Panchkarma Management of Malignant Astrocytoma – a Case Study

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Efficacy of Panchakarma and Ayurvedic Herbo-mineral Preparations in the Management of Malignant Astrocytoma – a Case Study

Authors: Dr. Sawant Prashant M.D. (Ayu), Dr. Jagtap Reshma M.D. (Ayu.), Dr. Kadam Sandhya M.D. (Ayu), Ayurlife Positive Health Centre and Research Institute, Chembur, Mumbai - 71

Note: This Case Study was selected for presentation at Second International Conference of the Society for Integrative Oncology held November 10-12, 2005 in San Diego, California. The Case Study is also published in the November 06 issue of 'Light On Ayurveda Journal' publised in the U.S.A

 

Introduction:

Brain tumors account for 85% to 90% of all primary central nervous system (CNS) tumors. In general, the incidence of primary brain tumors is higher in whites than in blacks, and mortality is higher in males than in females. Anaplastic astrocytoma and glioblastoma account for approximately 38% of primary brain tumors

Within the brain are nerve cells and also cells that support and protect the nerve cells (glial cells). A tumor of these cells is known as a glioma. Astrocytoma is a type of glioma which develops from astrocytes.

Tumors of Grade III and Grade IV astrocytomas are frequently referred to as malignant astrocytomas. For patients with brain tumors, 2 primary goals of surgery include (1) establishing a histologic diagnosis and (2) reducing intracranial pressure by removing as much tumor as is safely possible to preserve neurological function. Total elimination of primary intraparenchymal tumors by surgery alone is extremely rare. Radiation therapy and chemotherapy options vary according to histology and anatomic site of the brain tumor In Grade III astrocytoma, with conventional treatment, the patient's survival outcome is very poor.

The use of ayurvedic panchakarma treatment, namely, ‘basti’ (administration of medicines as an enema) and herbo-mineral internal medicine has shown promising result.

We are presenting a case study of a patient with Grade III Astrocytoma, who responded to the above mentioned treatment.

Case Report:

A female age 30 years, a known case of malignant astrocytoma Grade III, approached for ayurvedic treatment on 19th June 2004. Her had been surgically removed on 13th April 2004. She was then advised Radiation Therapy followed by Chemo Therapy. However due to severe debility and post-operative complications, she had to discontinue Radio Therapy after three sittings. She was subsequently advised against Chemo Therapy too

On her first visit to the centre she was looking very anxious and exhausted. She was complaining of dyspnoea on exertion and extreme fatigue. She had no complaints of headache, giddiness, diplopia or tinnitus. On examination she was afebrile, pulse 92 / minute, B.P 130 / 80 mm of Hg. No abnormality was detected on respiratory and cardiovascular examination. She weighed 39 Kg., markedly underweight for her height of 5’1”. There were no signs of neurological deficit.

History of Present Illness:

In early March 2004, the patient developed giddiness, nausea, headache and occasional diplopia in left eye. On examination left lateral rectus muscle palsy was observed. There was no evidence of pappilloedema. Respiratory, cardiovascular examinations were unremarkable.

She was advised CBC, ESR, RBS, serum creatinine. All the investigations were normal, except a moderate rise (32 mm / hr.) in the ESR. She was advised to take tab. Cinnarizine 25 mg. t.d.s. and tab. Prochlorperazine 2.5 mg in the morning and 5 mg at bed time. However, there was no relief in the symptoms after five days.

She was then advised MRI of the brain (3rd April, 2004), which revealed a large well defined lobulated non-enhancing, mixed intensity lesion in the left temporo parietal region (7.9 cm x 5.6 cm). It was causing marked mass effect on the left ventricle, 3rd ventricle, the mid brain, and left basal ganglia with midline shift, subfalcine and early transtentorial herniation to the right, suggestive of neoplasm.

MRI of the brain (3rd April, 2004)

Patient was immediately referred to a tertiary care hospital, where the tumor was surgically removed on 13th April 2004. In the histopathological study the dissected confirmed oligoastrocytoma grade III of left temporoparietal region.

Radiation Therapy (RT) and Chemotherapy were planned. She was given RT on 22nd, 23rd and 24th of April 2004 and was discharged on 24th April 2004.

However, she developed bleed under the scalp and was readmitted immediately on 25th April 2004. Subsequently, she developed high-grade fever in range 104 *F – 105 *F. which was not settling down even after antipyretics and higher anti-biotics.

CT scan on 25th April, 2004, showed left fronto-parieto-temporal mixed density lesion, which was partly the result of residual neoplasm with bleed within it. Left fronto-parieto-temporal, extracerebral collection and subfalcine herniation to the right was also noted.

CT scan on 25th April, 2004

The clot was evacuated on 27th April 2004. Debridement and skin grafting was done on the scalp was done on 15th May 2005. Eventually fever settled and the patient was discharged on 9th June 2004.

In view of complications and severe debility, the RT was suspended. Thereafter, it was decided not give RT or Chemotherapy. She was prescribed Oxytol, Librium, Restyl, B-complex and Folvite.

As there was no active conventional treatment planned, the patient, knowing the prognosis of the disease, approached for ayurvedic treatment.

