Zhu Guopei, He Shaoqin, Fu Xiaolong, Jiang Guoliang, Liu Taifu
Department of Radiation Oncology, Cancer Hospital of Fudan University, Shanghai, China.
Int J Radiat Oncol Biol Phys. 2004 Nov 15;60(4):1113-9. doi: 10.1016/j.ijrobp.2004.05.013.
To assess the factors that predict local control and survival in patients with thymoma treated with adjuvant radiotherapy (RT) and suggest strategies for optimizing adjuvant RT.
The study population comprised 47 patients with noninvasive thymoma and 128 patients with invasive thymoma. Treatment was surgery in 175 patients and radiotherapy in 169 patients; 25 patients also received adjuvant chemotherapy. The clinical factors (age, histologic features, stage, presence of myasthenia gravis) and therapeutic factors (extent of operation, irradiation dose, and field size) were retrospectively recorded and accessed using multivariate analysis.
The overall survival rate at 5 and 10 years was 86.4% and 80.6%, respectively. Only 2 patients had a relapse in the noninvasive group. None died of thymoma during the study period. The patients with invasive disease had a 5- and 10-year disease-free survival rate of 64.4% and 55.6%, respectively, with 24 intrathoracic failures, 14 extrathoracic failures, and 8 combined failures. The univariate and multivariate analyses showed that Mosaoka stage and extent of resection were the important prognostic factors for patient with invasive thymoma. The 5-year survival rate and local control rate was 96% and 96% for Stage II, 77.8% and 56.4% for Stage III, 56.6% and 42.7% for Stage lVa, and 35.6% and 21.6% for Stage IVb (p < 0.0001 among different stage groups), respectively. The 5-year local control rate in patients with the tumor bed irradiated was 68.2%, comparable to the group treated with an extended RT field (66.6%). Age, histopathologic findings, radiation dose, and presence of myasthenia gravis were not statistically significant prognostic factors.
Disease stage and extent of resection affected the prognosis of invasive thymoma patients. Extending the radiation field prophylactically was not associated with greater local control and is of questionable value for patients with invasive thymoma.
评估接受辅助放疗（RT）的胸腺瘤患者局部控制和生存的预测因素，并提出优化辅助放疗的策略。
研究人群包括47例非侵袭性胸腺瘤患者和128例侵袭性胸腺瘤患者。175例患者接受手术治疗，169例患者接受放疗；25例患者还接受了辅助化疗。回顾性记录临床因素（年龄、组织学特征、分期、重症肌无力的存在情况）和治疗因素（手术范围、照射剂量和野大小），并采用多因素分析进行评估。
5年和10年总生存率分别为86.4%和80.6%。非侵袭性组仅有2例复发。研究期间无患者死于胸腺瘤。侵袭性疾病患者的5年和10年无病生存率分别为64.4%和55.6%，有24例胸内复发、14例胸外复发和8例联合复发。单因素和多因素分析显示，Masaoka分期和切除范围是侵袭性胸腺瘤患者重要的预后因素。Ⅱ期患者的5年生存率和局部控制率分别为96%和96%，Ⅲ期为77.8%和56.4%，Ⅳa期为56.6%和42.7%，Ⅳb期为35.6%和21.6%（不同分期组间p<0.0001）。肿瘤床接受照射的患者5年局部控制率为68.2%，与扩大放疗野治疗组（66.6%）相当。年龄、组织病理学结果、放射剂量和重症肌无力的存在情况不是具有统计学意义的预后因素。
疾病分期和切除范围影响侵袭性胸腺瘤患者的预后。预防性扩大放疗野与更好的局部控制无关，对侵袭性胸腺瘤患者的价值存疑。
