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題名:LONG-TERM OUTCOME OF POSTOPERATIVE ADJUVANT RADIOTHERAPY FOR THYMOMA     (16點)
胸腺瘤手術後輔助放射治療之長期結果分析
著者:Huei-Chun Lu(呂慧君) ;Jian-Sheng Jan(詹建勝) ;Jin-Ching Lin(林進清)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:胸腺瘤 ; 放射線治療 ; Masaoka分期系統 ; Thymoma ; Radiation therapy ; Masaoka staging systeml
刊名:Therapeutic Radiology and Oncology
頁碼:101-108
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

目的:分析胸腺瘤術後輔助放射線治療的長期結果。 材料與方法:本研究選擇經病理證實是胸腺瘤的病人,且接受切除手術及40 Gy 以上的術後放射線治療。自1984 年10 月至2002 年8 月期間,本院癌症登記資料庫中有38 位符合條件。我們回顧了這些病人的病歷、放射線治療紀錄及檢查影像。腫瘤的分期是依據Masaoka 分期系統。這些病人的中位數年齡是47 歲(自22 歲到83 歲);男性/女性:26 位/ 12 位;第一期有4 位,第二期有15 位,第三期有15 位,第四期有4 位。放射治療技術主要是前後相對照野、楔形濾板(wedge pair)或三度空間順形治療,劑量中位數是50 Gy(40 至68 Gy),以傳統分次方式給予。我們使用Kaplan-Meier 統計方式來分析總存活率、局部無病存活率及無轉移存活率。 結果:經過中位數11 年的追蹤,38 位病人中有13 位病人腫瘤復發(2 位是局部復發,7 位是遠處轉移,4 位是局部復發合併遠處轉移)。五年的總存活率、局部無病存活率及無轉移存活率分別是75.5%、82.1% 和83.5%;十年的總存活率、局部無病存活率及無轉移存活率分別是51.2%、82.1% 和56.7%。單變項分析中,腫瘤分期和手術切除範圍大小是最重要的預後因素。年齡、性別、放射線劑量及是否合併有重症肌無力等因素並不影響存活率。在晚期腫瘤(第三期和第四期)的十年總存活率(24.1% vs. 89.5%, P = 0.0010)、十年局部無病存活率(59.9%vs. 100%, P = 0.0031)及十年無轉移存活率(29.6% vs. 82.9%, P = 0.0084)均較早期腫瘤(第一期和第二期)為差。有完全切除腫瘤的病人的十年總存活率(60.6% vs. 11.3%, P = 0.0083)、十年局部無病存活率(86.4% vs. 53.3%, P = 0.1101)及十年無轉移存活率(66.4% vs. 0%, P =0.0002)較只有部份腫瘤切除的病人為佳。多變項分析中,只有腫瘤分期是影響預後的因素。 結論:腫瘤分期和手術切除範圍大小是最重要的預後因素。術後輔助放射線治療對於早期腫瘤的控制有很好的效果,但對晚期腫瘤的治療效果不佳。在未來的研究中,應該考慮對晚期腫瘤的病人輔助化學治療。
Purpose : To analyze the long-term outcome of postoperative radiotherapy for thymoma. Materials and Methods : Patients with pathological-proven thymoma and receiving surgical resection plus postoperative radiotherapy  40 Gy were eligible for this retrospective study. From October 1984 to August 2002, 38 eligible patients were obtained from our Cancer Registration Database. We reviewed hospital charts, radiotherapy records and diagnostic imaging studies thoroughly. Tumor staging was defined according to the Masaoka staging system. Baseline characteristics of patients were median age 47 (range 22-83), male/female= 26/12, stage I/II/III/IV= 4/15/15/4. The radiotherapy was delivered by a wedge-pair or 3-D conformal-beam technique with a median dose of 50 Gy (range 40-68 Gy) by conventional fractionation. The end points were overall survival (OS), locoregional disease-free survival (LDFS) and metastasis-free survival (MFS) by the Kaplan-Meier method. Results : After a median follow-up of 11 years, 13 of 38 patients had tumor relapse (2 locoregional recurrence, 7 distant metastasis, and 4 locoregional plus distant failure). The 5-year and 10-year of OS, LDFS, and MFS for all patients were 75.5% and 51.2%, 82.1% and 82.1%, and 83.5% and 56.7%, respectively. On univariate analysis, stages and the extent of surgical resection were the most important prognostic factors. Age, gender, radiation dose, and association of myasthenia gravis did not affect the survival significantly. The 10-year OS (24.1% vs. 89.5%, P = 0.0010), LDFS (59.9% vs. 100%, P = 0.0031), and MFS (29.6% vs. 82.9%, P = 0.0084) were significantly lower in patients with advanced-stage (III + IV) than in those with early-stage (I + II). Patients with total resection had better 10-year OS (60.6% vs. 11.3%, P = 0.0083), LDFS (86.4% vs. 53.3%, P = 0.1101), and MFS (66.4% vs. 0%, P = 0.0002) than those with subtotal resection. The multivariate analysis revealed that stage was the only significant prognostic factor. Conclusion : Stages and the extent of surgical resection are the most important prognostic factors. Postoperative adjuvant radiotherapy has good tumor control for earlystage disease but is inadequate for advanced-stage disease. Chemotherapy should be considered for advanced-stage patients in future trials.


