Evidence-based Anticancer Materia Medica for Esophageal Cancer

  • Taixiang Wu
  • Minawaer Abudou
  • Shuo Chen
Part of the Evidence-based Anticancer Complementary and Alternative Medicine book series (ACAM, volume 2)


Traditional Chinese medicine (TCM) is a unique medical system based on thousands of years of experience and culture. In modern society, TCM is widely accepted for use in both general populations and specific clinical practices, and its use is growing worldwide. The goal of TCM treatment of cancer, including esophageal cancer, is primarily enhancement of immune system function as well as improvement in quality of life, and as a palliative care for end stage cancer patients. TCM treatment strategies are dependent on presentation of symptoms and are highly individualized. In this chapter, we introduce TCM treatment strategies for esophageal cancer. Clinical evidence of TCM treatment for esophageal cancer is based on systematic reviews of randomized controlled trials (RCTs). Searches included PubMed, Cochrane CENTRAL and CNKI databases from 1995 to 2010. We verified that identified RCTs used randomization to assign patients to study groups by conducting telephone interviews of primary authors; only studies using correct methods to generate allocation sequences were included for analysis. Assessment of methodological quality of included studies was carried out according to the Cochrane Handbook for Systematic reviews of Interventions 5.0.2. Results: A total of 13 trials were verified to be RCTs and were included. Analysis included pooled analysis of trials without clinical and methodological heterogeneity and subgroup analysis based on length of follow-up. We found that use of Java Brucea fruit oil emulsion injections resulted in benefits in 1-year and 2-year ­survival for esophageal cancer patients, and no statistical significant difference in 3-year survival. No reduction in tumor volume by using integrative therapy was observed on progressive disease. Groups using integrative treatment responded better than groups using herbal medicine alone and fewer patients suffered progressive disease than in the control groups. Integrative treatment also showed better quality of life comparing with the control group without using TCM. Clinical evidence supporting the use of TCM in the treatment of esophageal cancer is weak, mainly due to methodological inadequacies. However, the use of TCM may be an adjunct palliative care for advanced stage patients.


Esophageal Cancer Chinese Herbal Medicine Advanced Esophageal Cancer Combine Therapy Group Traditional Chinese Medicine Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Dr. Denise Adams, University of Alberta, Canada, for her kind help on proof reading the manuscript.


  1. Baba M, Ohmura M, Kishi N, Okada Y, Shibata S, Peng J et al (2000) Saponins isolated from Allium chinense G. Don and antitumor-promoting activities of isoliquiritigenin and laxogenin from the same drug. Biol Pharm Bull 23:660–662PubMedCrossRefGoogle Scholar
  2. Balakrishnan S, Menon VP, Manoharan S (2008) Ferulic acid inhibits 7,12-dimethylbenz[a]anthracene-induced hamster buccal pouch carcinogenesis. J Med Food 11:693–700PubMedCrossRefGoogle Scholar
  3. Blot WJ, Devesa SS, Fraumeni JF Jr (1993) Continuing climb in rates of esophageal adenocarcinoma: an update. JAMA 270:1320PubMedCrossRefGoogle Scholar
