透過您的圖書館登入
IP:54.198.34.207

摘要


目的:胸腺癌是一個不常見但致命的惡性腫瘤,我們分析了本院晚期胸腺癌病人的治療結果及預後因子。材料及方法:從1996年4月至2012年4月,共有18位新診斷胸腺癌病人於三軍總醫院接受治療,我們分析其病程記錄,共9位接受手術治療,其中包括3位接受術前治療與術後放射治療合併化學治療,5位接受術後放射治療合併化學治療及1位接受術後放射治療。8位腫瘤無法切除或無法接受手術的病人接受放射治療合併化學治療或放射治療。有1位病人沒有接受癌症治療而於診斷後2個月死亡。放射治療是採用三度空間順形放射治療、強度調控放射治療或立體定位放射治療,放射治療的劑量中位數為63 Gy。大部分接受化學治療的病人(93.3%)使用的藥物包含cisplatin。結果:依照Masaoka分期,有7位病人是第III期,4位是IVA期,7位是IVB期。所有病患5年整體存活率為46.5%,3年無惡化存活率為32.1%。17位接受放射治療的病患,其5年的照射範圍內腫瘤控制率為80.9%。在單變項分析中,使用放射治療劑量大於65 Gy是唯一對預後有幫助的因子,總放射劑量大於65 Gy可提升胸腺癌病人3年整體存活率(100% vs. 13.1%, p= 0.004)和3年無惡化存活率(47.6% vs. 16%, p= 0.044)。在沒有接受手術的胸腺癌病人,接受總放射劑量大於65 Gy對存活有好處。結論:積極多種方式的治療包括手術、放射治療和化學治療對於晚期胸腺癌病人是有幫助的。放射治療劑量大於65 Gy可以改善晚期胸腺癌病人的整體存活率和無惡化存活率,尤其是在沒有接受手術的病人。

並列摘要


Purpose: Thymic carcinoma is an uncommon but lethal malignancy. We analyze the outcomes and prognostic factors of patients with advanced thymic carcinoma treated at a single institution.Materials and Methods: The records of 18 patients with histologically confirmed thymic carcinoma treated between April 1996 and April 2012 at Tri-Service General Hospital were retrospectively reviewed. Surgical resection was performed in 9 patients, including 3 patients who received preoperative therapy and postoperative chemoradiotherapy followed by chemotherapy, 5 who received postoperative chemoradiotherapy followed by chemotherapy and 1 who received postoperative radiotherapy alone. Eight patients had tumor which were unresectable or medically inoperable and underwent chemoradiotherapy followed by chemotherapy or radiotherapy alone. One patient died 2 months after diagnosis without any cancer treatment. Radiotherapy was delivered with three-dimensional conformal radiation therapy, intensity-modulated radiation therapy or stereotactic ablative radiotherapy using Cyberknife (Accuray, Inc., Sunnyvale, CA). The median dose of radiotherapy was 63 Gy. Most (93.3%) of the chemotherapy regimen contained cisplatin.Results: The distribution of Masaoka stage at presentation was III in 7 patients, IVA in 4 patients and IVB in 7 patients. The 5-year overall survival (OS) rate and 3-year progression-free survival (PFS) rate were 46.5% and 32.1%, respectively. The 5-year in-field tumor control rate of 17 patients who underwent radiotherapy was80.9%. Univariate statistical analysis revealed that radiotherapy ≧ 65 Gy was the only statistically significant predictor of outcome. A total radiation dose of ≧ 65 Gy results in improved 3-year OS (100% vs. 13.1%, p= 0.004) and 3-year PFS (47.6% vs. 16%, p=0.044) in patients with thymic carcinoma. The survival benefit of receiving radiotherapy ≧ 65 Gy was apparent in the unresected group of patients with thymic carcinoma.Conclusions: Aggressive multidisciplinary treatments including surgery, radiotherapy, and chemotherapy, are helpful in treating advanced thymic carcinoma. Radiotherapy with dose above 65 Gy may improve the OS and PFS of patients with advanced thymic carcinoma, especially in the unresected group.

延伸閱讀