Iwasaki Yoshinobu, Ohsugi Shuji, Takemura Yoshizumi, Nagata Kazuhiro, Harada Hidehiko, Nakagawa Masao
Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602, Japan.
Chest. 2002 Dec;122(6):2249-52. doi: 10.1378/chest.122.6.2249.
We describe two patients with invasive thymomas who responded to high-dose chemotherapy followed by peripheral blood stem cell transplantation (PBSCT) combined with surgery and radiotherapy. The first patient was a 42-year-old man admitted to the hospital with chest pain, and the second patient was a 45-year-old man admitted with myasthenia gravis. Both patients had nonresectable thymomas (stage IVa) because of invasion of the aorta, pulmonary artery, or both, and dissemination to the pericardium. They initially received two cycles of chemotherapy consisting of adriamycin (40 mg/m(2), day 1), cisplatin (50 mg/m(2), day 1), vincristine (0.6 mg/m(2), day 3), and cyclophosphamide (700 mg/m(2), day 4) at 3-week intervals. Four weeks later, they were administered high-dose etoposide (300 mg/m(2), days 1 to 5) followed by granulocyte colony-stimulating factor (G-CSF) [50 micro g/m(2)/d] subcutaneously to mobilize stem cells into the blood. After two additional cycles of adriamycin, cisplatin, vincristine, and cyclophosphamide (ADOC), the patients received high-dose ifosfamide (1.5 g/m(2), days 1 to 4), carboplatin (400 mg/m(2), days 3 to 5), and etoposide (200 mg/m(2), days 1 to 5) followed by PBSCT. They were administered G-CSF (50 micro g/m(2)/d) after PBSCT, with subsequent rapid recovery of neutrophil and platelet level. The tumors shrank remarkably, and could be excised completely in both patients. Postoperatively, 50 Gy of irradiation was administered. Disease-free status has been maintained for 5 years in the first patient and 2 years in the second patient. Our findings suggest that high-dose ifosfamide, carboplatin, and etoposide followed by PBSCT in combination with an ADOC regimen, surgery, and radiotherapy is very effective and well tolerated in patients with advanced nonresectable thymoma.
我们描述了两名侵袭性胸腺瘤患者，他们在接受高剂量化疗后，接着进行外周血干细胞移植（PBSCT），并联合手术和放疗，取得了良好疗效。第一名患者是一名42岁男性，因胸痛入院；第二名患者是一名45岁男性，因重症肌无力入院。两名患者均因主动脉、肺动脉或两者均受侵犯且心包播散而无法切除胸腺瘤（IVa期）。他们最初接受了两个周期的化疗，化疗方案为阿霉素（40mg/m²，第1天）、顺铂（50mg/m²，第1天）、长春新碱（0.6mg/m²，第3天）和环磷酰胺（700mg/m²，第4天），每3周一个周期。4周后，给予高剂量依托泊苷（300mg/m²，第1至5天），随后皮下注射粒细胞集落刺激因子（G-CSF）[50μg/m²/天]，以动员干细胞进入血液。在另外两个周期的阿霉素、顺铂、长春新碱和环磷酰胺（ADOC）化疗后，患者接受高剂量异环磷酰胺（1.5g/m²，第1至4天）、卡铂（400mg/m²，第3至5天）和依托泊苷（200mg/m²，第1至5天），然后进行PBSCT。PBSCT后给予G-CSF（50μg/m²/天），随后中性粒细胞和血小板水平迅速恢复。肿瘤明显缩小，两名患者均能完全切除。术后给予50Gy的放疗。第一名患者无病生存状态已维持5年，第二名患者已维持2年。我们的研究结果表明，对于晚期不可切除胸腺瘤患者，高剂量异环磷酰胺、卡铂和依托泊苷后行PBSCT，联合ADOC方案、手术和放疗，疗效显著且耐受性良好。