  4. Broitman SA, Vitale JJ (1983) Ethanolic beverage consumption, cigarette smoking, nutritional status, and digestive tract cancers. Sem Oncol 10:322–329Google Scholar
  5. Brooks PJ, Enoch MA, Goldman D, Li TK, Yokoyama A (2009) The alcohol flushing response: an unrecognized risk factor for esophageal cancer from alcohol consumption. PLoS Med 6:191–195CrossRefGoogle Scholar
  6. Cao J, Wang SH (2002) Pharmacological function of Glossy Privet Fruit in different dose and clinical use. Capital Med 9:35Google Scholar
  7. Carter R, Smith JS, Anderson JR (1992) Laser recanalization versus endoscopic intubation in the palliation of malignant dysphagia: a randomized prospective study. Br J Surg 79:1167–1170PubMedCrossRefGoogle Scholar
  8. Chen CY, Zhu DY, Lin SF (2010) Effects of spleen invigoration and mass resoluing TCM medicines on chemotherapy for advanced esophageal cancer relapse. World Chin Med 5:90–92Google Scholar
  9. Chen WZ, Chen WY, Hao YH (2008) Study of the effect of Jinnong capsul in the radiotherapy of advanced esophageal cancer. Capital Med 2:32–33Google Scholar
  10. Chen YH, Liu P, Zhang ZP, Chen ML, Chen GY (1999) Effects of Spatholobus suberectus the granulopoiesis and monocylopoiesis in mice. Chin Pharm J 34:305–307Google Scholar
  11. Cheng ZQ, Zhu WT (2010) Clinical observation on Xihuang Pill combined with chemotherapy in treating 18 cases of advanced esophageal cancer. China J Tradit Chin Med Pharm 25:1302–1304Google Scholar
  12. Cho WC, Leung KN (2007a) In vitro and in vivo anti-tumor effects of Astragalus membranaceus. Cancer Lett 252:43–54PubMedCrossRefGoogle Scholar
  13. Cho WC, Leung KN (2007b) In vitro and in vivo immunomodulating and immunorestorative effects of Astragalus membranaceus. J Ethnopharmacol 113:132–141PubMedCrossRefGoogle Scholar
  14. Clark GW, Peters JH, Ireland AP, Ehsan A, Hagen JA, Kiyabu MT, Bremner CG, DeMeester TR (1994) Nodal metastasis and sites of recurrence after en bloc esophagectomy of adenocarcinoma. Ann Thorac Surg 58:646–654PubMedCrossRefGoogle Scholar
  15. Cooper JS, Guo MD, Herskovic A (1999) Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial. JAMA 281:1623–1627PubMedCrossRefGoogle Scholar
  16. Dai PX, Chen L, Lan SB (1982) Experimental study for the effective component of enhancing white blood cell of fructus Ligustri Lucidi. Chin Tradit Patent Med 1:42–43Google Scholar
  17. Ding YX, Zhou JA, Ye XM, Gu SF, Zeng FD (1991) Study of the effect of dauricine on platelet aggregation and its mechanism. Chin Pharmacol Bull 7:271–274Google Scholar
  18. Entwistle JW 3rd, Goldberg M (2002) Multimodality therapy for resectable cancer of the thoracic esophagus. Ann Thorac Surg 73:1009–1015PubMedCrossRefGoogle Scholar
  19. Fan QH, Hou YL, Zhu AH, Lu LX, Feng JQ (2004) Comparing the effects of different preparations of fructus Ligustri Lucidi on enhancing white blood cell and anti-hypoxia ability. Northwest Pharm J 19:20–22Google Scholar
  20. Fu Q, Tang Y, Luo XQ, Yang GW, He W, Wang XM (2009) Anti-tumor activity and mechanism with SSCE of Spatholobus suberctus. China J Chin Materia Medica 34:1570–1573PubMedGoogle Scholar
  21. Goldminc M, Maddern G, Le Prise E (1993) Oesophagectomy by a transhiatal approach or thoracotomy: a prospective randomized trial. Br J Surg 80:367–370PubMedCrossRefGoogle Scholar
  22. Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI (2003) Risk of malignancy in patients with celiac disease. Am J Med 115:191–195PubMedCrossRefGoogle Scholar
