Resbeut M, Mornex F, Richaud P, Bachelot T, Jung G, Mirabel X, Marchal C, Lagrange J P, Rambert P, Chaplain G
Fédération nationale des centres de lutte contre le cancer, Paris, France.
Bull Cancer Radiother. 1995;82(1):9-19.
Thymomas is a rare disease. Staging systems and surgical adjuvant treatments remain controversial. We retrospectively reviewed the outcome and the prognostic factors in a series of 149 patients with non metastatic thymomas treated in ten French cancer centers between 1979 and 1990. Patients were staged according to the "GETT" classification derived from that of Masaoka. There were 13 stage I patients, 46 stage II, 58 stage III and 32 stage IV. Surgery consisted of complete resection in 63 patients, partial resection in 31 patients and biopsy alone in 55 patients. All patients received postoperative radiation therapy and 74 were given postoperative chemotherapy. Median follow-up was 7.7 years. Local control was obtained in 117 patients (78.5%) and was influenced by the extent of surgery (p < 0.0001). Metastases occurred in 26 patients. Seven patients developed grade 3-4 pulmonary and heart complications. One patient developed a malignant lymphoma after 24 cycles of chemotherapy. Disease-free survival (DFS) rates were of five years 92%, 75%, 60%, 39% and 48% in stage I, II, IIIA, IIIB and IVA patients, respectively. After complete resection, partial resection and biopsy alone, these rates were 74%, 60% and 38%, respectively. With a multivariate analysis, DFS rates were influenced by the extent of surgery (p < 0.001) and by chemotherapy (p < 0.001). Three other factors could predict a worse DFS: young age (p < 0.006), stages III-IV (p < 0.04) and mediastinal symptoms (p < 0.001), "GETT" staging correlated well with local control and survival. After complete resection, a 50 Gy postoperative radiation therapy can be recommended in patients with invasive thymomas. Despite a 65% local control rate after partial resection or biopsy alone in this series, a higher dose of radiation (> 60 Gy) must be evaluated. Despite the benefit of the chemotherapy in this retrospective and multicentric study, the role of this treatment remains to be assessed.
胸腺瘤是一种罕见疾病。分期系统和手术辅助治疗仍存在争议。我们回顾性分析了1979年至1990年间在法国十个癌症中心接受治疗的149例非转移性胸腺瘤患者的治疗结果及预后因素。患者根据源自Masaoka分期的“GETT”分类进行分期。其中I期患者13例，II期46例，III期58例，IV期32例。手术方式包括63例患者行完整切除，31例患者行部分切除，55例患者仅行活检。所有患者均接受术后放疗，74例患者接受术后化疗。中位随访时间为7.7年。117例患者（78.5%）获得局部控制，且受手术范围影响（p < 0.0001）。26例患者发生转移。7例患者出现3 - 4级肺部和心脏并发症。1例患者在接受24周期化疗后发生恶性淋巴瘤。I期、II期、IIIA期、IIIB期和IVA期患者的五年无病生存率（DFS）分别为92%、75%、60%、39%和48%。完整切除、部分切除及仅行活检后，这些比率分别为74%、60%和38%。多因素分析显示，DFS受手术范围（p < 0.001）和化疗（p < 0.001）影响。另外三个因素可预测更差的DFS：年轻（p < 0.006）、III - IV期（p < 0.04）和纵隔症状（p < 0.001），“GETT”分期与局部控制和生存情况相关性良好。对于侵袭性胸腺瘤患者，完整切除术后可推荐50 Gy的术后放疗。尽管本系列中部分切除或仅行活检后的局部控制率为65%，但必须评估更高剂量放疗（> 60 Gy）的效果。尽管在这项回顾性多中心研究中化疗有益，但该治疗的作用仍有待评估。
