Abstract
Oral Squamous Cell Carcinoma (OSCC) is the most common type of oral cancer, accounting for 90%–95% of all cancers in the mouth. It is typically noted in individuals over the age of 40, especially men between 60 and 80. However, there has been a recent increase in oral cancer cases among women and younger individuals. We present a case of a 49-year-old female diagnosed with Stage III, moderately differentiated Squamous cell carcinoma of the tongue in August 2005. The patient underwent radiation therapy (35 fractions/70 Gy) and received adjunct chemotherapy (6 cycles of Inj. Cisplatin – LD on October 21, 2005). Despite these treatments, residual induration on the tongue persisted, leading to a Knife biopsy in April 2007 that confirmed the presence of squamous carcinoma infiltrating the lingual muscles. Further, she underwent Wide Excision Glossectomy with Left Supra-Omohyoid Neck Dissection in May 2007 and Total Glossectomy with Hemi mandibulectomy with Left Supra-Omohyoid Neck Dissection in August 2011. In addition to conventional cancer treatments, the patient opted for Ayurvedic treatment at our center, which included a combination of oral Herbo-mineral metallic medicines and detoxifying Panchakarma procedures. The 12-year progression-free survival achieved in this case highlights the potential benefits of combining conventional cancer treatment with personalized adjunct Ayurvedic therapy.
Keywords: Ayurveda, Oral squamous cell carcinoma, Panchakarma, Rasayana, Tongue cancer
1. Introduction
Oral cancer is a common type of cancer and is a major concern in many parts of the world. India has a high burden of oral cancer, accounting for one-third of cases worldwide [1]. The most common type of oral cancer is oral squamous cell carcinoma (OSCC), which mainly affects older men. However, recent studies have shown an increase in oral and base tongue SCC among women and younger patients without traditional risk factors [2]. Despite advancements in diagnosis and treatment, the prognosis for advanced-stage SCC of the tongue is generally poor, with a 5-year survival rate of around 50% [3]. However, Ayurvedic formulations are being considered as an additional treatment for oral cancer [4,5].
Here, we present a case of a female patient diagnosed with stage III, Squamous cell carcinoma of the left lateral border of the tongue with recurrence stage I, who was given adjunct Ayurvedic treatment post-surgery, chemotherapy, and radiation, resulting in Progression Free Survival (PFS) of 12 years with good quality of life.
2. Patient information
A 49-year-old female (at the time of diagnosis, 54 years at the time of registration at our centre) had a sedentary job in the government sector. She had no addictions. She had a history of menopause at the age of 50 years and had a first-degree relative positive family history of cancer. She was diagnosed with type II diabetes mellitus in 2011. She had 4-5 tooth extractions due to dental caries since 2003. She had multiple calcified sebaceous cysts over the scalp for the past 40 years.
3. Timeline for health events and treatment
The timeline is depicted in Fig. 1.
Fig. 1.
Timeline.
4. Ayurvedic treatment and assessment
Her health condition was evaluated through an Ayurvedic approach along with other clinical details. She was diagnosed as Dushta Mansaja Granthi (Tridosha Dushti) of left lateral border of tongue. General, physical, and systemic examinations along with vital parameters were normal. Her treatment including Oral Ayurvedic Medicines (OAM) and detoxifying Panchakarma therapies were initiated on June 28, 2011 and August 05, 2013, respectively; using eight combinations of medicines (Table 1) to prevent further progression and maintain a good Quality of Life leading to Progression-free survival (PFS).
Table 1.