  23. Hao Q, Zhao P, Niu J, Wang J, Yu J, Xue X (2010) Effect of ferulic acid on proliferation and mechanism in human breast cancer cells. Zhongguo Zhong Yao Za Zhi 35:2752–2755PubMedGoogle Scholar
  24. He LJ, Luo HQ, Xiang L (2010) Efficacy of brucea javanica oil emulsion combined radiotherapy on treating advanced esophageal carcinoma. Chin J Exp Tradit Med Formulae 16:212–214Google Scholar
  25. Herskovic A, Martz K, al-Sarraf M (1992) Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 326:1593–1598PubMedCrossRefGoogle Scholar
  26. Homs MY, Eijkenboom WM, Coen VL, Haringsma J, Blankenstein M, Kuipers EJ et al (2003) High dose rate brachytherapy for the palliation of malignant dysphagia. Radiother Oncol 66:327–332PubMedCrossRefGoogle Scholar
  27. Hu YY, Ruan Q, He XX, Xu YF (2004) The effect of ligustrazine and ferulic acid rat in vitro heart on blood flow dynamics. J Zhejiang Teach Univ (Nat Sci) 4:182Google Scholar
  28. Huang HY, Shen HX, Zhen JH (2006a) Investigation of ferulic acid and its analogs: synthesis and scavenging free radicals. Chin J New Drugs 15:454–458Google Scholar
  29. Huang JQ, Luo XX, Wang SW, Xie YH, Shi XY (2006b) Effects of cinnamaldehyde on platelet aggregation and thrombosis formation. Chin J Clin Rehabil 10:34–36Google Scholar
  30. Huang JQ, Luo XX, Wang SW, Xie YH (2006c) Effect of cinnamaldehyde on activity of tumor and immunological function of S180 sarcoma in mice. Chin J Clin Rehabil 10:107–110Google Scholar
  31. Islami F, Pourshams A, Nasrollahzadeh D, Nasrollahzadeh D, Kamangar F, Fahimi S, Shakeri R et al (2009) Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study. BMJ 338:b929PubMedCrossRefGoogle Scholar
  32. Jia YS, Wu SQ, Lu SL, Zhang LP, Xu LP (2008) Clinical analysis of brucea javanica oil emulsion injection plus radiotherapy for advanced esophageal cancer. China J Chin Materia Medica 33:2174–2176Google Scholar
  33. Jian J, Hu ZF, Huang Y (2009) Effect of ginsenoside Rg3 on Pim-3 and Bad proteins in human pancreatic cancer cell line PANC-1. Chin J Cancer 28:461Google Scholar
  34. Jiang MT, Yang XH, Chen GR, Chen D, Gu YQ (1984) Decumbent Corydalis Tuber research: inhibiting platelet aggregation and block synthesis of thromboxane A2. J Norman Bethune Univ Med Sci 10:609–613Google Scholar
  35. Jiang N, Huo H, Li LF, Zhou J, Li CH, Guo SY et al (2003) Changes in hypothalamus proteins levels in febrile rat after administration of cinnamic aldehyde. Pharmacol Clin Chin Materia Medica 19:11–13Google Scholar
  36. Jin Y, Qu TT, Liu YD, Jing H, Liu SQ, Guan HQ et al (2006) An experimental study of Ginsenoside Rb1, Rg1 and 5-Fluorouracil affect dexamethasone inducing spleen lymph cell apoptosis of mice with tumor. Tradit Chin Med Res 19:16–18Google Scholar
  37. Kirby TJ, Rice TW (1994) The epidemiology of esophageal carcinoma. The changing face of a disease. Chest Surg Clin N Am 4:217–225PubMedGoogle Scholar
  38. Knyrim K, Wagner HJ, Bethge N (1993) A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 329:1302–1307PubMedCrossRefGoogle Scholar
  39. Kong XY, Gong PL (2005) Effect of phenolic alkaloids of menispermum dauricum on thrombosis and platelet aggregation. Acta Pharm Sin 40:916–919PubMedGoogle Scholar
  40. Kong XY, Yang XY, Gong PL (2006) Effects of phenolic alkaloids of menispermum dauricum on platelet aggregation and its mechanism. Chin Pharm J 41:910–913Google Scholar
  41. Lagergren J, Bergström R, Lindgren A, Nyrén O (1999) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831PubMedCrossRefGoogle Scholar
