Clinical Outcomes of Up-front Surgery Versus Surgery After Induction Chemotherapy for Thymoma and Thymic Carcinoma: A Retrospective Study

IntroductionAlthough induction chemotherapy improves the resectability of thymic neoplasms, it is unclear whether surgery after induction chemotherapy can improve outcomes. We compared long-term outcomes of surgery with and without induction chemotherapy in patients with thymic neoplasms.Patients and MethodsWe retrospectively investigated the clinical information of patients with thymic neoplasms at the National Taiwan University Hospital between 2005 and 2013.ResultsOf 204 patients, 119 underwent direct surgery (group 1), 45 underwent surgery after induction chemotherapy (group 2), and 40 underwent no surgery (group 3). The 5-year overall survival rates of groups 1, 2, and 3 were as follows: for 204 patients, 96.3%, 76.4%, and 35.5% (P < .001); for 119 thymoma patients, 96.6%, 88.9%, and 100.0% (P = .835); for 85 thymic carcinoma patients, 94.7%, 69.7%, and 17.7% (P < .001); for 36 American Joint Committee on Cancer (AJCC) stage III-IVA thymoma patients, 92.9%, 83.3%, and 100% (P = .833); and for 28 stage III-IVA thymic carcinoma patients, 75.0%, 76.2%, and 62.5%, (P = .160). Univariate analysis showed that for group 2 (P = .0208) and group 3 (P < .0001), thymic carcinoma pathology type (P = .0010) and stage IVB disease (P < .0001) were poor prognostic factors. Multivariate analysis found thymic carcinoma (P = .0026) and stage IVB disease (P = .0449) to be poor prognostic factors.ConclusionUp-front surgery leads to best overall survival, and induction chemotherapy followed by surgery may improve resectability and outcomes. Only thymic carcinoma and stage IVB disease were poor prognostic factors in multivariate analysis.     

A Phase 2 Study of Palbociclib for Recurrent or Refractory Advanced Thymic Epithelial Tumors (KCSG LU17-21)

IntroductionThymic epithelial tumors (TETs) are rare but are the most common tumors of the anterior mediastinum. Platinum-based combination chemotherapy is the standard of care for such tumors and is associated with a 50% to 90% objective response rate (ORR) in metastatic disease. Nevertheless, there is no standard chemotherapeutic option after failure of platinum-based combination chemotherapy. Genetic alterations associated with the cell cycle, including pRB, p16^INK4A, and cyclin D1, are most often observed in TETs. On the basis of these results, we conducted a phase 2 trial to evaluate the efficacy and safety of palbociclib in patients with recurrent or refractory advanced TETs.MethodsThis is a phase 2, multicenter, open-label, single-arm study of palbociclib monotherapy in patients with recurrent or metastatic advanced TETs who failed one or more cytotoxic chemotherapies. The patients received 125 mg of oral palbociclib daily for 21 days, followed by a 7-day break. The primary end point was progression-free survival (PFS). The secondary end points were ORR, duration of response, overall survival, and safety.ResultsBetween August 2017 and October 2019, a total of 48 patients were enrolled. The median number of previous chemotherapies was one (range: one to four), and 21 (43.7%) of 48 patients received thymectomy. By the WHO classification, the patients were type A (n = 1), type B1 (n = 2), type B2 (n = 8), type B3 (n = 13), thymic carcinoma (n = 23), and unknown (n = 1). With a median follow-up of 14.5 months (range: 0.8–38.2), the median number of cycles of palbociclib monotherapy was 10 (range: 1–40). The ORR was 12.5% (four partial responses in thymoma and two partial responses in thymic carcinoma). The PFS at 6 months was 60.2%, and the median PFS was 11.0 months (95% confidence interval: 4.6–17.4). The median overall survival was 26.4 months (95% confidence interval: 17.4–35.4). The most common treatment-related adverse events of any grade were neutropenia (62.5%), anemia (37.5%), and thrombocytopenia (29.1%), and the most common grade 3/4 treatment-related hematologic adverse event was neutropenia (41.7%). Neutropenia above grade 3 was reversible, and there were no cases with neutropenic fever.ConclusionsPalbociclib monotherapy was well tolerated and had encouraging efficacy in patients with TETs who failed platinum-based combination chemotherapy.     