Protocols and Rationale of Adjunct Ayurvedic Treatment with duration used in the present case study.
| Protocol set | Medicines | Dose and Vehicle | Duration | Rationale |
|---|---|---|---|---|
| 1 |
|
5 g with warm water after breakfast and evening snacks | 56 weeks (June 21, 2011 to July 20, 2012) |
|
|
1 g with lukewarm water after lunch and dinner | |||
| ||||
| 2 |
|
395 mg with Ghee in the morning after breakfast | 34 weeks (July 21, 2012 to March 15, 2013) |
|
|
5 g with warm water after breakfast and evening snacks | |||
|
1 g with lukewarm water after lunch and dinner | |||
| ||||
| 3 |
|
395 mg with Ghee in the morning after breakfast | 142 weeks (March 16, 2013 to December 04, 2015) |
|
|
500 mg with lukewarm water after dinner | |||
| ||||
|
Local Application on both legs | |||
|
1 g with lukewarm water after breakfast and evening snacks | |||
| 4 |
|
395 mg with Ghee in the morning after breakfast | 81 weeks (December 05, 2015 to June 25, 2017) |
|
|
500 mg with lukewarm water after breakfast | |||
|
500 mg with lukewarm water after lunch and dinner | |||
|
Gargling (Gandush) | |||
|
Local application in the mouth (Mukhapratisaran) | |||
| 5. |
|
125 mg with milk after breakfast and evening snacks | 15 weeks (June 26, 2017 to October 13, 2017) |
|
|
500 mg with milk after breakfast and evening snacks | |||
|
5 g with milk after breakfast and evening snacks | |||
|
10 ml with a half cup of water after lunch and dinner | |||
|
10 ml with a half cup of water after lunch and dinner | |||
|
Gargling (Gandush) | |||
| 6. |
|
125 mg with Ghee after breakfast and evening snacks | 45 weeks (October 14, 2017 to August 24, 2018) |
|
|
500 mg with milk after breakfast and evening snacks | |||
|
5 g with milk after breakfast and evening snacks | |||
|
1 gm with lukewarm water after lunch and dinner | |||
|
Gargling (Gandush) | |||
| 7. |
|
125 mg with milk after breakfast and evening snacks | 57 weeks (August 25, 2018 to September 27, 2019) |
∗Pacifies Vata and pitta ∗Digestion of undigested toxins (Aamapachaka) ∗Leads to proper metabolism of the Dhatus (tissues) and balances their respective Agni |
|
500 mg with milk after breakfast and evening snacks | |||
|
500 mg with milk after breakfast and evening snacks | |||
|
5 g with milk after breakfast and evening snacks | |||
|
1 g with lukewarm water after lunch and dinner | |||
| 8. |
|
125 mg with milk after breakfast and evening snacks | 183 weeks (September 28, 2019 to April 07, 2023) |
|
|
500 mg with milk after breakfast and evening snacks | |||
|
1 g with lukewarm water after Lunch & Dinner. | |||
|
Local application in the mouth (Mukhapratisaran) | |||
| TOTAL | 613 WEEKS | |||
| 9. | Krumighna Basti (Anti-helminthic Enema) | August 05, 2013 to August 07, 2013 August 09, 2013 and August 11, 2013 August 08, 2013 and August 11, 2013 |
Significant improvement in the Quality of Life in patients of various types of cancers treated with yearly Panchakarma treatment [25]. | |
