MXSG decoction has mainly been used to treat cough, bronchial inflammation and fever from bacterial pneumonia or viral infection in China. 11 The initial herbal prescription is composed of mostly MXSG decoction, which includes Ephedrae Herba (EH), Semen Armeniacae Amarum (SAA), Gypsum Fibrosum (GF) and Glycyrrhizae Radix et Rhizoma (GR). In contrast, per TCM theory, the logical selection of comprehensive herbal formula in each process of disease was made based on ‘syndrome differentiation’ rather than aetiology of symptoms. As this patient declined thorough imaging evaluation with the occurrence of neurological symptoms, it is unclear whether the brain metastases existed or the symptoms resulted from a potential cerebrovascular event. Based on TCM theory of fifth elements and yinyang, TCM diagnosis and basal assessment of cancer cannot be fully interpreted in the setting of standard WM system. Often, the ultimate goals of management at this stage are to prolong the survival and to better the quality of life, rather than to reduce the tumour burden aggressively. 10 Due to the complementary role of TCM in western oncology, TCM physicians have primarily treated patients with late-stage disease. 7–9 Herbal remedies, a major component of TCM, has been used as part of combination therapy or monotherapy to reduce the side effects of chemotherapy. TCM has been widely accepted as a complementary medicine for the management of malignancies, particularly as supportive and palliative care of patients with late-stage cancer. Of note, it is also the longest survival with the largest pulmonary SCC tumour burden reported in the literature. 6 Although we report 48-month survival with stable disease (rather than complete remission), our patient received TCM as the monotherapy with extended survival and improvement in her quality of life. The patient had medicated herself with oral germanium sesquioxide after receiving two cycles of chemotherapy followed by radiation. In this case, the CT of the thorax revealed a 3.5×4.5×6.5 cm hilar mass at the level of aortic arch. 5 One case reported complete remission of SCC with clinical and radiographical evidence of remission at 42 months, which is the longest survival to date. Only 3 of 12 patients had a survival of more than 11 months. 2–4 In inoperable cases, platinum-based chemotherapy was selected according to non-small cell carcinoma regimens. 2 Previous case reports showed poor prognosis and rapid progression of SCC. 1 There is no standard treatment for SCC, though the conventional therapies including surgery, chemotherapy and radiotherapy are commonly used. Pulmonary SCC is a highly malignant variant of carcinoma with histological properties of both epithelial and mesenchymal tumours. Accordingly, a modified herbal treatment introducing Gastrodiae Rhizoma (GR) and Uncaria Ramulus (UR) (Tian-ma-gou-teng, abbreviated as GRUR) decoction at the basis of MXSG decoction was prescribed to reduce her headaches and dizziness. The patient denied further MRI evaluation to verify the brain lesion because of the financial issue. A regular head CT and thoracic CT was conducted, indicating a 15.0×13.5×10.0 cm irregular pulmonary mass at the level of aortic arch ( figure 1A,C) and low-density lesion in the brainstem. In July 2015, she reported headaches, dizziness and ataxia. She kept this herbal treatment for 8 months (150–180 mL orally twice daily). With this herbal treatment, her fevers abated, her cough improved, and she no longer reported haemoptysis. Our TCM physician gave her herbal prescription whose core components consisted of Ma-xing-shi-gan (MXSG) decoction. Given her financial constraints, TCM was the only option for this patient. In October 2014, she reported new symptoms including 38☌ fever and intermittent haemoptysis to a TCM hospital in another city. However, due to her weakened condition and financial hardships, she declined conventional treatment of Western medicine (WM). Typically, conventional therapies include surgery, chemotherapy and radiotherapy. Pathology from fine-needle aspiration showed pulmonary SCC. Thoracic CT showed a large mass located in her right lung invading the right hilum with ipsilateral mediastinal lymph node enlargement. Medical history and family history were both negative.

A 58-year-old woman presented with recurrent cough with yellow sputum to a cancer hospital in China in July 2014.

Spindle cell carcinoma