TPS1新辅助化疗对局部晚期鼻咽癌的疗效观察

目的 研究局部晚期鼻咽癌使用TPS1新辅助化疗的ORR及不良反应,探讨TPS1替代TPF新辅助化疗的可能性.方法 对29例局部晚期鼻咽癌,使用TPS1新辅助化疗2个周期后行同步放化疗.结果 TPS1新辅助化疗后BMI(体重指数)变化中位数0.34(0~1.1),总体放化疗后BMI(体重指数)变化中位数1.1(0.73~2.11).新辅助化疗后鼻咽部即时疗效评价:CR 4例(13.8%),PR 24例(82.8%),SD 1例(3.4%),ORR 96.6%.总体放化疗后鼻咽部即时疗效评价:CR 22例(75.9%),PR 7例(24.1%),ORR 100.0%.TPS1新辅助化疗后全组无4级不良反应,罕见3级不良反应,大多为0~1级不良反应,2级反应主要为恶心(48.0%),呕吐(21.0%),白细胞减少(24.0%)和中性粒细胞减少(14.0%).整体放化疗结束后全组无4级不良反应,少见3级不良反应(口腔黏膜炎除外).主要急性毒副作用表现为血液毒性,放射性皮炎,口腔黏膜炎,口干,脱发和呕吐.结论 对局部晚期鼻咽癌使用TPS1新辅助化疗有很好的近期疗效及较低的毒副反应,TPS1有替代TPF方案的可能.     

伊立替康联合替吉奥或5-氟尿嘧啶方案二线治疗晚期胃癌的疗效观察

目的 比较伊立替康联合替吉奥与伊立替康联合5-氟尿嘧啶二线治疗晚期胃癌的临床疗效及 不良反应。方法 77例既往应用含铂方案治疗失败的晚期胃癌患者随机分为两组,A组: 36例患者接 受伊立替康联合替吉奥胶囊的化疗方案,B组: 41例患者接受伊立替康联合5-氟尿嘧啶的化疗方案,按 照WHO标准评价客观疗效和不良反应。结果 患者经治疗后, A组总有效率为 41.7％, 最主要的不良反 应为血液学毒性, 表现为白细胞和血小板降低、贫血及腹泻等, 机体可以耐受这些不良反应。B组总有 效率为39.2% , 主要的不良反应为静脉炎、腹泻等。A组和B组中位疾病进展时间（TTP）分别为4.8月 和3.1月（P=0.001）。结论 两种联合化疗方案都具有较好的疗效, 相对来说,A组具有中位疾病进展 时间长和不良反应相对小的优点, 且住院时间短, 可作为既往应用含铂方案治疗失败的晚期胃癌患者的 二线化疗方案之一。     

替吉奥联合奥沙利铂及多西他赛治疗晚期及复发性胃癌的临床观察

目的探讨替吉奥胶囊(S-1)联合奥沙利铂及多西他赛治疗晚期及复发性胃癌的近期疗效和不良反应。方法对晚期及复发性胃癌52例采用多西他赛75 mg/m2静脉滴注1 h,第1天;奥沙利铂130 mg/m2静脉滴注3 h,第1天;替吉奥胶囊(S-1)40 mg/m2,早晚饭后各1次,口服化疗,第1～14天,服用14天后停药7天。每21天为1个周期,连用2个周期后评价疗效和不良反应。结果 52例均可评价,其中6例达到完全缓解(CR),22例达部分缓解(PR),15例达稳定(SD),9例进展(PD),总有效率(CR+PR)53.8%,临床受益率为82.7%。主要不良反应为胃肠道反应、白细胞减少和周围神经毒性,均较轻,未影响治疗。结论替吉奥胶囊联合奥沙利铂及多西他赛化疗治疗晚期及复发性胃癌的近期疗效较好,不良反应可以耐受,值得临床进一步研究应用。     

A Phase II Study of Pemetrexed in Patients with Recurrent Thymoma and Thymic Carcinoma

Introduction

Thymoma and thymic carcinoma (TC) are neoplastic diseases with reported chemosensitivity to a broad range of agents. However, because of the rarity of these diseases, few prospective trials have been conducted in patients with advanced thymic malignancies. We conducted a prospective phase II trial to evaluate the clinical activity of pemetrexed, a multitargeted antifolate agent, in previously treated patients with thymoma and TC.

ELF与FAM方案治疗晚期胃癌57例临床分析

我科自１９８５年５月至１９９５年３月，用ＥＬＦ及ＦＡＭ方案治疗晚期胃癌５７例，其中ＥＬＦ组２５例，ＦＡＭ组３２例。疗效分别为５６％（１４／２５）和３１．２５％（１０／３２），完全缓解率为１２％（３／２５）和１２．５％（４／３２）。恶心呕吐的Ⅲ级毒性发生率：ＥＬＦ组为０％，ＦＡＭ组为２５％（８／３２）；口腔粘膜Ⅱ级以上毒性发生率：ＥＬＦ组为４４％（１１／２５），ＦＡＭ组为０％；ＥＬＦ组未见心脏毒性，而ＦＡＭ为１２．５％。两者疗效无统计学差异（Ｐ＞０．０１）。恶心呕吐发生率ＦＡＭ方案明显大于ＥＬＦ方案（Ｐ＜０．０２５），而ＥＬＦ组的口腔炎发生率明显高于ＦＡＭ组（Ｐ＜０．００１）。结果表明ＥＬＦ方案更适合于不能耐受强烈化疗或存在基础心脏疾病的进展期胃癌患者。     

