摘要
目的探讨Ⅲ、Ⅳa期侵袭性胸腺瘤的诊断及术前诱导治疗策略。方法回顾分析13例Ⅲ、Ⅳa期侵袭性胸腺瘤患者的临床资料,其中Ⅲ期8例,Ⅳa期5例。肿瘤均侵犯大血管、心包或肺组织,或胸膜、心包转移。所有患者均经带芯穿刺、胸腔镜或前纵膈切开活检确诊,经长春瑞滨+顺铂(NP)或环磷酰胺,表阿霉素,顺铂(CAP)方案术前诱导化疗3周期或同步放疗30GY,肿瘤缩小、分期降低后行完全性或姑息性手术切除。均长期随访。结果13例病理均为恶性胸腺瘤,其中B2型4例,B3型6例,C型3例。诱导化疗疗效评价,部分缓解(PR)9例,疾病稳定(SD)4例。根治性切除7例,姑息性切除2例。9例手术患者均存活超过3年,超过5年7例(77.7%),超过8年1例;4例未手术患者均在4年内死亡。结论对于无法完全切除的Ⅲ、Ⅳa期侵袭性胸腺瘤,术前诱导治疗,可使原发肿瘤缩小,控制转移灶,降低临床分期,提高手术的完全切除率,有延长生存期的趋势。
Objective To discuss the diagnosis and inductive chemoradiotherapy of stage III and stage IVa invasive thymoma. Methods Clinical data of 13 cases with incomplete resected invasive thymoma were an- alyzed retrospectively, among which 8 cases were in stage III and 5 cases in stage IVa. All the 13 cases had in- vasion of major vessels, pericardial and lung tissues, or had metastasis of pleura and pericardium. Each patient got pathological diagnosis by fine needle aspiration, video-assisted thoracoscopic biopsy or anterior mediastinal biopsy. After 3 cycles of NP or CAP inductive chemotherapy and synchronous radiotherapy, tumors shrank and got palliative or complete surgical resection. The Follow up ranged from 2.8 to 9 years. Results All the 13 eases were malignant thymoma, including 4 eases of type B2, 6 cases of type B3 and 5 eases of type C. 7 patients got radical resection and 2 got palliative resection. 9 patients survived more than 3 years after operation, 7 patients survived more than 5 years, one patient even lived 8 years, and the other 4 patients without getting surgery died in 4 years. Conclusion Inductive chemoradiotherapy could shrink stage III and stage IVa invasive thymoma, reduce clinical stage, improve the resection rate, and prolong survival.
出处
《中华内分泌外科杂志》
CAS
2016年第3期228-231,共4页
Chinese Journal of Endocrine Surgery
关键词
侵袭性胸腺瘤
诱导治疗
手术
Invasive thymomas
Induction treatment
Operation