晚期胸腺癌的治療與預後因子

TREATMENT AND PROGNOSTIC FACTORS FOR ADVANCED

莊富成(Fu-Cheng Chuang) ； 張慶雄(Ching-Hsiung Chang) ； 陳建勳(Chien-Hsun Chen) ； 胡渝昌(Yu-Cahng Hu)

《放射治療與腫瘤學》 14卷2期 (2007/06) Pp. 75-81

https://doi.org/10.6316/TRO/200714(2)75

摘要

目的：胸腺癌為罕見之胸腔惡性腫瘤，發現時多已晚期且預後不佳。本研究旨在分析晚期胸腺癌病患在本院接受各種治療方式的結果及影響治療的預後因子。
材料與方法：自1992至 2005年，共有29位晚期胸腺癌的病患至本院接受放射線治療。其中3位失去聯絡，1位未完成治療，1位有雙重癌症皆不列入討論。治療方式除放射線治療外，有些病患也合併接受腫瘤切除手術，或者是 cisplatin-based 的化學治療。放射線治療以分次治療，用傳統前後對照、楔形照野或者是三維立體順形技術來治療原發腫瘤。本研究分析病患特徵、是否接受手術、化學治療、未開刀病患之放射線劑量、治療模式對整體存活率的影響。
結果：全體 24 位病患其年齡中位數是 58 歲，接受放射線劑量中位數為 54.5 Gy （36~66 Gy）。除 4 位病患 KPS 為 70，其餘皆在 80 以上。在 24 位中有 7 位接受手術切除，有 9 位接受cisplatin-based 的化學治療。在單變數分析上發現手術切除腫瘤可以增加存活率（p= 0.017），然而是否能夠完全切除腫瘤、放射線治療劑量及化學治療的有無對預後無關。以多變數分析來看，手術切除此因素仍有意義（p= 0.046）。整體存活時間中位數為 26 個月，一年存活率為78.3%，三年整體存活率為 15.3%。有5人發生局部復發，復發時間從 2 至 49 個月。22名病患的局部控制率一年為 64.6%，兩年為 37.7%。
結論：目前對晚期胸腺癌病患的治療方法仍無有效的整合。依本次研究結果，我們發現腫瘤手術切除為重要的預後因子。對未能手術切除之病患而言，放射線治療及化學治療的定位對病患的幫助依然不明。

並列摘要

Purpose : Thymic carcinoma is a rare malignant mediastinal tumor. It is usually found at a late stage and the prognosis is poor. This retrospective study reviewed the treatment results of patients with advanced stage thymic carcinoma and analyzed the prognostic factors.
Materials and Methods : This retrospective study was to analyze 29 patients with advanced thymic carcinoma who received radiotherapy in our hospital between 1992 and 2005. Because of incomplete course of radiotherapy, lost follow-up, or double cancer, five patients were excluded. The treatment modality included external beam radiotherapy, tumor resection or cisplatin-based chemotherapy.
Fractionated radiotherapy was given in conventional or 3D conformal techniques. The characteristics of patients, receiving tumor resection, chemotherapy, the dose of radiotherapy in inoperable patients and treatment modality were analyzed to find the prognostic factors for overall survival retrospectively.
Results : The median age was 58 year-old. The median radiotherapy dose of 24 patients was 54.5 Gy. The Karnofsky performance status was 70 for 4 of the patients, and above 80 for the rest. Seven patients received surgical resection, and 9 patients had cisplatin-based chemotherapy. The survival
rate was improved by receiving surgical resection significantly in univariate analysis (p= 0.017) but not by the completeness of tumor resection, the dose of radiotherapy, or chemotherapy. In multivariate analysis of these factors, only receiving surgical resection still remained to improve the survival rate (p= 0.046). The median overall survival time was 26 months. One-year survival rate was 78.3% and 3-year survival rate was 15.3%. Local recurrence occurred in 5 patients, and the relapse time
was from 2 to 49 months. The local control rate of 22 patients at 1 and 2 years was 64.6% and 37.7% respectively.
Conclusion : There is no effective treatment protocol for patients with advance stage thymic carcinoma. In our study, we found tumor resection as an important prognostic factor in advanced stage thymic carcinoma. For unresectable thymic carcinoma, the roles of radiotherapy and chemotherapy
remain ambiguous.