| Matra Basti: | ||||
| 1.Nimba tail (Azadirachta indica oil) 10 ml | ||||
| 2. Nirgundi tail (Vitex negundo oil) 10 ml | ||||
| 3. Karanja tail (Pongamia pinnata oil) 10 ml | ||||
| Sneha Basti: | ||||
| 1.Nimba taila --20 ml | ||||
| 2.Nirgundi taila-- 20 ml | ||||
| 3.Karanja taila-- 20 ml | ||||
| Niruha: 450 ml decoction of 1. Vidanga (Embelia ribes) – 10 gm | ||||
| 2.Triphala (as given above) – 10 gm | ||||
| 3.Shigru (Moringa oleifera) – 05 gm | ||||
| 4.Musta (Cyperus rotundus) – 10 gm | ||||
| 5.Dantimoola (Baliospermum montamum) – 10 gm | ||||
| 6.Yava (Hordeum vulgare) – 10 gm | ||||
| 7.Nimba tail (Azadirachta indica oil) 20 ml | ||||
| 8.Nirgundi tail (Vitex negundo oil) 20 ml | ||||
| 9.Karanja tail (Pongamia pinnata oil) 20 ml | ||||
| 10.Madhu (Honey) 30 gm | ||||
| 11.Saindhav (Rock salt) 10 gm | ||||
|
August 12, 2013 to August 18, 2013 |
|
||
| Erandamuladi Basti | Basti Chikitsa modulates immune responses by regulating pro-inflammatory cytokines, functional and immunoglobulin properties of T-cells [25] | |||
| Anuvasan: | ||||
| 1.Panchtikta Taila 20 ml | ||||
| 2.Dashmool Taila 20 ml | ||||
| 3.Eranda Taila 10 ml | ||||
| Niruha: 450 ml | ||||
| 1.Erandamoola (Ricinus communis powder) 10 gm | ||||
| 2.Dantimoola (Baliospermum montamum) 10 gm | ||||
| 3.Madanphal (Randia dumetorum) – 10 gm | ||||
| 4.Triphala (as given above)– 10 gm | ||||
| 5.Shigru (Moringa oleifera) – 5 gm | ||||
| 6.Musta (Cyperus rotundus) – 10 gm | ||||
| 7.Tila taila 30 ml | ||||
| 8.Dashmool Taila 30 ml | ||||
| 9.Erand Taila 10 ml | ||||
| 10.Madhu (Honey) 30 gm | ||||
| 11.Rock salt (Saindhav) 10 gm | ||||
| Nasya-Yashtimadhu taila | ||||
| 1.Yashtimadhu (Glycyrrhiza glabra) | ||||
| 2.Sesame oil | ||||
| Tailadhara- Dashamoola Taila (over mandibular region) | ||||
| 1.Dashamoola | ||||
| 2.Sesame oil | ||||
| Gandusha | ||||
| 1.Haridra + Triphala + Saidhava | ||||
5. Outcome and follow-up
This patient has been under regular periodic follow-ups since June 2011 till date. Within a few weeks of starting Ayurvedic treatment, her appetite (Grade 1 to 0) and dysphagia (Grade 2 to 1) improved, constipation (Grade 2 to 0) was relieved, and trismus (Grade 3 to 1) reduced but dysarthria was persistent to date. As the chemotherapy sessions progressed, she experienced hair fall, leg pain (Grade 1), rectal bleeding with black stools (Grade 1), dysuria (Grade 1), weakness (Grade 2), bilateral feet peripheral neuritis (Grade 2), and stomatitis (Grade 2). All the chemo-induced symptoms except peripheral neuritis were absent by October 2011, and she recovered from peripheral neuritis by December 2012 [Table 2a]. She had post-operative disfigurement of the face, which was persistent. Even during the Covid-19 pandemic, she remained unaffected and was on regular follow-up.
Table 2a.
Periodic clinical, haematological, and biochemical evaluation of the patient's radiological.