The Ayurvedic Treatment:

Thirty ‘Rajayapan Basti’ (a multi-ingredient generic formulation administered as an enema) were administered consecutively from 22nd June 2004 to 24th July 2004.

Simultaneously, eight ‘shodhana nasya’ (nasal instillation of medicine) with ‘panchendriya gunavardhana taila’, was administered consecutively from 22nd June 2004. It was followed by ‘shamana nasya’ every day.

Herbo-mineral formulation, containing generic ayurvedic medicines, namely, Vajra bhasma, Suvarna bhasma, Bruhat Vata Chintamani Rasa, Abhrak bhasma (1000 puti), Shankha bhasma, Bramhivati, Shankhapushpi churna, in a prescribed dose was given orally.

Results:

CT Scan (23rd August 2004): On comparison with scan dated 25th April 2004, there has been a complete regression of left extra cerebral and subglial collection. There was regression in ill-defined hyperdensity seen within the left temporoparietal hypodense lesion.

CT Scan (23rd August 2004)

 

CT Scan (12th Feb 2005): On comparison with scan dated 23rd August 2004, there had been no significant changes, there was no evidence of enhancing residual lesion.

CT Scan (12th Feb 2005)

Follow up on 4th June 2005

The patient was asymptomatic. Afebrile, pulse rate 88/ min., B.P: 120/70 mm of Hg. No abnormality detected on respiratory, cardiovascular and CNS examination.

Investigations including C.B.C, Urine Analysis, Renal Profile and Liver Profile were within normal limits.

Follow up C.T Scan, 31st October 2005

Post operative status. Left temporo-perital hopdense lesion, most likely representing post-operative gliosis. No evidence of enhancing residual lesion.

Follow up C.T Scan, 27th May 2006

No evidence of enhancing residual lesion was identified. On comparison with CT Scan of 31st October 2005, no change was noted.

As on date: (2nd Nov 2006) Patient is stable and asymptomatic. She is continuing with the nasya (shamana) and oral medicines. She is also advised a course of eight ‘Rajayapana basti’, repeated every four months.

Discussion:

According to ayurved, regeneration of cells is carried out by the ‘shukra dhatu’ and is controlled by the ‘vata dosha’. The uncontrolled cell division is a result of imbalance of ‘vata dosha’, which results into neoplasm. Therefore, the aim of the treatment is to restore the proper balance of vata dosha and fortify the shukra dhatu by giving rasayan medicines specific for shukra dhatu.

‘Basti’11 (therapeutic enema) is the ideal treatment for ‘vata' related disorders. ‘Rajayapana basti’ is a type of ‘basti’ in which a specific formulation as described in treaties of ayurved, is administered per rectum. This particular type of basti is selected because it is recommended for fortification of shukra dhatu. It immediately restores strength and prolongs life.

‘Nasya’ is useful in the diseases of head and neck. It clears the channels of nutrition of the organs in the region. Nasal route is the only route by which the medicines can directly reach the brain vault, through the porous cribiform plate of the roof of the nose.

The herbomineral formulation used internally, is a combination of generic formulations described in ayurvedic treaties. Each of these formulations has a specific role in the management of neoplasm and prevention of its relapse. The main propertoes of the key ingredients is as under:

Medicine

Main Properties

Vajra bhasma4

Yogawahi (reaches in to the smallest part), Rasayana

Suvarna bhasma5

Vayasthapana (enhances quality of life), useful in diseases of nervous system, improves blood circulation in the brain, increases ‘oja’.

Bruhat Vata Chintamani Rasa6

Fast acting, vata dosha balancing

Abhrak bhasma7

Promotes strength, intellect promoting, useful in diseases of nervous system

Shankha bhasma8

Useful in reducing ‘arbuda’ (mass / tumor)

Bramhivati9

Brain tonic, nervine tonic

Shankhapushpi churna10

Nervous system specific Rasayana

The Hypothesis:

The cell division is controlled by vata dosha. The exact information about this cell division and multiplication is coded in the shukra dhatu (sarvadehik).

The uncontrolled / abnormal multiplication of cells may result from

1. Vitiation of vata dosha caused by the etiological factors.

2. Faulty encoding of shukra dhatu which may be by birth or acquired

The aim of treatment:

1. Restore balance of vata dosha by vata balancing herbo-mineral medicines, basti and nasya

2. Lekhana – scrapping of tumor mass with internal medicines

3. Rasayana – Tissue specific medicines which may be responsible for normal information encoding at ‘shukra dhatu’ level.

Conclusion:

The treatment protocol based on ayurvedic hypothesis used to treat this particular case has yielded positive outcome. However, the usefulness of this therapy for malignant astrocytoma has not been established and the hypothesis needs to be extensively evaluated.

References:

Charak Samhita / Siddhishtana / XII / 16.)

Ashtanga Hrudaya / Sutra / 20 /1

Rasatantra sara

Rasatarangini / 23 / 25-26

Rasatarangini / 15 / 69-80

Bhaishajyaratnavali / Vatavyadhi Chikitsa / 91-94

Rasatarangini / 10 / 72-73

Rasatarangini / 12/ 20-21,29

Rasatantra sara

Charak Samhita / Chikitsa / 1.3 / 31

Ashtanga Hrudaya / Sutrasthana / 19 / 1

Case Studies

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