Uematsu M, Yoshida H, Kondo M, Itami J, Hatano K, Isobe K, Ito H, Kobayashi K, Yamaguchi Y, Kubo A
Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
Int J Radiat Oncol Biol Phys. 1996 May 1;35(2):357-60. doi: 10.1016/0360-3016(96)00086-7.
To evaluate the feasibility and efficacy of prophylactic entire hemithorax irradiation (EH) in addition to mediastinal irradiation (MRT) following a complete resection in Stage II-III invasive thymoma.
Forty-three patients with invasive thymoma treated with surgery and radiation therapy between 1978 and 1993 were analyzed retrospectively. All 43 patients underwent a complete surgical resection and were judged to have Masaoka's Stage II-III invasive thymoma. Of these, 23 patients received EH and MRT (EH-MRT) and the remaining 20 received MRT. Of the 23 patients with EH-MRT, 11 were Stage II and 12 Stage III. Of the 20 with MRT, 11 were Stage II and 9 Stage III. In most cases, EH was 15 Gy per 15 fractions over 3 weeks (without lung compensation calculation). In both the EH-MRT and MRT group, the total radiation doses to the mediastinum were similar with a median of 40 Gy. The median follow-up time after surgery was 63 months and no patients were lost to follow-up.
Only one of the 23 patients with EH-MRT relapsed. On the other hand, eight of the 20 with MRT relapsed, six of whom died of disease. The pleura was the most common site of failure. At 5 years, the relapse-free rate was 100% for those receiving EH-MRT and 66% for those with MRT (p = 0.03); the overall survival rate was 96% for those with EH-MRT, and 74% for those with MRT (p: not significant). The only significant treatment-related complication was radiation pneumonitis requiring treatment, in one patient who received MRT and three who received EH-MRT, including one death of a 72-year-old man and one 68-year-old woman with severe lung fibrosis.
Except for elderly patients, EH-MRT following a macroscopically complete resection appears to be safe and feasible, and can reduce intrathoracic relapses.
评估在II - III期浸润性胸腺瘤完整切除后，除纵隔放疗（MRT）外进行预防性全胸照射（EH）的可行性和疗效。
回顾性分析了1978年至1993年间接受手术和放疗的43例浸润性胸腺瘤患者。所有43例患者均接受了完整的手术切除，且被判定为Masaoka II - III期浸润性胸腺瘤。其中，23例患者接受了EH和MRT（EH - MRT），其余20例接受了MRT。在接受EH - MRT的23例患者中，11例为II期，12例为III期。在接受MRT的20例患者中，11例为II期，9例为III期。在大多数情况下，EH为每3周15次，每次15 Gy（未进行肺部补偿计算）。在EH - MRT组和MRT组中，纵隔的总辐射剂量相似，中位数为40 Gy。手术后的中位随访时间为63个月，无患者失访。
在接受EH - MRT的23例患者中，只有1例复发。另一方面，接受MRT的20例患者中有8例复发，其中6例死于疾病。胸膜是最常见的复发部位。5年时，接受EH - MRT的患者无复发生存率为100%，接受MRT的患者为66%（p = 0.03）；接受EH - MRT的患者总生存率为96%，接受MRT的患者为74%（p：无显著性差异）。唯一与治疗相关的显著并发症是放射性肺炎需要治疗，接受MRT的患者中有1例，接受EH - MRT的患者中有3例，包括1例72岁男性和1例68岁女性因严重肺纤维化死亡。
除老年患者外，宏观上完整切除后进行EH - MRT似乎是安全可行的，并且可以减少胸内复发。
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