|
Status and duration of OAM→ |
Beginning of OAM and ongoing chemotherapy |
End of chemotherapy |
1 Y |
2 Y |
3 Y |
4 Y |
5 Y |
6 Y |
7 Y |
8 Y |
9 Y |
10 Y |
11 Y |
12 Y |
13Y |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Month/Year → | June 2011 | Aug 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
| A) Clinical parameters | |||||||||||||||
| Weakness | 2 | 2 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Dysphagia | 2 | 2 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Dysuria | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Stomatitis | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| PR bleeding | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Constipation | 2 | 2 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Black stool | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Leg Pain | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Loss of appetite | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Trismus | 3 | 2 | 2 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Indistinct speech | 3 | 3 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 1 | 1 |
| B/L LL Neuritis | 1 | 2 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Pain | 6 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Weight (Kg) | 65 | 55 | 59 | 65 | 67.6 | 65.4 | 63.3 | 62.5 | 64.2 | 63.6 | 62.9 | 64.3 | 63.5 | 63.4 | 65.4 |
| Karnofsky Performance Score (KPS) | 80 | 80 | 80 | 100 | 90 | 100 | 100 | 90 | 100 | 100 | 90 | 100 | 100 | 100 | 100 |
| Functional Score from QLQ C30 | 73.33 | 93.33 | 93.33 | 86.67 | 86.67 | 84.4 | 100 | 80 | 77.78 | 75.56 | 80 | 80 | 75.56 | 88.89 | 73.33 |
| Symptom Score from QLQ C30 | 28.20 | 12.82 | 12.82 | 5.21 | 5.21 | 7.69 | 0 | 10.26 | 12.82 | 12.82 | 15.38 | 28.20 | 20.51 | 2.56 | 17.95 |
| Global Score from QLQ C30 | 41.67 | 58.33 | 58.33 | 83.3 | 83.3 | 83.3 | 83.33 | 83.3 | 66.67 | 66.67 | 75 | 58.33 | 66.67 | 66.67 | 83.33 |
| QLQ H&N 35 | 123.08 | 76.92 | 76.92 | 84.62 | 92.31 | 87.18 | 53.85 | 92.31 | 92.31 | 97.44 | 100 | 97.44 | 120.51 | 97.44 | 115.8 |
| B) Haematological parameters | |||||||||||||||
| Hb ∗(12–16 g/dl) | 12.40 | 10.50 | 12.60 | – | 13.8 | 12.7 | 12.20 | 12.6 | 12.70 | 13.2 | – | – | 13.0 | 13.40 | 13.6 |
| WBC ∗(4000–11000/cmm) | 3700 | 19800 | 5300 | – | 6640 | 6400 | 6700 | 5700 | 6300 | 6700 | – | – | 6000 | 6350 | 5100 |
| Platelets ∗(150–450 x 103/cmm) | 252 | 329 | 203 | – | 238 | 221 | 220 | 254 | 237 | 255 | – | – | 238 | 260 | 280 |
| S. Bilirubin ∗(0–1.2 mg/dl) | 0.93 | 0.76 | – | – | 0.78 | – | 0.5 | 0.55 | – | – | – | – | – | 1.09 | – |
| SGOT ∗(0–31 U/L) | 28 | 27 | – | – | 24.1 | – | 17 | 14.3 | – | – | – | – | – | 16.76 | – |
| SGPT ∗(0–32 U/L) | 30 | 26 | – | – | 22.6 | – | 19 | 18.1 | – | – | – | – | – | 12.15 | – |
| S. Alkaline phosphatase ∗(44–147 U/L) | 62 | 93 | – | – | 76.9 | – | 102 | 88.1 | – | – | – | – | – | 104.62 | – |
| S. Creatinine ∗(0.7–1.7 mg/dl) | 0.8 | 0.8 | – | – | – | – | 0.90 | 0.90 | 0.90 | 0.90 | – | – | 1.22 | 0.76 | 0.99 |
| Total Cholesterol ∗(130–220 mg/dl) | – | – | – | – | 181 | 202 | 191 | 202 | 213 | 207 | – | – | 200 | 235.55 | 228 |
| HDL ∗(35–55 mg/dl) | – | – | – | – | 50.90 | 50.8 | 60.6 | 50 | 51.2 | 56.2 | – | – | – | 56.15 | 42 |
| LDL ∗(110–140 mg/dl) | – | – | – | – | 106 | 125 | 107 | 132 | 138 | 123 | – | – | – | 161.69 | 159.6 |
| Triglycerides ∗(50–200 mg/dl | – | – | – | – | 119 | 132 | 119 | 98 | 119 | 137 | – | – | – | 88.54 | 132 |
| Total T3 ∗(70–204 ng/dL), T3 ∗(0.58–1.59 ng/mL) | – | 0.76 | 76.40 | 0.78 | 122 | – | 0.982 | 81 | 0.976 | – | – | 0.80 | 2.25 | 0.805 | |
| T4 ∗(5.13–14.06 μg/dl) | – | 4.28 | 4.50 | 5.61 | 8.15 | – | 7.79 | – | 8.0 | 7.19 | – | – | 6.38 | 1.27 | 7.71 |
| TSH ∗(0.4–4.0 mIU/dl) | – | 26.20 | 33.750 | 7.04 | 5.070 | – | 1.77 | – | 1.710 | 2.33 | – | – | 8.64 | 8.67 | 11.31 |
| FBS ∗(70–110 mg/dl) | 116 | 151 | 95 | – | 109 | 117 | 96 | 99 | 110 | 119 | – | – | 131 | 134.81 | 124 |
∗Indicates normal range of haematological and biochemical parameters.