  42. Lai H, Wang TM, Zhao HH, Zeng L, Gao J, Lu YL (2006) Effects of Ginsenoside for cholinergic fibers in the hippocampus of elder rat. J Anat 29:249–251Google Scholar
  43. Lan LQ, Tang XL, Geng L (2009) Clinical observation on Yiyiren emulsion as complementary in treating esophageal cancer. Pract Chin West Integr Clin 9:29–30Google Scholar
  44. Lee SY, Kim GT, Roh SH, Song JS, Kim HJ, Hong SS et al (2009) Proteome changes related to the anti-cancer activity of HT29 cells by the treatment of ginsenoside Rd. Pharmazie 64:242PubMedGoogle Scholar
  45. Li HD, Ge X, Deng Q, Huang M, Xie JX (2010) Tao Hong Si Wu Tang and MVP chemo­therapy in the treatment of haemostasis inter-junction esophageal cancer. Med Recapit 16:2531–2532Google Scholar
  46. Lin DR (2006) Tang dynasty. Hu XF, Zheng Ti Lei Yao (ed) People’s Health Publish House, BeijingGoogle Scholar
  47. Liu TG, Huang Y, Cui DD, Huang XB, Mao SH, Ji LL et al (2009) Inhibitory effect of ginsenoside Rg3 combined with gemcitabine on angiogenesis and growth of lung cancer in mice. BMC Cancer 23:250CrossRefGoogle Scholar
  48. Lu WQ, Ma Z (1992) Study of comparing active contents of in the gizzard-membrane of duck, goose and chicken. J Chin Med Mat 16:14–16Google Scholar
  49. Luo X, Chen DH, Yu MY, Zhao YQ, Wang H, Yang ZR (2005) Effects of Spatholobus suberectus decoction on red cell proliferation. China J Chin Materia Medica 30:477–479Google Scholar
  50. Ma YY, Li CH, Guo JY, Zhao BS, Li LF, Guo SY et al (2007) Study on antipyretic effect and its mechanism of cinnamaldehyde. Chin J Exp Tradit Med Formulae 13:22–25Google Scholar
  51. Mandarda AM, Hainautb P, Hollsteinc M (2000) Genetic steps in the development of squamous cell carcinoma of the esophagus. Mutat Res/Rev Mutat Res 462:335–342CrossRefGoogle Scholar
  52. Merry AH, Schouten LJ, Goldbohm RA, van den Brandt PA (2007) Body Mass Index, height and risk of adenocarcinoma of the oesophagus and gastric cardia: a prospective cohort study. GUT 56:1503–1511PubMedCrossRefGoogle Scholar
  53. Messmann H (2001) Squamous cell cancer of the oesophagus. Best Pract Res Clin Gastroenterol 15:249–265PubMedCrossRefGoogle Scholar
  54. Nishihira T, Hashimoto Y, Katayama M, Mori S, Kuroki T (1993) Molecular and cellular features of esophageal cancer cells. J Cancer Res Clin Oncol 119:441–449PubMedCrossRefGoogle Scholar
  55. O’Byrne KJ, Dalgleish AG (2001) Chronic immune activation and inflammation as the cause of malignancy. Br J Cancer 85:473–483PubMedCrossRefGoogle Scholar
  56. Ogiwara T, Satoh K, Kadoma Y, Murakami Y, Unten S, Atsumi T, Sakagami H, Fujisawa S (2002) Radical scavenging activity and cytotoxicity of ferulic acid. Anticancer Res 22:2711–2717PubMedGoogle Scholar
  57. Park W, Vaezi M (2005) Etiology and pathogenesis of achalasia: the current understanding. Am J Gastroenterol 100:1404–1414PubMedCrossRefGoogle Scholar
  58. Pera M (2001) Recent changes in the epidemiology of esophageal cancer. Surg Oncol 10:81–90PubMedCrossRefGoogle Scholar
  59. Ruan H (1999) The regulation for lymphocytes IL-2 induced by Fructus Ligustri Lucidi polysaccharide in mice. Shanghai J Immunol 19:337Google Scholar
  60. Sammon AM (1998) Protease inhibitors and carcinoma of the esophagus. Cancer 83:405–408PubMedCrossRefGoogle Scholar
  61. Sarper A, Oz N, Cihangir C, Demircan A, Isin E (2003) The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg 23:794–798PubMedCrossRefGoogle Scholar
