■胸腺上皮肿瘤(TET)很少见,起源于胸腺。胸腺瘤和胸腺癌是最常见的TET类型。在这两个人中,胸腺瘤往往具有更好的预后,并且通常是局部的,而胸腺癌的预后较差,更容易扩散。Masaoka-Koga分级系统通常用于确定TET的阶段。完全切除是首选的治疗选择,但是由于周围结构的侵入,处理局部先进的TET可能具有挑战性。在这种情况下,给予诱导治疗以降低肿瘤的分期并使其能够完全切除。我们进行了这篇叙述性综述,以评估局部晚期TET诱导治疗的当前进展。
■文献检索是在2023年6月使用PubMed和WebofScience进行的。前瞻性和回顾性发表的试验,系统和叙述性评论,并纳入荟萃分析。
■诱导化疗通常用作晚期TETs的术前治疗。铂和蒽环类化疗方案通常用于治疗胸腺瘤(反应率,37-100%),完全切除是非常常见的。顺铂和依托泊苷治疗,卡铂和紫杉醇,多西他赛和顺铂也显示出有效性,特别是不能耐受蒽环类药物的胸腺癌或胸腺瘤患者。免疫疗法和靶向疗法的出现可以为TET的治疗提供额外的选择。诱导放疗,作为TET的唯一治疗方法,由于担心对周围组织的潜在损害,因此并未广泛使用。然而,将现代放射技术与手术相结合,在选定的患者中显示出有希望的结果。诱导放化疗,结合了化疗和放疗,是一种新兴的治疗TET的方法。尽管缺乏比较化疗和放化疗的随机试验,40-50Gy辐射剂量的同步放化疗通常被认为是胸腺癌患者或更晚期特殊情况下的最佳诱导治疗,如巨大的船只入侵。
■总的来说,局部晚期TETs的最佳治疗仍存在争议。诱导治疗,包括化疗,放射治疗,或者放化疗,用于低级肿瘤并提高可切除性。治疗的选择取决于个体因素,如肿瘤分期,组织学,和患者的整体状况。然而,需要进一步的研究和精心设计的研究来确定针对局部晚期TET的最有效治疗策略.
UNASSIGNED: Thymic epithelial tumors (TETs) are rare and originate from the thymus. Thymomas and thymic carcinomas are the most common types of TETs. Of the two, thymomas tend to have a better prognosis and are typically localized, while thymic carcinomas have a worse prognosis and are more likely to spread. The Masaoka-Koga staging system is commonly used to determine the stage of TETs. Complete resection is the preferred treatment option, but treating locally advanced TETs can be challenging due to the invasion of surrounding structures. In such cases, induction therapy is administered to downstage the tumors and enable complete resection. We conducted this narrative review to evaluate the current progress in induction treatment for locally advanced TETs.
UNASSIGNED: The literature search was performed using PubMed and Web of Science in June 2023. Prospective and retrospective published trials, systemic and narrative reviews, and meta-analyses were included.
UNASSIGNED: Induction chemotherapy is often used as a preoperative treatment for advanced TETs. Platinum and anthracycline-based chemotherapy regimens are commonly used for treating thymoma (response rate, 37-100%), and complete resection is highly common. Treatment with cisplatin and etoposide, carboplatin and paclitaxel, docetaxel and cisplatin have also demonstrated effectiveness, particularly in patients with thymic carcinoma or thymoma who cannot tolerate anthracycline regimens. The emergence of immunotherapy and targeted therapies may provide additional options for the treatment of TETs. Induction radiotherapy, as the sole treatment for TETs, is not widely practiced due to concerns about potential damage to surrounding tissues. However, combining modern radiation techniques with surgery has shown promising results in selected patients. Induction chemoradiotherapy, which combines chemotherapy and radiation, is an emerging approach for treating TETs. Despite the lack of randomized trials comparing chemotherapy with chemoradiotherapy, concurrent chemoradiation with radiation doses of 40-50 Gy is often considered the optimal induction therapy for thymic carcinoma patients or in more advanced special situations, such as great vessel invasion.
UNASSIGNED: Overall, the optimal treatment for locally advanced TETs remains controversial. Induction therapy, including chemotherapy, radiotherapy, or chemoradiotherapy, is administered to downstage tumors and improve resectability. The choice of treatment depends on individual factors such as tumor stage, histology, and overall patient condition. However, further research and well-designed studies are needed to determine the most effective treatment strategies for locally advanced TETs.