The patient's regular check-ups, including clinical exams and various tests, showed gradual improvement and disease control. Their Karnofsky Performance Score and Quality of Life [using QLQ C30 and QLQ H&N 35 of the European Organization for Research and Treatment of Cancer (EORTC)] were evaluated annually and found to improve and remain stable. Assessing their Quality of Life periodically revealed an increase in functioning and overall well-being, as well as a decrease in symptoms related to head and neck cancer. Overall, these findings indicate that the patient's well-being improved after cancer treatment.
The latest follow-up was taken on 2nd May 2025 when patient visited the clinic. She is asymptomatic and continued with oral ayurvedic medicines.
6. Discussion
Oral cancer rates have risen and treatment outcomes remain poor due to the cancer spreading and invading aggressively [6]. Chronic irritation to the tongue, caused by poorly fitting devices or sharp teeth, increases the risk of developing oral squamous cell carcinoma on the side of the tongue [7]. In this specific case, the ongoing trauma from a partially extracted tooth likely led to long-term inflammation on the side of the tongue. Studies show that specific genetic variations in TNF-α and IL-6 can cause an increased inflammatory response, potentially leading to cancer development at the site of inflammation [8].
Recurrence is an important prognostic indicator for patients with OSCC, with a 5-year survival rate of 92% and 30% and median survival times of 76.8 and 42.5 months, respectively, for patients without and with recurrence [9]. Patients with OSCC who experience post-operative tumor recurrence have a poor prognosis and low QoL, which impact their DFS [10]. This case had a PFS of 12 years and a high QoL. This may be attributed to combining conventional cancer treatment with an aptly selected multimodal Ayurvedic regimen [Table 1].
Several studies have examined the risks of first-degree relatives developing familial oral squamous cell carcinoma (OSCC) as an autosomal dominant disease, with odds ratios ranging from 1.1 to 9.25 [11]. The presence of tumors in families with different lifestyles, early onset in individuals without risk factors, and clustering of tumor sites in families suggest a genetic syndrome associated with OSCC [12]. In this case, the patient's father had a history of oropharyngeal cancer, leading to the hypothesis that the susceptibility to oral cancer is inherited in her family. Further genetic studies, such as sequencing or polymorphism studies of genes like TP53, CD44, VAV2, IQGAP1, etc., could provide more insights into this factor.
It is important to investigate if female sex hormones and other endocrine hormones have a role in the development of oral cancer in a non-smoking, non-drinking female. Sex hormones are believed to affect genes involved in cancer and biological processes. Previous studies have shown that impaired oestrogen metabolism may increase the risk of oral cancer. Tongue cancer patients have been found to have imbalances in hormones related to the pituitary-adrenal-testicular axis. Furthermore, the patient in this case was of pre-menopausal age, suggesting that hormonal imbalances could be a factor [13,14].
In 2019, the patient developed white patches on the hard palate, known as leucoplakia. Leucoplakia appears as non-removable white plaques on the tongue's surface. It has a low chance of becoming cancerous, and it is recommended to remove it through various techniques [15]. In this particular case, the white patches likely disappeared after applying turmeric and honey topically for 3 months. No surgical excision was required.
