|
|
一例Masaok IVa期巨大胸腺瘤的治疗回顾及文献复习
|
Abstract:
临床上巨大胸腺瘤案例罕见，对于IVa期巨大胸腺瘤治疗方法尚无共识，且可供选择的治疗方法又尤为缺乏。本文介绍一例35岁Masaoka IVa期巨大胸腺瘤的患者，行手术切除后联合化疗及免疫治疗，获得无复发生存时间(Recurrence Free Survival, RFS)为13个月，复发后又通过局部放疗联合化疗、免疫治疗后基本达到完全缓解(Complete Response, CR)。临床上对于Masaoka IVa期巨大胸腺瘤患者应采取多学科诊疗模式，即以手术为主，全身及局部治疗为辅的治疗模式下进行。随着免疫治疗在胸腺瘤中的机制及疗效正不断被披露，本例患者加用免疫治疗后取得不错的疗效，且未见明显副作用，这也提示我们免疫治疗的加入或可使难治性胸腺瘤从治疗中获益，或为临床决策提供了更多的选择。
Giant thymoma cases are rare in clinical practice, and there remains a lack of consensus regarding treatment approaches for stage IVa giant thymomas. Furthermore, the available treatment options are limited. The present study reports on a case of a 35-year-old patient diagnosed with Masaoka stage IVa thymoma, who underwent surgical resection followed by combined chemotherapy and immunotherapy, achieving a recurrence-free survival time (RFS) of 13 months. Furthermore, upon relapse, the patient attained near-complete response (CR) through local radiotherapy in combination with chemotherapy and immunotherapy. In clinical practice, a multidisciplinary approach is recommended for patients with Masaoka stage IVa thymoma, wherein surgery serves as the primary treatment of giant thymoma treatment and systemic and local therapies are employed as adjunctive treatments. With an increasing comprehension of the mechanisms and efficacy of immunotherapy in thymomas, this case demonstrates favorable therapeutic effects without significant adverse reactions upon the addition of immunotherapy. This implies that incorporating immunotherapy may confer benefits to patients with refractory thymoma while offering additional options for clinical decision-making.
| [1] | Engels, E.A. (2010) Epidemiology of Thymoma and Associated Malignancies. Journal of Thoracic Oncology, 5, S260-S265. https://doi.org/10.1097/jto.0b013e3181f1f62d |
| [2] | Kondo, K. and Monden, Y. (2003) Therapy for Thymic Epithelial Tumors: A Clinical Study of 1320 Patients from Japan. The Annals of Thoracic Surgery, 76, 878-884. https://doi.org/10.1016/s0003-4975(03)00555-1 |
| [3] | Dolan, D.P., Polhemus, E., Lee, D.N., Mazzola, E., Jaklitsch, M.T., Wee, J.O., et al. (2022) Hyperthermic Intraoperative Chemotherapy (HIOC) for Stage IVa Thymic Malignancy May Improve 5‐Year Disease‐Free Survival. Journal of Surgical Oncology, 127, 734-740. https://doi.org/10.1002/jso.27150 |
| [4] | Tartarone, A., Lerose, R., Lettini, A.R. and Tartarone, M. (2023) Current Treatment Approaches for Thymic Epithelial Tumors. Life, 13, Article No. 1170. https://doi.org/10.3390/life13051170 |
| [5] | Dumont, J., Bou-Gharios, J., Keller, A., Chambrelant, I., Pamart, G., Mascaux, C., et al. (2024) Impact of Adjuvant Radiotherapy and Chemotherapy on Thymoma. Cancer/Radiothérapie, 28, 174-181. https://doi.org/10.1016/j.canrad.2023.08.009 |
| [6] | Fujiwara, M., Watanabe, H., Takigawa, Y., Goda, M., Shiraha, K., Inoue, T., et al. (2024) Successful Treatment of Type B2 Thymoma with Steroid and Radiotherapy. Respirology Case Reports, 12, e70006. https://doi.org/10.1002/rcr2.70006 |
| [7] | Mastromarino, M.G., Bacchin, D., Aprile, V., Ceccarelli, I., Korasidis, S., Lenzini, A., et al. (2023) Unradical Surgery for Locally-Advanced Thymoma: Is It Time to Evolve Perspectives? Lung Cancer, 180, Article ID: 107214. https://doi.org/10.1016/j.lungcan.2023.107214 |
