术前化疗及手术治疗Ⅲ期、Ⅳ_a期恶性胸腺瘤

Preoperative chemotherapy and operation for invasive Masaoke stage Ⅲ and Ⅳ_a thymoma

目的 评价术前化疗在进展期恶性胸腺瘤治疗中的作用。方法 14例Masaoka分期为Ⅲ期、Ⅳa 期 (其中Ⅲ期 12例、Ⅳa 期 2例 )恶性胸腺瘤患者术前以CAVP方案化疗 3～ 4个疗程 (环磷酰氨 6 0 0mg/m2 ,第 1天 ;阿霉素 30mg/m2 或表阿霉素 40mg/m2 ,第 1天 ;长春新碱 0 .6mg/m2 ,第 1天 ,或长春酰胺 3mg/m2 ,第 1,8天 ;顺铂 30mg/m2 ,第 1,2 ,3天 )。所有患者均在化疗结束后 1～ 3个月内手术 ,其中 10例采用胸骨正中切口 ,4例为前外侧切口 (其中 2例加胸骨横断 )。除化疗后病理证实为完全缓解者外 ,其余患者再行放疗 ,总剂量 5 0～ 6 0Gy。随访 6个月至 3年。结果 化疗后 5例(35 7% )获得完全缓解 (CR) ,9例 (6 4 3% )获得部分缓解 (PR)。手术中肿瘤完全切除 9例 ,大部切除5例。术后病理检查 ,5例CR患者仅见胸腺残留组织纤维增生。随访期中 ,2例患者分别于术后 18个月及 2年死于远处转移 ,其余患者均存活至今。结论 术前化疗能够提高Ⅲ期、Ⅳa 期恶性胸腺瘤患者的手术切除率。

Objective To assess the effect of preoperative chemotherapy on invasive thymoma.Methods Fourteen patients with invasive thymoma (12 cases in Masaoka stage Ⅲ and 2 cases in stage Ⅳa) were treated with 3～4 cycles of CAVP (cyclophosphamide 600 mg/m 2 Dl, adriamycin 30 mg/m 2 or epi adriamycin 40 mg/m 2 Dl, vincristine 0.6 mg/m 2 D1 or vindestine 3 mg/m 2 D1, D8, cisplatin 30 mg/m 2 D1, 2, 3). Following chemotherapy, patients were operated within 1～3 months. In 10 patients, sternotomy was performed and in 4 patients, anterolateral thoracotomy was performed. Radiotherapy was given with a total dose of 50～60 Gy in all patients except in those who were pathologically in complete remission. The patients were followed up for 6 months to 3 years.Results After chemotherapy, complete response was observed in 5 patients (35.7%) and partial response in 9 patients (64.3%). Nine patients received radical tumor resection and 5 patients received partial resection. Histologic examination of the surgical specimens showed fibrosis of the remnant thymus in 5 patients. All but two patients survied in the follow up period. Patient died from distant metastases at 18 and 24 months after treatment, respectively.Conclusion Preoperative chemotherapy helps increase the resectability of stage Ⅲ and Ⅳa invasive thymoma. A longer follow up period and more patients are needed to ascertain the impact of this treatment strategy on long term survival.