Mangi Abeel A, Wain John C, Donahue Dean M, Grillo Hermes C, Mathisen Douglas J, Wright Cameron D
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Ann Thorac Surg. 2005 Jun;79(6):1834-9. doi: 10.1016/j.athoracsur.2004.12.051.
The criteria for administration of adjuvant radiation therapy after thymoma resection remains controversial, and it is unclear whether patients with Masaoka stage III thymoma benefit from adjuvant radiation. The goal of this report was to determine whether or not this group benefits from radiation therapy in disease-specific survival and disease-free survival.
Case records of the Massachusetts General Hospital were retrospectively reviewed from 1972 to 2004. One hundred and seventy-nine patients underwent resection for thymoma, of which 45 had stage III disease.
Forty-five stage III patients underwent resection and in 36 it was complete. Thirty-eight stage III patients received radiation therapy. Baseline prognostic factors between radiated and nonradiated groups were similar. The addition of adjuvant radiotherapy did not alter local or distant recurrence rates in patients with stage III thymoma. Disease-specific survival at 10 years in stage III patients who did not receive radiation was 75% (95% confidence interval, 32% to 100%) and in patients who did receive radiation therapy it was 79% (95% confidence interval, 64% to 94%) (p = 0.21). The most common site of relapse was the pleura.
Most patients who have stage III thymoma undergo complete resection. Some patients enjoy prolonged disease-free survival without adjuvant radiation after resection of stage III thymoma. Radiation does not seem to prevent pleural recurrences when given after resection of stage III thymomas. The use of routine adjuvant radiation after a complete resection of stage III thymoma needs to be re-addressed. There may be a role for the use of chemotherapy to reduce pleural recurrences.
胸腺瘤切除术后辅助放疗的标准仍存在争议，Masaoka III期胸腺瘤患者是否能从辅助放疗中获益尚不清楚。本报告的目的是确定该组患者在疾病特异性生存和无病生存方面是否能从放疗中获益。
回顾性分析了1972年至2004年马萨诸塞州总医院的病例记录。179例患者接受了胸腺瘤切除术，其中45例为III期疾病。
45例III期患者接受了手术，36例手术完整。38例III期患者接受了放疗。放疗组和未放疗组的基线预后因素相似。辅助放疗的加入并未改变III期胸腺瘤患者的局部或远处复发率。未接受放疗的III期患者10年疾病特异性生存率为75%（95%置信区间，32%至100%），接受放疗的患者为79%（95%置信区间，64%至94%）（p = 0.21）。最常见的复发部位是胸膜。
大多数III期胸腺瘤患者接受了完整切除。一些患者在III期胸腺瘤切除术后未接受辅助放疗的情况下仍享有较长的无病生存期。III期胸腺瘤切除术后放疗似乎无法预防胸膜复发。III期胸腺瘤完整切除后常规辅助放疗的使用需要重新审视。化疗在减少胸膜复发方面可能有作用。