三维适形放疗联合化疗治疗局部晚期鼻咽癌的临床观察

目的探讨三维适形放疗联合同期化疗加辅助化疗治疗局部晚期鼻咽癌的治疗效果、毒副反应。方法 120例局部晚期鼻咽癌患者随机分为观察组和对照组,2组均采用三维适形放疗,观察组患者在放疗的基础上给予同期化疗和辅助化疗。结果观察组和对照组近期有效率分别为90.00%、70.00%,差异有统计学意义（P〈0.05）;3 a总生存率分别为81.67%、68.33%,差异有统计学意义（P〈0.05）;3 a无瘤生存率分别为71.67%、58.33%,差异有统计学意义（P〈0.05）。观察组血液学毒性和胃肠道反应发生率较对照组高,差异有统计学意义（P〈0.05）。结论三维适形放疗联合同期化疗加辅助化疗治疗局部晚期鼻咽癌能够有效控制肿瘤和改善生存状况。     

Clinical Analysis of 45 Patients with Thymic Carcinoma

OBJECTIVE To retrospectively evaluate the prognostic factors for advanced thymic carcinoma.METHODS The data from 45 patients with advanced thymic carcinoma were retrospectively analyzed according to Masaoka stage criteria. There were 29 Stage Ⅲ patients and 16 Stage Ⅳ patients (13 Stage IVA patients and 3 Stage IVB patients).According to the World Heath Organization Histological Criteria (2004), 25 cases were identified as low-grade and 20 cases were identified as high-grade. All diagnoses were confirmed by biopsy. Five patients underwent gross total resection, 21patients underwent subtotal resection and 19 patients underwent biopsy alone. Forty-two patients received radiotherapy with a median dose of 60 Gy, and 37 patients underwent conventional radiotherapy, including local irradiation and expanded irradiation.Local irradiation volume covered the primary tumor bed and approximately 1-2 cm2 surrounding the tumor (according to preoperative imaging). Expanded irradiation volume covered the full mediastinal and pericardium areas (with or without prophylactic irradiation in the supraclavicular area). Five cases received stereotactic radiotherapy. Thirty-one patients were also treated with chemotherapeutics, including Cisplatin, VP-16,Endoxan, 5-FU and taxol.RESULTS The median follow-up period was 59 months. The overall 3-year survival rate was 57.8%, and the median survival was 45 months. Univariate statistical analysis showed that the histological subtype and Masaoka stage were prognostic factors.The 3-year survival rate was 61.9% in patients treated with gross total resection and 55.0% in those who underwent biopsy only. The 3-year survival rate was 59.5% in patients treated with conventional radiotherapy and 80% in those treated with stereotactic radiotherapy. The 3-year survival rate was 64.5% in patients treated with simultaneous chemotherapy and 42.9%in patients treated without simultaneous chemotherapy (P >0.05). Chemotherapy in combination with radiation treatment and surgery achieved better outcomes for Stage Ⅳ patients than radiation treatment and surgery without chemotherapy (P < 0.05).CONCLUSION For patients with Stage Ⅲ and Ⅳ thymic carcinoma, complete resection and postoperative radiotherapy or fractionated stereotactic radiotherapy constitute the best treatment solution. Chemotherapy can also be used in combination to improve prognosis. For patients with Stage Ⅳ thymic carcinoma,chemotherapy is necessary.     

替吉奥联合草酸铂治疗晚期胃癌的临床观察

目的 评价替吉奥联合草酸铂治疗晚期胃癌的临床疗效和安全性.方法 31例晚期胃癌患者接受替吉奥联合草酸铂一线化疗,至少完成2周期后评价化疗有效率和毒副反应.结果 31例患者均可评价疗效,其中PR 14例,SD 9例,PD 8例,有效率为45.2%,疾病控制率为74.2%.中位疾病进展时间为7.3个月.主要毒副反应为血液学毒性、胃肠道反应和外周神经毒性,以Ⅰ、Ⅱ度为主.结论 替吉奥联合草酸铂化疗方案一线治疗晚期胃癌近期疗效较好,毒副反应可耐受.     

术前新辅助化疗治疗局部晚期宫颈癌临床疗效的观察

目的 探讨Ⅰb2～Ⅱb期局部晚期宫颈癌于根治术前给予新辅助化疗(NACT)的疗效.方法 回顾性分析48例Ⅰb2～Ⅱb期局部晚期宫颈癌NACT 1～2疗程后根治性手术者(NACT组)和38例直接根治性手术者(对照组)的临床资料,评价NACT在宫颈癌治疗中的作用及安全性.结果 术前NACT总有效率77.1%,化疗毒副反应轻...