medical Center. After surgery, he took the patent medicine Shenqi Shiyiwei Keli (Astragalus-Angelica Eleven-Ingredient Granules) and Zhenqi Fuzheng Keli (Ligustrum-Astragalus Vitality-Strengthening Granules) to boost immunity.

The parents reported that the child developed mouth ulcers with every chemotherapy session, as though a layer of rust lay on his tongue, and again felt afraid of the postoperative chemotherapy.

At that time, because of the surgery and previous chemotherapy, the child's blood picture was very poor: platelets, white blood cells, red blood cells and hemoglobin were all far below normal, especially the platelets, which had dropped so low that chemotherapy could not continue; the herbs previously taken locally in Shanghai had had no obvious effect. I advised the parents to decoct Huangqi (Astragalus) and Xianhecao (Agrimonia), each one liang (about 50 g), with Danggui 10 g and an appropriate amount of Yiyiren (Coix seed), and give it to the child to raise platelets. The platelets began to recover, but the hemoglobin still fell. I therefore added Shudi (rehmannia) and Zhi Shouwu (processed Polygonum multiflorum), each 25 g, to the formula.

The parents kept wavering and did not want to undergo standardized treatment; I did my best to persuade them to follow the standard Western treatment and not to over-fear the side effects.

On February 13, the child's first postoperative chemotherapy ended, and his condition in all respects was not good. I therefore prescribed a decoction: Sheng Huangqi 30 g, Taizishen 15 g, Baizhu 6 g, Fuling 6 g, Zhi Gancao 6 g, Danggui 6 g, Baishao 6 g, Shudi 6 g, Jixueteng 15 g, Xianhecao 50 g, Huangjing 15 g, Zhi Shouwu 6 g, Mohanlian (Eclipta) 6 g, Nuzhenzi (ligustrum) 6 g, Shayuanzi (Astragalus complanatus seed) 6 g, Tusizi (Cuscuta) 6 g, Chenpi 6 g, Zhuru (bamboo shavings) 6 g, Roucongrong 15 g, Chao Maiya 15 g, Jiao Shanzha 6 g, Dazao 5 pieces. Considering the child was young and the herbs were bitter, I told the parents to add one or two liang of honey to the decoction and stir it before giving it to the child. Because the child was so small, he could not keep taking this decoction, and when the blood picture was too low he received transfusions.

After the second postoperative chemotherapy, the child's platelets were 20, hemoglobin 75, and white blood cells 1.0, so I revised the previous decoction to: Sheng Huangqi 30 g, Dangshen 30 g, Taizishen 15 g, Baizhu 6 g, Fuling 6 g, Zhi Gancao 6 g, Danggui 6 g, Baishao 6 g, Shudi 6 g, Jixueteng 15 g, Xianhecao 50 g, Huangjing 15 g, Zhi Shouwu 6 g, Mohanlian 6 g, Nuzhenzi 6 g, Shayuanzi 6 g, Tusizi 6 g, Chenpi 6 g, Zhuru 6 g, Roucongrong 15 g, Chao Maiya 15 g, Jiao Shanzha 6 g, Dazao 5 pieces.

This time the child himself was willing to drink the herbs, because the side effects of chemotherapy were truly unbearable. After taking the decoction, his appetite and blood picture both improved markedly. Thereafter, during further chemotherapy, his blood picture stayed good and he needed no more transfusions. Only at the turn of spring and summer did taking the decoction show a slight “shanghuo” (internal heat) tendency; I advised reducing Huangqi and Dangshen by 10 g each and continuing.

The postoperative chemotherapy evaluation report showed a good chemotherapeutic effect; by the end of April 2021, the child's condition was quite well controlled. Only the tumor within the spinal canal had not improved markedly, but by then the pressure of treating it was much lower.

Over these five-plus months, the parents repeatedly wanted to give up and felt helpless because the chemotherapy side effects were too severe; but with TCM adjuvant support, the child's later chemotherapy had no major side effects, and the postoperative chemotherapy was completed. So this persistence was well worth it.

I often encounter families of children with neuroblastoma, and I always do my best to persuade them toward integrated Chinese-Western treatment rather than relying on TCM or Western medicine alone. Chinese and Western medicine both exist to help patients solve problems; neither should be favored over the other. If TCM and Western doctors cooperate actively, they can better benefit patients.

In addition, I often see TCM decoctions prescribed to assist chemotherapy that perform poorly; the reason, I believe, is that the dosages of the herbs used are too low. The dose I used for this two-year-old child was already higher than the doses other TCM doctors use for adults; often, even when the formula is the same, too low a dose is still ineffective. So during chemotherapy, the dose of the herbs used as adjuvant chemotherapy should be increased.