  62. Steup WH, De Leyn P, Deneffe G, Van Raemdonck D, Coosemans W, Lerut T (1996) Tumors of the esophagogastric junction: long-term survival in relation to the pattern of lymph node metastasis and a critical analysis of the accuracy or inaccuracy of pTNM classification. J Thorac Cardiovasc Surg 111:85–94, discussion 94–95PubMedCrossRefGoogle Scholar
  63. Su YM, Zhang C, Xiao JY, Gang HL, Wang ZG, Hua D (2007) Effects of PAMD on the proliferation human tumour cells of PC-3 and BT5637. J Harbin Med Univ 41:129–131Google Scholar
  64. Su YM, Liu K, Zhang Y, Li WJ, Li YH, Cui Y (2010) Inhibition of daueicine for BXPC-3 tumor and effect of MMP-9 of tumor tissue. Acta Chin Med Pharmacol 38:1Google Scholar
  65. Sun XB, Zhou ZC (1986) The effect of veluet for immune function. Chin Patent Drug Res 2:24Google Scholar
  66. Sun CW, Lei CL, Lu WW, Chen Y, Wu Y (1994) The effect of astragaloside on experimental heart failure. J Norman Bethune Univ Med Sci 20:125–127Google Scholar
  67. Swanstrom LL (2002) Minimally invasive surgical approaches to esophageal cancer. J Gastrointest Surg 11:337–350Google Scholar
  68. Syrjänen KJ (2002) HPV infections and oesophageal cancer. J Clin Pathol 55:721–728PubMedCrossRefGoogle Scholar
  69. Tang Y, Fu Q, He W, Sun YK, Wang YZ, Wang XM (2008) Non-apoptotic programmed cell death induced by extract of Spatholobus suberctus in human lung cancer A549 cells. China J Chin Materia Medica 33:2040–2044PubMedGoogle Scholar
  70. Teng S, Karl R (1999) Surgical approaches to esophageal cancer. Cancer Control 6:36–42PubMedGoogle Scholar
  71. Tuyns AG, Prquignot G (1979) Esophageal cancer and alcohol consumption: importance of type of beverage? Int J Cancer 23:443–447PubMedCrossRefGoogle Scholar
  72. Victora CG, Munoz N (1987) Hot beverage and esophageal cancer in southern Brazil: a case-control study. Int J Cancer 39:710–716PubMedCrossRefGoogle Scholar
  73. Wang DP (2008) Efficacy of Dougenguan Shitong oral liquid combined with chemotherapy and regulation of serum CA199, CEA, GST-Pi on advanced esophageal cancer. Chin Arch Tradit Chin Med 26:2380–2381Google Scholar
  74. Wang Y (2010) Effect of the effective part SSCE of Spatholobus suberectus on A549 cell apoptosis. Chin J Pathophysiol 26:2011Google Scholar
  75. Wang QL, Yang F (2010) Clinical effects of Zhisheng capsule combined with chemotherapy on patients with middle or advanced stage esophageal cancer. Drugs Clinic 25:297–299Google Scholar
  76. Wang YH, Du GH (2009) Ginsenoside Rg1 inhibits beta-secretase activity in vitro and protects against a beta-induced cytotoxicity in PC12 cells. J Asian Nat Prod Res 11:604PubMedCrossRefGoogle Scholar
  77. Whiteman DC (2009) Hot tea and increased risk of oesophageal cancer. BMJ 338:b610PubMedCrossRefGoogle Scholar
  78. Williamson WA, Ellis FH Jr (1991) Barrett’s esophagus: prevalence and incidence of adenocarcinoma. Arch Intern Med 151:2212–2216PubMedCrossRefGoogle Scholar
  79. Wu PC, Posner MC (2003) The role of surgery in the management of oesophageal cancer. Lancet Oncol 4:481–488PubMedCrossRefGoogle Scholar
  80. Wu MT, Lee YC, Chen CJ (2001) Risk of betel chewing for oesophageal cancer in Taiwan. Br J Cancer 85:658–660PubMedCrossRefGoogle Scholar
  81. Xie G, Ren GG, Guo ZX (2009) A clinical research of traditional Chinese medicine in the treatment of early stage of postoperative. Mod J Integr Tradit Chin West Med 18:1338–1339Google Scholar