From an Ayurvedic standpoint, several factors contributed to the digestive impairment observed in this case, including distracted eating habits or consumption of stale food, leading to a disturbance in digestive power. Vatadosha was aggravated by frequent fasting or an anxious disposition and occupational stress, while Pittadosha was exacerbated by the regular intake of hot, pungent foods (pickles, papads, green chilies, tea, and bakery products). Kaphadosha imbalance primarily stemmed from the consumption of heavy, sweet foods coupled with a sedentary lifestyle or lack of exercise. Additionally, the patient's history of recurrent trauma, such as repeated tooth extractions, and a positive family history of cancer must be considered. Moreover, patient had undergone first-line surgery and radio-chemotherapy at the time of enrolment. Hence, the patient had some side effects of conventional treatment due to their acting principles or qualities like hot (Ushna), penetrating (Tikshna), and fast acting (Vyavayi and Vikasi) qualities, which could lead to vitiation of Rakta and Mamsadhatu. Hence, the Ayurvedic line of treatment was decided on the basis of diagnosis as Mamsaja Granthi (Tridosha dushti) over left lateral border of tongue and side effects of conventional treatment. Therefore, Ayurvedic treatment aimed at reducing vitiated three doshas, and impairment at pathogenesis site (Sthanadushti). Since the site of disease is oral cavity and tongue, which have predominance of Kapha (Bodhaka - one of the types of Kapha which resides in oral cavity), and Rakta, Mamsa dhatu. Hence, an Ayurvedic treatment containing combination of herbs, minerals, and metals, possessing Tikta, Kashaya, Madhura rasa was administered internally as well as externally in the form of Gandusha and Mukhapratisarana, aimed to alleviate dosha-dhatu dushti and maintain oral health. Specifically, Yashtimadhu Ghruta, Vasadi Vati, and Sukshma Triphala primarily target the Adhisthana, while Arogyavardhini and Sukshma Triphala address the disease (Vyadhipratyanika- Granthi). When considering Dhatudushti, Mahamanjisthadi Vati, Liv Atharva, and Pipplyasava, they work on vitiated Raktadosha, while Arogyavardhini focuses on vitiated Mamsadhatu. Yashtimadhu Ghruta eradicates vitiated three dosha. Through this approach, all the prescribed sets of medicines effectively target Dosha-dushya, Vyadhi, and Adhisthana (Jivha). Additionally, the Panchakarma treatment is used to purify the body by getting rid of imbalanced Dosha. This treatment helps maintain balance in the body by improving digestion, reducing toxicity, and providing anti-inflammatory benefits. It also has immunomodulatory effects and enhances the body's tissues. The specific drugs and their ingredients used in this treatment are explained in Table 1.
The patient began treatment for various purposes including treating ulcers, inflammation, tumors, and promoting skin regeneration. The treatment also aimed to alleviate the side effects of chemotherapy. After the first set of medicines Yashtimadhu Ghrut [19, 5/16–18, 1/145–146], Shatavari Vati [19, 3/186–188], and Ananta Vati [19, 3/238], the patient experienced improved appetite and reduced pain. In the second set, Suvarna Bhasmadi Vati (SBD) [19, 3/258; 20, Part 1/90,141] was added to prevent the recurrence of the disease as well as to address specific symptoms such as weakness, peripheral neuritis and, excessive salivation. In the third set, Aarogyavardhini (AV) [20, Part 2/27], Mahamanjishtadi Ghana vati [19, 1/42–43,103,190–191,197], orally and Paribhadra taila [19, 3/96, 19/2–6] were included to treat dry eczema over the legs, which indicative of Rakta and Mamsadushti [21]. She responded well to the above set of medicines. Vasadi vati was added intermittently, as the patient complained of rhinorrhoea. As Nasagata mala (nasal discharge) is considered as excretory part of the Mamsadhatu (Singhanaka- Mamsadhatu Khamala) [19, 3/89–90, 2/116, 1/145–146]. In the fourth set, SBD was replaced by Suvarna Malini Vasant (SMV) [20, Part 5/6,22] due to the patient's significant weight gain. Mauktika Yukta Kamduddha (MKD) [20, Part 1/90, Part 2/51] and Sukshma Triphala [19, 1/42–43; 20, Part 2/43] were added to address symptoms of stomatitis, vertigo, and a wound in the oral cavity.
