Maury Jean Michel, Girard Nicolas, Tabutin Mayeul, Grima Renaud, Chalabreysse Lara, Pavlakovic Isabelle, Sayag-Beaujard Annie, Leroux Caroline, Souquet Pierre-Jean, Glehen Olivier, Tronc François
Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France; Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France.
Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France; Department of Respiratory Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France.
Lung Cancer. 2017 Jun;108:1-6. doi: 10.1016/j.lungcan.2017.02.014. Epub 2017 Feb 24.
Pleural recurrences are a hallmark of thymomas, and represent a challenge for multidisciplinary management. The purpose of this study was to assess the feasibility and the results in terms of morbidity, mortality and survival rates, of Intra-Thoracic Chemo-Hyperthermia (ITCH) for the treatment of pleural recurrences of thymomas.
Retrospective analysis of 19 consecutives patients between 1997 and 2015 treated by surgical cytoreduction (pleurectomy) followed by ITCH with 25mg/m of mitomycin, and 50mg/m of Cisplatin.
There were 8 men and 11 women with a median age of 44 years. ITCH was combined with pleurectomy alone in 4 (22%) patients, pleurectomy and wedge resections in 14 (74%) patients; 1 (5%) patient had a pleuropneumonectomy. There were no perioperative deaths, and 5 patients (26%) presented with postoperative complication, including 3 (16%) cases related to chemotherapy (one case of reversible grade 2 bone marrow aplasia, and 2 cases of reversible, acute kidney failure). The median length of stay in intensive care unit and hospital were 1day and 10days, respectively. After a median follow-up period of 39 months (range 10-127 months), median disease-free survival was 42 months. Five patients (26%) died during follow-up.
Our data indicate that ITCH is a feasible option for selected patients with pleural recurrence of thymomas. ITCH clearly provides long local control, without major safety issues, and prolonged survival may be achieved in selected patients. This therapeutic option should be discussed at a multidisciplinary tumor board.
胸膜复发是胸腺瘤的一个标志，也是多学科管理面临的一项挑战。本研究的目的是评估胸腔内热化疗（ITCH）治疗胸腺瘤胸膜复发的可行性以及在发病率、死亡率和生存率方面的结果。
回顾性分析1997年至2015年间连续19例接受手术细胞减灭术（胸膜切除术），随后接受ITCH治疗的患者，ITCH使用丝裂霉素25mg/m²和顺铂50mg/m²。
患者中男性8例，女性11例，中位年龄44岁。4例（22%）患者ITCH仅与胸膜切除术联合，14例（74%）患者ITCH与胸膜切除术及楔形切除术联合；1例（5%）患者接受了胸膜肺切除术。围手术期无死亡病例，5例（26%）患者出现术后并发症，其中3例（16%）与化疗相关（1例可逆性2级骨髓发育不全，2例可逆性急性肾衰竭）。重症监护病房和医院的中位住院时间分别为1天和10天。中位随访期39个月（范围10 - 127个月）后，无病生存期的中位数为42个月。5例（26%）患者在随访期间死亡。
我们的数据表明，ITCH对于选定的胸腺瘤胸膜复发患者是一种可行的选择。ITCH明显能提供长期的局部控制，且无重大安全问题，部分选定患者可能实现生存期延长。这种治疗选择应在多学科肿瘤讨论会上进行讨论。
