A Multidisciplinary Approach to Therapy for Unresectable Malignant Thymoma

作者：Dong Min Shin, Garrett L. Walsh, Ritsuko U Komaki, Joe Bill Putnam, Jonathan C. Nesbitt, Jae Yoon Ro, Hyung Ju C. Shin, Keun Hong Ki, Amanda Wimberly, Katherine M.W. Pisters, David S. Schrump, Mary Ann Gregurich, James D. Cox, Jack A. Roth, Waun Ki Hong · 发表于：Annals of Internal Medicine · 年份：1998 · DOI：10.7326/0003-4819-129-2-199807150-00006 · 被引用次数：147 · 研究领域：Myasthenia Gravis and Thymoma、Meningioma and schwannoma management、Lymphatic Disorders and Treatments

BACKGROUND: The therapeutic outcome for unresectable, locally advanced, malignant thymoma has been poor. OBJECTIVE: To improve tumor resectability and patient survival rates by studying a multimodal approach to therapy for unresectable malignant thymoma. DESIGN: Prospective cohort study. SETTING: Tertiary care cancer center. PARTICIPANTS: All eligible patients had newly diagnosed, histologically proven, unresectable malignant thymoma. INTERVENTION: The treatment regimen consisted of induction chemotherapy (three courses of cyclophosphamide, doxorubicin, cisplatin, and prednisone), surgical resection, postoperative radiation therapy, and consolidation chemotherapy (three courses of cyclophosphamide, doxorubicin, cisplatin, and prednisone). Tissue samples were taken at the time of surgical resection for assessment of tumor necrosis and Ki-67 expression. MEASUREMENTS: Tumor response and resectability (both overall and after induction chemotherapy) and disease-free survival rate in patients who received multimodal therapy. RESULTS: 13 patients were consecutively enrolled from February 1990 to December 1996, and 12 evaluable patients were assessed for response. Disease responded to induction chemotherapy completely in 3 patients (25%) and partially in 8 patients (67%); 1 patient had a minor response (8%). Eleven patients had surgical resection; 1 refused surgery. Tumors were removed completely in 9 (82%) and incompletely in 2 (18%) of 11 patients who had been receiving radiation t...