Wang Changlu, Gao Lanting, Fang Wentao
Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
Mediastinum. 2019 Mar 4;3:7. doi: 10.21037/med.2019.02.01. eCollection 2019.
To investigate the effect of two modalities, radiotherapy (RT) and surgery plus entire hemithoracic radiotherapy (EHRT), on stage IVa thymoma. Patients enrolled in this study meet the following criteria: histologically proven thymoma; primary stage IVa or pleural dissemination after initial curative treatment. One treatment modality is intensity-modulated radiotherapy (IMRT) for pleural lesions with a dose ranging from 30-50 Gy, the other is macroscopically surgical resection plus EHRT with a dose of 13 Gy in 13 fractions. From July 2012 to April 2018, there were totally 56 patients enrolled in this study. The median age was 45 years old (range, 20-75 years old). There were 35 male and 21 female patients. The histology subtype distribution was 1 AB, 8 B1, 20 B2 and 27 B3, respectively. Thirty-one patients received IMRT for pleural dissemination and the response rate (CR + PR) was 97%. The mean local control time was 40 months (95% CI, 32.6-47.3 months). The in-field and out-field recurrence were 32% and 94%, respectively. The 2-year progression free survival (PFS) was 18%. While for patients who were treated by surgery plus EHRT, the in- and out-field recurrence were 8% and 16%, respectively. The 2-year PFS was 40%. The 2-year PFS for B1, B2 and B3 were 20%, 50% and 23%, respectively (P=0.255). Major toxicity occurred in IMRT group, 5 died of radiation-induced pneumonitis. Both IMRT and surgery plus EHRT showed good local control for stage IVa thymoma. Since stage IVa thymoma has a tendency to involve the whole hemithorax, surgery plus EHRT has a potential to produce longer PFS.
为研究两种治疗方式，即放射治疗（RT）和手术加全胸段放疗（EHRT），对IVa期胸腺瘤的疗效。本研究纳入的患者符合以下标准：组织学确诊为胸腺瘤；初始根治性治疗后为原发性IVa期或胸膜播散。一种治疗方式是对胸膜病变进行调强放射治疗（IMRT），剂量范围为30 - 50 Gy，另一种是肉眼可见的手术切除加EHRT，剂量为13 Gy，分13次。2012年7月至2018年4月，本研究共纳入56例患者。中位年龄为45岁（范围20 - 75岁）。男性35例，女性21例。组织学亚型分布分别为1例AB型、8例B1型、20例B2型和27例B3型。31例患者因胸膜播散接受IMRT，缓解率（CR + PR）为97%。平均局部控制时间为40个月（95%CI，32.6 - 47.3个月）。野内和野外复发率分别为32%和94%。2年无进展生存率（PFS）为18%。而接受手术加EHRT治疗的患者，野内和野外复发率分别为8%和16%。2年PFS为40%。B1、B2和B3型的2年PFS分别为20%、50%和23%（P = 0.255）。主要毒性反应发生在IMRT组，5例死于放射性肺炎。IMRT和手术加EHRT对IVa期胸腺瘤均显示出良好的局部控制。由于IVa期胸腺瘤有累及整个半胸的倾向，手术加EHRT有可能产生更长的PFS。
