Ambrogi Marcello Carlo, Korasidis Stylianos, Lucchi Marco, Fanucchi Olivia, Giarratana Silvia, Melfi Franca, Mussi Alfredo
Division of Thoracic Surgery, Department of Surgical Medical Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy.
Division of Thoracic Surgery, Department of Surgical Medical Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
Eur J Cardiothorac Surg. 2016 Jan;49(1):321-6. doi: 10.1093/ejcts/ezv039. Epub 2015 Feb 9.
Recurrences of thymoma are described in 10-30% of cases up to 10 years after surgical resection. Herein we report our experience with surgical removal of pleural recurrences followed by hyperthermic intrathoracic perfusion chemotherapy (HITHOC).
We prospectively collected data of patients with pleural recurrence of thymoma who underwent surgery followed by HITHOC. After thoracotomy had been closed, drainages were connected to a dedicated perfusion machine, pleural space was filled with saline solution, progressively heated up to 42.5°C. At this time, chemotherapeutic agents (Doxorubicin and Cisplatin) were injected and perfusion lasted 60 min.
In the period 2005-2012, 13 consecutive patients have been treated (8 males, 5 females, mean age 46 years). Initial Masaoka-Koga stage was 2 IIa, 5 IIb, 5 III, 1 IVa. Disease-free interval was 47.2 months on average [standard deviation (SD): 25.5]. Nine patients presented paraneoplastic syndromes (8 myasthenia gravis and 1 red cell aplasia). Complete resection was achieved in all cases except one. HITHOC was successfully performed in all cases and no signs or symptoms of toxicity were recorded in the perioperative period. With a mean follow-up period of 64.6 months (SD: 32.5), 1 patient died for toxicity following systemic chemotherapy, another one died disease-free, 4 patients developed pleural relapses (2 ipsilateral, 2 contralateral) and 1 mediastinal and abdominal nodal metastases. Mean survival was 58 months [SD: 34.4), median survival by the Kaplan-Meier method was not reached while 5-year actuarial survival was 92%.
HITHOC was shown to be feasible and safe. In terms of efficacy, it seems promising but multicentre studies and a longer follow-up period are required to ascertain its effectiveness.
在手术切除后长达10年的时间里，胸腺瘤复发率为10% - 30%。在此，我们报告手术切除胸膜复发灶并随后进行胸腔内热灌注化疗（HITHOC）的经验。
我们前瞻性收集了接受手术及HITHOC治疗的胸腺瘤胸膜复发患者的数据。开胸手术关闭后，将引流管连接至专用灌注机，向胸膜腔内注入生理盐水溶液，逐步加热至42.5°C。此时，注入化疗药物（阿霉素和顺铂），灌注持续60分钟。
在2005 - 2012年期间，连续治疗了13例患者（8例男性，5例女性，平均年龄46岁）。初始Masaoka - Koga分期为2例IIa期、5例IIb期、5例III期、1例IVa期。无病生存期平均为47.2个月[标准差（SD）：25.5]。9例患者出现副肿瘤综合征（8例重症肌无力和1例纯红细胞再生障碍）。除1例患者外，所有病例均实现了完全切除。所有病例均成功进行了HITHOC，围手术期未记录到毒性的体征或症状。平均随访期为64.6个月（SD：32.5），1例患者因全身化疗毒性死亡，另1例患者无病生存死亡，4例患者出现胸膜复发（2例同侧，2例对侧），1例出现纵隔和腹部淋巴结转移。平均生存期为58个月[SD：34.4]，采用Kaplan - Meier法未达到中位生存期，5年精算生存率为92%。
HITHOC被证明是可行且安全的。在疗效方面，它似乎很有前景，但需要多中心研究和更长的随访期来确定其有效性。