    

本卷期目次
Therapeutic Radiology and Oncology
The Efficacy of Radiation Therapy for Keloid and Hypertrrophic Scar: The Experience of Nine Cases/ Yu-Wen Rubin WangHow-Ran GuoChin-Wu Cheng
Long-Term Outcome of Postoperative Adjuvant Radiotherapy for Thymoma/ Huei-Chun LuJian-Sheng JanJin-Ching Lin
蒙地卡羅方法模擬於臨床電子直線加速器之電子射源項參數研究/ 紀金輝張國平蕭安成陳信雄楊世能潘榕光梁基安趙敏
Clinical Features and Management of Distant Metastases from Nasopharyngeal Carcinoma/ Chia-Chun HuangMu-Tai LiuCheng-Chuan ChangMu-Kuan ChenTung-Hao ChangChu-Ping PiChih-Chieh Hsu
Early-Stage Esophageal Squamous Cell Carcinoma Adjacent to Cirrhosis-Related Varices: A Case Report/ Yu-Nong WangDai-Wei LiuHsi-Sheng ChsiaWen-Lin Hsu
快速成型技術直接製作放射治療填充物之效能評估/ 吳錦榕孫述平蕭世禎彭秋萍游佩潔紀淑妮陳柏婷林家弘薛文雅郭名傑詹淑如
The Treatment Results of Unknown Primary Head and Neck Cancers without Epstein-Barr Virus Infection/ Bing-Shen HuangJi-Hong HongPing-Ching PaiChun-Chieh WangNgan-Ming Tsang
Verification of Patient Setup Error in Tomotherapy through Image Guided Radiation Therapy (IGRT) Procedure/ Shao-Ti LiWen-Shan LiuYing-Hsiang ChouPei-Wei HsiungHsiu-Ting HsuHsi-Chang Chang
LONG-TERM OUTCOME OF POSTOPERATIVE ADJUVANT RADIOTHERAPY FOR THYMOMA/ Huei-Chun LuJian-Sheng JanJin-Ching Lin
CLINICAL FEATURES AND MANAGEMENT OF DISTANT METASTASES FROM NASOPHARYNGEAL CARCINOMA/ Chia-Chun HuangMu-Tai LiuCheng-Chuan ChangMu-Kuan ChenTung-Hao ChangChu-Ping PiChih-Chieh Hsu
VERIFICATION OF PATIENT SETUP ERROR IN TOMOTHERAPY THROUGH IMAGE GUIDED RADIATION THERAPY (IGRT) PROCEDURE/ Shao-Ti LiWen-Shan LiuYing-Hsiang ChouPei-Wei HsiungHsiu-Ting HsuHsi-Chang Chang
蒙地卡羅方法模擬於臨床電子直線加速器之電子射源項參數研究/ 紀金輝張國平蕭安成陳信雄楊世能潘榕光梁基安趙敏
快速成型技術直接製作放射治療填充物之效能評估/ 吳錦榕孫述平蕭世禎彭秋萍游佩潔紀淑妮陳柏婷林家弘薛文雅郭名傑詹淑如
THE EFFICACY OF RADIATION THERAPY FOR KELOID AND HYPERTRROPHIC SCAR: THE EXPERIENCE OF NINE CASES/ Yu-Wen Rubin WangHow-Ran GuoChin-Wu Cheng
EARLY-STAGE ESOPHAGEAL SQUAMOUS CELL CARCINOMA ADJACENT TO CIRRHOSIS-RELATED VARICES: A CASE REPORT/ Yu-Nong WangDai-Wei LiuHsi-Sheng ChsiaWen-Lin Hsu
THE TREATMENT RESULTS OF UNKNOWN PRIMARY HEAD AND NECK CANCERS WITHOUT EPSTEIN-BARR VIRUS INFECTION/ Bing-Shen HuangJi-Hong HongPing-Ching PaiChun-Chieh WangNgan-Ming Tsang
 
   
 
   

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