Lucchi Marco, Ambrogi Marcello Carlo, Duranti Leonardo, Basolo Fulvio, Fontanini Gabriella, Angeletti Carlo Alberto, Mussi Alfredo
Division of Thoracic Surgery, Cardiac and Thoracic Department, University of Pisa, Pisa, Italy.
Ann Thorac Surg. 2005 Jun;79(6):1840-4. doi: 10.1016/j.athoracsur.2004.12.047.
With the aim of evaluating the results of multidisciplinary approaches, we reviewed our experience in multimodality treatment of advanced stage (III and IVA) thymic tumors.
From 1976 to 2003, 56 patients with Masaoka stage III and IVA thymic tumors underwent a multimodality treatment. Thirty-six patients underwent neoadjuvant chemotherapy, surgery, and postoperative radiotherapy; 20 patients were treated by primary surgery and postoperative radiotherapy (n = 12), chemotherapy (n = 1) or chemoradiotherapy (n = 7). The neoadjuvant or adjuvant chemotherapy consisted of three courses of cisplatin, epidoxorubicin, and etoposide every 3 weeks. Adjuvant radiotherapy consisted of 45 Gy for complete resections or 60 Gy for incomplete resections.
The preoperative diagnosis of invasive thymomas was performed in a total of 29 cases: 15 by mediastinotomy, 6 by video-assisted thoracoscopic surgery, and 8 by fine-needle aspiration. In 27 cases no diagnosis was available, but in most of them a thymus-related syndrome was present. Thirty-four patients are still alive (31 disease-free), and 22 have died (2 disease-free). Ten-year survival was 48% and 45.7% for stage III and IVA thymomas, respectively. The presence of myasthenia gravis (p = 0.04) and neoadjuvant chemotherapy (p = 0.004) affected survival significantly.
The multimodality treatment of stage III and IVA thymic tumors allows a good long-term outcome; the neoadjuvant chemotherapy improves the resectability rate and the survival of both stages of the disease.
为了评估多学科治疗方法的效果，我们回顾了我们在晚期（III期和IVA期）胸腺瘤多模式治疗方面的经验。
1976年至2003年，56例Masaoka III期和IVA期胸腺瘤患者接受了多模式治疗。36例患者接受了新辅助化疗、手术和术后放疗；20例患者接受了初次手术和术后放疗（n = 12）、化疗（n = 1）或放化疗（n = 7）。新辅助或辅助化疗每3周进行三个疗程的顺铂、表柔比星和依托泊苷。辅助放疗对于完全切除的患者为45 Gy，对于不完全切除的患者为60 Gy。
共29例患者术前诊断为浸润性胸腺瘤：15例通过纵隔切开术诊断，6例通过电视辅助胸腔镜手术诊断，8例通过细针穿刺诊断。27例患者未得到诊断，但其中大多数存在胸腺相关综合征。34例患者仍存活（31例无病生存），22例患者死亡（2例无病生存）。III期和IVA期胸腺瘤的10年生存率分别为48%和45.7%。重症肌无力的存在（p = 0.04）和新辅助化疗（p = 0.004）对生存有显著影响。
III期和IVA期胸腺瘤的多模式治疗可获得良好的长期疗效；新辅助化疗提高了疾病两个阶段的可切除率和生存率。
