非手术方法治疗局部侵袭性胸腺肿瘤

Outcome of Nonsurgical Treatment for Locally Advanced Thymic Tumors

背景与目的手术切除是早期胸腺肿瘤的主要治疗方法,而对于Ⅳ期的病变,化疗则是最常用的方案。对于局部晚期的肿瘤,尤其是不适合手术的病例,何种治疗方案效果更优则没有明确的结论。鉴于此,我们做了这项回顾性的研究,通过对三种非手术疗法的比较,希望找到一些线索。方法自2000年10月至2010年12月,共有42例患者接受了三种非手术方案的治疗。这三种模式分别是单独放疗(radiotherapy,RT)、序贯化放疗(sequential chemoradiation,SCRT)以及同步放化疗(concurrent chemoradiation,CCRT)。并对三种方案的缓解率(objective response rate,ORR)、总生存期(overall survival,OS)以及治疗的相关毒副反应进行比较。结果全组42例患者中,总的缓解率为61.9%,5年生存率为46%。RT组、SCRT组以及CCRT组的缓解率分别是43.8%、50%和87.5%(RT vs SCRT,P=0.692;RT vs CCRT,P=0.009;SCRT vs CCRT,P=0.051)。RT组、SCRT组以及CCRT组的5年生存率分别是30%、50%和61.9%(RT vs SCRT,P=0.230;RT vs CCRT,P=0.011;SCRT vs CCRT,P=0.282)。共有11例患者发生了3度-4度的中性粒细胞减少,其中7例出现在CCRT组,另4例出现在SCRT组。有9例患者主诉有3度放射性食道炎,其中RT组2例,SCRT组3例,CCRT组4例。另外,CCRT组还出现了2例3度的放射性肺炎。未发现致命的5度毒副反应。结论在治疗不适合手术的局部晚期胸腺肿瘤上,CCRT显示出了比RT和CCRT更好的局部控制以及长期生存优势,不过也有增加肺损伤风险的可能。对于局部侵袭性的胸腺肿瘤,CCRT可提供最佳的肿瘤控制效果。

Background and objectiveSurgical resection remains the mainstay of treatment for patients with early-staged thymic tumors, while chemotherapy is most commonly used in stage IV cases. As for locally advanced thymic tumors, especially those unsuitable for surgery, the optimal therapy is still controversial. hTus, we conducted this retrospective study by comparing three nonsurgical treatment modalities to ifnd some clues.Methods hTree treatment modalities were used in 42 pa-tients from October 2000 to December 2010, including radiotherapy （RT） alone, sequential chemoradiation （SCRT） and con-current chemoradiation （CCRT）. Objective response rate （ORR）, overall survival （OS） and toxicity of the three regimens were compared accordingly.Results The ORR in all 42 patients was 61.9%, and 5-year OS was 46%. The ORR of RT, SCRT and CCRT were 43.8%, 50% and 87.5%, respectively （RTvs SCRT,P=0.692; RTvs CCRT,P=0.009; SCRTvs CCRT,P=0.051）. The 5-year OS of RT, SCRT and CCRT were 30%, 50% and 61.9%, respectively （RTvs SCRT,P=0.230; RTvsCCRT,P=0.011; SCRTvs CCRT,P=0.282）. Eleven patients developed neutropenia of grade 3-4, with 7 in CCRT group and 4 in SCRT, respec-tively. Nine patients experienced esophagitis of grade 3 with 2 in RT, 3 in SCRT and 4 in CCRT. There were also two cases of grade 3 radiation induced pneumonitis in CCRT group. No life-threatening side effects were noted.Conclusion When used to treat locally advanced thymic tumors unsuitable for surgery, CCRT performed more favorably than RT alone or SCRT in both tumor response and long time survival, but probably with the increasing risk of pulmonary damage. CCRT may offer the best chance of disease control in the management of locally advanced disease.