During the patient's fifth round of medicine, she was treated with Praval [20, Part 1/70], Liv Atharva Liquid (LA) [19, 3/229–230], and Pippalyadyasav (PLA) [20, Part 5/93] for excessive salivation. In the sixth round, the patient experienced joint pain, so she was given Mashadi Vati [19, 8/41–43, 3/8–10, 3/62–63, 1/44–48, 1/75–77] and Shatavari Kalpa [19, 3/186–188; 23]. Despite Shatavari Kalpa being sugar-based, the patient's blood sugar levels remained normal [23]. In the seventh round, the patient's dizziness persisted, hence Suvarna Sootshekhar [20, Part 1/141, Part 5/11; 27] was used instead of SMV. Her symptoms improved with Suvarna Sutshekhar (SSS) as well as with Tab. vertin. Her recovery was more prompt after adding SSS. The administration of Suvarna Bhasma over 10 years helped prevent recurrence or metastasis due to its immunomodulatory properties [24]. Overall, the combination of these medications improved the patient's overall health, as indicated by her ECOG and Karnofsky scores. (Table 2a, Table 2b).
Table 2b.
Periodic radiological evaluation of the patient.
| Status and duration of OAM→ | Month/Year → | MRI Neck | CT Neck/PNS/Brain | ||
|---|---|---|---|---|---|
| Beginning of OAM and ongoing chemotherapy | 2011 | 03-06-2011 | Abnormally altered signal intensity is seen in the halt of the tongue involving the anterior, middle, and posterior parts measuring 4.5 × 6.0 × 3 cm (SI × AP × ML). This is hypointense on T1W and hyperintense on STIR sequence. Deviation of the tongue is seen |
– | |
| End of chemotherapy | 2011 | 05-08-2011 | An area of altered signal intensity involving the anterior third of the tongue on the left side 2.7 × 4.0 cms suggestive of residual disease. As compared to previous MRI scan dated June 03, 2011, the lesion has significantly regressed in size and extent. |
– | |
| 1 Y | 2012 | – | 20-12-2012 | No residual/recurrent lesion, a 2.5 × 1.9 cm low soft tissue lesion with tiny calcific foci within is seen in the occipital scalp without erosion of adjacent bone, represents a sebaceous cyst. | |
| 5 Y | 2016 | – | 04-05-2016 | Myocutaneous flap with fatty infiltration within is seen at the site of the tongue. Focal severe narrowing of the left ICA at the origin due to calcified plague. | |
| 11 Y | 2022 | – | 07-07-2022 | Multiple calcified hypodense lesions largest 5.6 × 4.7 × 7.6 cm in left occipital scalp region – likely benign etiology -? Calcified sebaceous cysts. | |
| 12 Y | 2023 | 8-04-2023 | PET CT- Three subcutaneous nodular lesions in the scalp- likely benign/ calcified nodular scalp. No abnormality detected elsewhere in the body. | ||
Panchakarma (Table 1) was used to eliminate toxins from the body, and it was accompanied by oil-based therapies, a strict diet, and lifestyle changes [25,26]. Additional measures like Gandusha and Mukhapratisaran were prescribed timely to maintain oral health. These procedures cleanse the mouth, balance oral pH, and improve blood flow, which helps reduce inflammation and promote healing [17,27].