| [8] | Almeida, P.T. and Heller, D. (2024) Anterior Mediastinal Mass. |
| [9] | Alqaidy, D. (2023) Thymoma: An Overview. Diagnostics, 13, Article No. 2982. https://doi.org/10.3390/diagnostics13182982 |
| [10] | Imbimbo, M., Ottaviano, M., Vitali, M., et al. (2018) Best Practices for the Management of Thymic Epithelial Tumors: A Position Paper by the Italian Collaborative Group for ThYmic MalignanciEs (TYME). Cancer Treatment Reviews, 71, 76-87. |
| [11] | Marx, A., Ströbel, P., Badve, S.S., Chalabreysse, L., Chan, J.K.C., Chen, G., et al. (2014) ITMIG Consensus Statement on the Use of the WHO Histological Classification of Thymoma and Thymic Carcinoma: Refined Definitions, Histological Criteria, and Reporting. Journal of Thoracic Oncology, 9, 596-611. https://doi.org/10.1097/jto.0000000000000154 |
| [12] | Mallick, J., Peterson, J.M., Pina-Oviedo, S., Patel, N., Venkatesan, R., Stevenson, H.L., et al. (2022) Liver Metastasis of Thymoma: Case Report and Review of the Literature. International Journal of Surgical Pathology, 31, 755-760. https://doi.org/10.1177/10668969221115818 |
| [13] | Farin, A., Aryan, H.E. and Abshire, B.B. (2005) Thymoma Metastatic to the Extradural Spine. Journal of Clinical Neuroscience, 12, 824-827. https://doi.org/10.1016/j.jocn.2004.09.028 |
| [14] | Nakagawa, K. (2019) Induction Chemotherapy for Locally Advanced Thymic Epithelial Tumors: Consideration from the RYTHMIC Prospective Cohort. Mediastinum, 3, Article No. 13. https://doi.org/10.21037/med.2019.04.03 |
| [15] | Lucchi, M., Ambrogi, M.C., Duranti, L., Basolo, F., Fontanini, G., Angeletti, C.A., et al. (2005) Advanced Stage Thymomas and Thymic Carcinomas: Results of Multimodality Treatments. The Annals of Thoracic Surgery, 79, 1840-1844. https://doi.org/10.1016/j.athoracsur.2004.12.047 |
| [16] | Alessandrini, G., Sperduti, I., Forcella, D., Marino, M., Ceribelli, A., Facciolo, F., et al. (2015) Induction Therapy versus Initial Surgery in Advanced Thymic Tumors: Perioperative and Oncological Outcome. The Thoracic and Cardiovascular Surgeon, 65, 234-243. https://doi.org/10.1055/s-0035-1564890 |
| [17] | Suh, J.W., Park, S.Y., Lee, C.Y., Song, S.H., Kim, D.J., Paik, H.C., et al. (2019) Neoadjuvant Therapy for Thymic Neoplasms Reduces Tumor Volume per 3D-Reconstructed Images but Does Not Improve the Complete Resection Rate. PLOS ONE, 14, e0214291. https://doi.org/10.1371/journal.pone.0214291 |
| [18] | Koçer, B., Kaplan, T., Günal, N., Koçer, B.G., Akkaş, Y., Yazkan, R., et al. (2018) Long-Term Survival after R0 Resection of Thymoma. Asian Cardiovascular and Thoracic Annals, 26, 461-466. https://doi.org/10.1177/0218492318778634 |
| [19] | Wei, Y., Gu, Z., Shen, Y., Fu, J., Tan, L., Zhang, P., et al. (2016) Preoperative Induction Therapy for Locally Advanced Thymic Tumors: A Retrospective Analysis Using the Chart Database. Journal of Thoracic Disease, 8, 665-672. https://doi.org/10.21037/jtd.2016.03.02 |
| [20] | Murakawa, T., Karasaki, T., Kitano, K., Nagayama, K., Nitadori, J., Anraku, M., et al. (2014) Invasive Thymoma Disseminated into the Pleural Cavity: Mid-Term Results of Surgical Resection. European Journal of Cardio-Thoracic Surgery, 47, 567-572. https://doi.org/10.1093/ejcts/ezu210 |