  82. Xu DH, Zhao HF, Xu YJ, Xie SX, Si YS, Han D et al (2004) Cardiotonic constituents of Aconitum carmichaeli. Chin Tradit Herb Drugs 35:964–966Google Scholar
  83. Xu FF, Liu CQ, Ma T, Zhou XM, Cao YL, Zhang WQ (2005) Protective effects of Ginsenoside Re on the dopaminergic neurons in the MPTP-induced mouse model of PD. J Shenyang Pharm Univ 22:35–44Google Scholar
  84. Xu M, Yu L, Ding YY, Wang YM, Wang SW, Pei JM (2006) Experimental study on hypotensive effects of cinnamaldehyde in anesthetized rats. Chin Heart J 18:272–276Google Scholar
  85. Xue LJ, Han JG, Li DW (2009) Study on the antineoplastic effect of caulis spatholobi extracts. Modern Med Health 25:3–5Google Scholar
  86. Yan YH (1980) Song dynasty: Re-edited Yan’s Ji Sheng Fang. People’s Health Publish House, BeijingGoogle Scholar
  87. Yang Y, Chen MZ (2001) Inhibitory effect of total extract of Astragalus on hepatocyte apoptosis. Chin J Pharmacol Toxicol 15:287–292Google Scholar
  88. Yang WS, Sun S, Lu H (2010) Detection of anti-tumor proliferation of active components of the menispermum dauricum by MTT method. J Med Sci Yanbian Univ 33:261–262Google Scholar
  89. Yang Y, Song SG, Chen MZ (2001) Effects of the total extract of astragalosides on the growth, AFP secretion and γ-GT activity of human hepatoma cells. Chin J Clin Pharmacol Therap 6:18–20Google Scholar
  90. Yoo JH, Kwon HC, Kim YJ, Park JH, Yang HO (2010) KG-135, enriched with selected ginsenosides, inhibits the proliferation of human prostate cancer cells in culture and inhibits xenograft growth in athymic mice. Cancer Lett 289:99PubMedCrossRefGoogle Scholar
  91. Yue YR, Sun QM, Liang H, Wu NB (2010) Clinical study of brucea javanica oil emulsion combined with radio- and chemotherapy in the treatment of esophageal cancer. Chin J Tradit Chin Med 22:18–20Google Scholar
  92. Zhang H (2010) Clinical observation of “Qi Ge Shan Jie Tang” combined with radiotherapy in the treatment of esophageal cancer. Med Info 11:3308–3309Google Scholar
  93. Zhang H, Zeng S (2010) Clinical observation for Chinese medicine “Yi Qi Huo Xue Hua Tan Fang” in the prevention and treatment of radiation esophagitis. Chin J Info Tradit Chin Med 17:61–62Google Scholar
  94. Zhang Q, Gao E (2003) The experimental study of the volatile oil extracted from Allium macrostemon Bunge on anti-tumor effects. Tumor 23:228–231Google Scholar
  95. Zhang RN, Wu LP, Zhang WW (2010) Observation for effect of Chinese medicine combined with three-dimensional conformal radiotherapy in the treatment of esophageal cancer. China Pract Med 5:33–35Google Scholar
  96. Zhang TY, Li J, Gu JY, Lin L (1997) Ultrastractureal observation on cultured cardiomyocytes in hypoxia/reoxygenation damage and protective effects of astragalus saponin. Chin J Clin Exp Pathol 13:355–357Google Scholar
  97. Zhang YN, Yue XF, Zhang ZQ (2004) Study for four Chuanxiong chemical components reaction with myocardial cell membrane receptor. Chin J Tradit Med 29:660–662Google Scholar
  98. Zhang YZ, Liu DX, Li YS, Feng YB, Mao HY (1998) Effect of dauricine on redistribution of glycoprotein IV in Platelet membrane of patients with mitral stenosis. Chin J Integr Tradit West Med 4:247–250Google Scholar

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© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.West China HospitalSichuan UniversityChengduPR China
  2. 2.The First HospitalXinjiang Medical UniversityUrumqiPR China

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