Srirajaskanthan R, Toubanakis C, Dusmet M, Caplin M E
Neuroendocrine Tumour Unit, Department of Gastroenterology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
The Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Lung Cancer. 2008 Apr;60(1):4-13. doi: 10.1016/j.lungcan.2008.01.014. Epub 2008 Mar 17.
Tumours of the thymus are uncommon and are generally regarded as being indolent. Whilst this is often true of thymomas; thymic adenocarcinoma and thymic neuroendocrine cancer can be aggressive and have a poor prognosis. Understanding the biology of these tumours is important for prognosis and management. The pathological features of these tumours are examined in detail. Imaging modalities for aiding in diagnosis and staging of these tumours are described; this includes CT and MRI, plus more recent advances including the use of FDG-PET and Indium-111 Octreotide scintigraphy. The treatment options available including curative surgery, debulking surgery, chemotherapy, somatostatin analogues and peptide receptor radionuclide therapy are discussed. The optimal chemotherapy regimens are still unclear, although promising results have been obtained with platinum-based chemotherapy. The role for adjuvant therapy in both thymic carcinoma and thymoma is unclear except, in patients with stage I thymomas. There is a high expression of somatostatin receptors in thymic tumours and anti-tumour benefit has been reported in patients treated with somatostatin analogues. A new development is the role of peptide receptor radionuclide therapy. This has become an established therapy in management of gastroenteropancreatic neuroendocrine tumours and its use has been recently described in case reports in both thymoma and thymic carcinoma.
胸腺肿瘤并不常见，通常被认为生长缓慢。虽然胸腺瘤大多如此，但胸腺腺癌和胸腺神经内分泌癌可能具有侵袭性，预后较差。了解这些肿瘤的生物学特性对于预后和治疗管理很重要。本文详细研究了这些肿瘤的病理特征。描述了有助于这些肿瘤诊断和分期的影像学检查方法，包括CT和MRI，以及包括使用FDG-PET和铟-111奥曲肽闪烁扫描在内的最新进展。讨论了现有的治疗选择，包括根治性手术、减瘤手术、化疗、生长抑素类似物和肽受体放射性核素治疗。尽管铂类化疗已取得了有前景的结果，但最佳化疗方案仍不明确。除了I期胸腺瘤患者外，辅助治疗在胸腺腺癌和胸腺瘤中的作用尚不清楚。胸腺肿瘤中生长抑素受体高表达，据报道，接受生长抑素类似物治疗的患者有抗肿瘤获益。肽受体放射性核素治疗是一个新进展。它已成为治疗胃肠胰神经内分泌肿瘤的既定疗法，最近在胸腺瘤和胸腺腺癌的病例报告中也有其应用的描述。