| [21] | Ichinose, Y., Ohta, M., Yano, T., Yokoyama, H., Asoh, H. and Hata, K. (1993) Treatment of Invasive Thymoma with Pleural Dissemination. Journal of Surgical Oncology, 54, 180-183. https://doi.org/10.1002/jso.2930540311 |
| [22] | Zhang, Y., Li, Z., Chen, Y., Tan, L., Zeng, Z., Ding, J., et al. (2021) Induction Strategy for Locally Advanced Thymoma. Frontiers in Oncology, 11, Article ID: 704220. https://doi.org/10.3389/fonc.2021.704220 |
| [23] | Wagner, C., Wakeam, E. and Keshavjee, S. (2021) The Role of Surgery in the Management of Locally Advanced and Metastatic Thymoma: A Narrative Review. Mediastinum, 5, Article No. 14. https://doi.org/10.21037/med-20-34 |
| [24] | Hamanaka, K., Koyama, T., Matsuoka, S., Takeda, T., Miura, K., Yamada, K., et al. (2018) Analysis of Surgical Treatment of Masaoka Stage III-IV Thymic Epithelial Tumors. General Thoracic and Cardiovascular Surgery, 66, 731-735. https://doi.org/10.1007/s11748-018-0996-9 |
| [25] | Kumar, A., Pulle, M.V., Asaf, B.B., Shivnani, G., Maheshwari, A., Puri, H.V., et al. (2020) Surgical and Oncological Outcomes in Locally Advanced Thymoma. Indian Journal of Surgical Oncology, 12, 350-357. https://doi.org/10.1007/s13193-020-01215-2 |
| [26] | Xu, C., Feng, Q., Fan, C., Zhai, Y., Chen, Y., Zhang, H., et al. (2015) Patterns and Predictors of Recurrence after Radical Resection of Thymoma. Radiotherapy and Oncology, 115, 30-34. https://doi.org/10.1016/j.radonc.2015.03.001 |
| [27] | Safieddine, N., Liu, G., Cuningham, K., Ming, T., Hwang, D., Brade, A., et al. (2014) Prognostic Factors for Cure, Recurrence and Long-Term Survival after Surgical Resection of Thymoma. Journal of Thoracic Oncology, 9, 1018-1022. https://doi.org/10.1097/jto.0000000000000215 |
| [28] | Achey, R.L., Lee, B.S., Sundar, S., Benzel, E.C. and Krishnaney, A.A. (2018) Rare Thymoma Metastases to the Spine: Case Reports and Review of the Literature. World Neurosurgery, 110, 423-431. https://doi.org/10.1016/j.wneu.2017.11.161 |
| [29] | Umana, G.E., Passanisi, M., Tranchina, M.G., Fricia, M., Nicoletti, G.F., Cicero, S., et al. (2020) Letter to the Editor Regarding “Rare Thymoma Metastases to the Spine: Case Reports and Review of the Literature”. World Neurosurgery, 138, 567-569. https://doi.org/10.1016/j.wneu.2020.01.192 |
| [30] | (2023) Thymoma and Thymic Carcinoma. In: Bennett, P, Mintz, A, Perry, B, et al., Eds., Specialty Imaging: PET, Elsevier, 208-211. https://doi.org/10.1016/B978-0-323-52484-1.50050-9 |
| [31] | Liao, J., Liu, T., Zhang, H., Cai, F., Chen, J. and Dang, J. (2018) The Role of Postoperative Radiation Therapy for Completely Resected Stage III Thymoma and Effect of Higher Heart Radiation Dose on Risk of Cardiovascular Disease: A Retrospective Cohort Study. International Journal of Surgery, 53, 345-349. https://doi.org/10.1016/j.ijsu.2018.04.018 |
| [32] | Nolan, M.T., Russell, D.J. and Marwick, T.H. (2016) Long-Term Risk of Heart Failure and Myocardial Dysfunction after Thoracic Radiotherapy: A Systematic Review. Canadian Journal of Cardiology, 32, 908-920. https://doi.org/10.1016/j.cjca.2015.12.020 |
| [33] | Rimner, A., Gomez, D.R., Wu, A.J., Shi, W., Yorke, E.D., Moreira, A.L., et al. (2014) Failure Patterns Relative to Radiation Treatment Fields for Stage II-IV Thymoma. Journal of Thoracic Oncology, 9, 403-409. https://doi.org/10.1097/jto.0000000000000099 |
