恶性胸腺瘤合并上腔静脉综合征患者的循证治疗

Evidence-Based Treatment of a Patient with Malignant Thymoma

目的:针对1例恶性胸腺瘤合并上腔静脉综合征的治疗问题,检索当前最佳证据,为患者的治疗提供依据。方法:根据循证临床实践的PIC0原则,针对恶性胸腺瘤提出问题并检索证据,对证据进行质量评价后结合患者意愿制定治疗方案。检索资源为NGC、CochraneLibrary、PubMed、Embase Database、SUM search、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库等数据库。结果共纳入10个随机对照试验,3个系统评价/Meta分析和1个临床指南。通过分析检索结果,为患者制定合理治疗方案。结果:显示:外科手术是胸腺瘤治疗的首选方法,应尽可能完全切除或尽可能多的切除肿瘤。对不能进行手术的患者,可以先行辅助放化疗,待时机成熟立即行手术切除。以铂类为基础的化疗方案是目前恶性胸腺瘤的标准化疗方案之一。结合患者情况,我们采用术前顺铂联合多帕菲3天疗法3周期进行诱导化疗,并行30Gy同步放疗,待上腔静脉综合征缓解且肿瘤组织体积缩小超过原体积的一半时进行外科手术。治疗后,患者病情好转,生活质量提高,家属对治疗方案认同。结论:采用循证治疗的方法,为不能切除的恶性胸腺瘤患者制定辅助放化疗的治疗方案,可有效提高近期疗效,但远期疗效有待进一步随访观察。

Objective： he objective of this study is to find evidence-based treatment for a patient with malignant thymoma and superior vena cava syndrome（SVCS）. Methods：Based on the PICO（patient intervention comparison outcome） principle and the clinical question raised, evidence was collected and critically assessed. We searched NGC,Cochrane Library, PubMed,Embase Database,SUM search,CBM,et al, for evidence. Results： There are 10 randomized controlled trials, 3 systematic reviews or recta-analyses and I clinical guideline included. Treatment plan was formed after we analyzed these data carefully. The evidence indicated that surgical operation is the preferred method in the treatment of malignant thymoma, and the tumor must be resected completely or as much as possible. For unresectable patients, induced chemoradiotherapy followed by surgery is a good choice. Platinum-based chemotherapy is one of the standard chemotherapies of malignant thymoma. In this case, we used preoperative cisplatin combined with docetaxel therapy three days for a few cycles and the preoperative radiation dose was 38Gy/19f, after the tumor volume reduced more than a half, the patient received surgery. This patient＇s outcome is PR after the above treatments, and enjoys a higher quality of life.Conclusion：The patients with temporarily unresectable malignant thymoma and SVCS might benefit from induced chemoradiotherapy and have a chance for resection. The short-term prognostic benefits is obvious, however the long-term prognostic benefits should be confirmed by firber follow-up.