Berruti A, Borasio P, Roncari A, Gorzegno G, Mossetti C, Dogliotti L
Department of Clinical and Biological Sciences, University of Torino, Italy.
Ann Oncol. 1993 May;4(5):429-31. doi: 10.1093/oxfordjournals.annonc.a058527.
Locally advanced malignant thymomas are usually radically resectable in about 60% of stage III but hardly ever in stage IVA. Neoadjuvant chemotherapy followed by surgery could improve both resection rate and curability. Cisplatin containing regimens have repeatedly been found to be highly active in advanced disease, with overall response rates ranging from 80%-90%.
3 patients with stage III and 3 with stage IVA invasive thymomas, according to Masaoka staging, entered the study. Histology was: lymphoepithelial 4 cases, epithelial 2 cases. 4 cycles of the ADOC scheme--Adriamycin (40 mg/sqm), cisplatin (50 mg/sqm) on day 1, vincristine (0.6 mg/sqm) on day 2, and cyclophosphamide (700 mg/sqm) on day 3, every 21 days--were administered to 5 patients, while 1 patient received 5 cycles.
5/6 patients (83.3%) attained partial responses and underwent radical surgery followed by two further ADOC cycles. The disease-free intervals were 5+, 6+, 15+, 16+, 26+ months. One patient showing stable disease at the end of the fifth cycle was referred to radiotherapy. Toxicity was tolerable: grade III (WHO) nausea/vomiting and leukopenia grade III occurred in 2 patients each.
These results suggest that the ADOC scheme is active as a neoadjuvant approach in invasive thymoma stages III and IVA, rendering possible radical resectability in 83% of patients.
局部晚期恶性胸腺瘤在Ⅲ期患者中约60%通常可根治性切除，但在ⅣA期患者中几乎无法做到。新辅助化疗后手术可提高切除率和治愈率。含顺铂方案多次被发现对晚期疾病具有高度活性，总缓解率为80%-90%。
根据Masaoka分期，3例Ⅲ期和3例ⅣA期浸润性胸腺瘤患者进入本研究。组织学类型为：淋巴上皮型4例，上皮型2例。5例患者接受4个周期的ADOC方案——阿霉素（40mg/m²）、第1天给予顺铂（50mg/m²）、第2天给予长春新碱（0.6mg/m²）、第3天给予环磷酰胺（700mg/m²），每21天重复一次——，1例患者接受5个周期。
5/6例患者（83.3%）获得部分缓解并接受了根治性手术，随后再进行两个周期的ADOC方案。无病生存期分别为5+、6+、15+、16+、26+个月。1例在第5个周期结束时病情稳定的患者接受了放疗。毒性反应可耐受：2例患者出现Ⅲ级（世界卫生组织）恶心/呕吐，2例患者出现Ⅲ级白细胞减少。
这些结果表明，ADOC方案作为新辅助治疗方法对Ⅲ期和ⅣA期浸润性胸腺瘤有效，使83%的患者有可能进行根治性切除。