| [34] | Ohm, B. and Jungraithmayr, W. (2022) Balancing the Risk of Adverse Events against the Efficacy of Immunotherapy in Advanced Thymic Epithelial Tumors. Cancers, 15, Article No. 289. https://doi.org/10.3390/cancers15010289 |
| [35] | Song, J.S., Kim, D., Kwon, J.H., Kim, H.R., Choi, C. and Jang, S.J. (2019) Clinicopathologic Significance and Immunogenomic Analysis of Programmed Death-Ligand 1 (PD-L1) and Programmed Death 1 (PD-1) Expression in Thymic Epithelial Tumors. Frontiers in Oncology, 9, Article No.1055. https://doi.org/10.3389/fonc.2019.01055 |
| [36] | Katsuya, Y., Horinouchi, H., Asao, T., Kitahara, S., Goto, Y., Kanda, S., et al. (2016) Expression of Programmed Death 1 (PD-1) and Its Ligand (PD-L1) in Thymic Epithelial Tumors: Impact on Treatment Efficacy and Alteration in Expression after Chemotherapy. Lung Cancer, 99, 4-10. https://doi.org/10.1016/j.lungcan.2016.05.007 |
| [37] | Cho, J., Kim, H.S., Ku, B.M., Choi, Y., Cristescu, R., Han, J., et al. (2019) Pembrolizumab for Patients with Refractory or Relapsed Thymic Epithelial Tumor: An Open-Label Phase II Trial. Journal of Clinical Oncology, 37, 2162-2170. https://doi.org/10.1200/jco.2017.77.3184 |
| [38] | Song, X., Fan, J., Zhu, L., Wang, Z., He, Y. and Zhou, C. (2021) The Efficacy and Safety of Immunotherapy in Thymic Epithelial Tumors: More Effective, More Risky: A Systematic Review. Journal of Thoracic Disease, 13, 5093-5103. https://doi.org/10.21037/jtd-21-290 |
| [39] | Hao, Y., Lin, G., Xiang, J., Wang, W., Xu, C., Wang, Q., et al. (2022) Analysis of the Efficacy and Safety of Immunotherapy in Advanced Thymoma Patients. Cancer Medicine, 12, 5649-5655. https://doi.org/10.1002/cam4.5357 |
| [40] | Maniar, R. and Loehrer, P.J. (2023) Understanding the Landscape of Immunotherapy in Thymic Epithelial Tumors. Cancer, 129, 1162-1172. https://doi.org/10.1002/cncr.34678 |
| [41] | Uchida, N., Fujita, K., Okamura, M., Nakatani, K. and Mio, T. (2019) The Clinical Benefits of Immune Checkpoint Inhibitor for Thymic Carcinomas Experience of Single Public Hospital in Japan. Respiratory Medicine Case Reports, 26, 39-41. https://doi.org/10.1016/j.rmcr.2018.11.007 |
| [42] | Fiorelli, A., D’Andrilli, A., Vanni, C., Cascone, R., Anile, M., Diso, D., et al. (2017) Iterative Surgical Treatment for Repeated Recurrences after Complete Resection of Thymic Tumors. The Annals of Thoracic Surgery, 103, 422-431. https://doi.org/10.1016/j.athoracsur.2016.08.086 |
| [43] | Marulli, G., Margaritora, S., Lucchi, M., Cardillo, G., Granone, P., Mussi, A., et al. (2015) Surgical Treatment of Recurrent Thymoma: Is It Worthwhile? European Journal of Cardio-Thoracic Surgery, 49, 327-332. https://doi.org/10.1093/ejcts/ezv086 |
| [44] | Hamaji, M., Ali, S.O. and Burt, B.M. (2014) A Meta-Analysis of Surgical versus Nonsurgical Management of Recurrent Thymoma. The Annals of Thoracic Surgery, 98, 748-755. https://doi.org/10.1016/j.athoracsur.2014.04.028 |
| [45] | Sandri, A., Cusumano, G., Lococo, F., Alifano, M., Granone, P., Margaritora, S., et al. (2014) Long-Term Results after Treatment for Recurrent Thymoma: A Multicenter Analysis. Journal of Thoracic Oncology, 9, 1796-1804. https://doi.org/10.1097/jto.0000000000000370 |