Table 2a, Table 2b presents a summary of the adverse effects experienced by the patients with Head and Neck cancer who received radiotherapy and chemotherapy, as assessed by the QLQ-C30 and QLQ-H&N35 questionnaires. Some adverse effects, such as weakness, sticky saliva, insomnia, dysphagia, xerostomia, pain, and peripheral neuritis, returned to normal levels after treatment. However, symptoms like emotional dysfunction, trismus, indistinct speech, and deterioration of teeth continued to persist. The patient's well-being and quality of life improved over 12 years of adjunct Ayurvedic treatment, as evidenced by improved functional and global scores, decreased symptom scores, and improved Karnofsky Performance Status. In 2016, all scores were normal, but in 2017, the Symptom score increased due to excessive salivation and joint pains. In 2022, the patient had an infected scalp fibroma, leading to an increase in the Symptom score, but this resolved in a few months. Radiological investigations showed no disease progression or recurrence, and the patient's hematological, liver, and kidney function tests were all within normal range, indicating no toxicity from long-term Ayurvedic medicines.
7. Patient perceptive
It was recorded on 9th May 2022 as below:
“I am a resident of Mumbai. Just before my Surgery in 2011, I consulted at this center in Mumbai. I was afraid of Surgery so I requested to heal me through Ayurvedic medicines. The Ayurvedic doctors told me that by taking Ayurvedic medicines I would be able to maintain my health and my quality of life will improve and I can take both medicines simultaneously. Accordingly, in August 2011, I was operated wherein some part of my gums was also removed. My face contour and pronunciation were deformed. My speech was not interpretable. My diet had also altered.
In 2011, I started Ayurvedic treatment from Dr. SPS. Now I am feeling much better. Along with medicines I was also recommended dietary changes which helped me to give energy. I can do all household chores with ease. I have regular follow-ups every month. Since 2011, my health has now maintained. I have overcome the fear of Cancer. In 2013, I visited their Centre for 21 days of Panchakarma treatment.
Back then in 2007, I had got information on Ayurvedic treatment given by Dr SPS. During that period, I had been operated and was feeling much better. I didn't feel the need to start any medication. I sometimes regret my decision. I feel if I had started Ayurvedic medicines in 2007, I could have avoided the recurrence in 2011. I would be spared of dietary and speech problems that I faced due to the operation in 2011. From my experience, I feel that if anybody is diagnosed with cancer, do not panic. If you start Ayurvedic treatment along with Allopathy the chances of recurrence will minimize. Ayurvedic treatment will improve your immunity and quality of life.”
8. Informed consent
Informed consent was taken from the patient before the treatment and for publishing her details.
9. Conclusion
In this case, a patient with stage III squamous cell carcinoma of the tongue chose not to receive any additional cancer treatment after starting Ayurvedic therapy. However, we believe that the 12 years of progression-free survival with good quality of life, without any additional cancer therapy, can be attributed to the combination of conventional treatment with anti-inflammatory, immunomodulatory, and anti-cancer effects of the oral Ayurvedic medicines and detoxifying Panchakarma treatment.
Sources of funding
None.
Author contribution
SS, VD, developed the concept of integration of Ayurvedic treatment in cancer patients undergoing conventional treatments; SS, VD, VG, SK, and SG investigated the patient as well as visualized, and validated the data curated. All authors were involved in designing the methodology of Ayurvedic and modern treatment for this patient, data curation as well as analysis of data. SD, SB, VD, and SC wrote the original manuscript while the final manuscript was approved by all the authors.
Declaration of generative AI in scientific writing
During this work, author did not use AI tools in writing the draft of the paper.
Conflict of interest
We declare that a few medicines used in this patient are part of a patent filed and published (Indian Patent File No. 202021030193- Published, PCT Application No. PCT/IB2021/056285- Published, US Patent File No. 18/015,577) for radiotherapy side effects treatment.
Acknowledgement
The authors acknowledge the support of our team in the treatment and follow-up of this patient.
Footnotes
Peer review under responsibility of Transdisciplinary University, Bangalore.
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