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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 8  |  Page : 927-932

Value of Adjuvant Radiotherapy for Thymoma with Myasthenia Gravis after Extended Thymectomy


1 Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
2 Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

Correspondence Address:
Dr. Lei Yu
Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.229894

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Background: The co-existence of myasthenia gravis (MG) and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy. Methods: A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery (Group A); whereas the other 24 patients did not receive radiation therapy (Group B). According to the time that patients started mediastinal radiation therapy, we subdivided the 157 patients in Group A into subgroups (1-month subgroup, n = 98; 2-month subgroup, n = 7; and 3-month subgroup, n = 52). We then compared the effect of the mediastinal radiation therapy across these different groups using the survival rate, the rate of postoperative myasthenic crisis, and the complete stable remission (CSR) rate as the primary endpoints. Results: There was a significant difference in the occurrence of postoperative myasthenic crisis between 1-month subgroup and Group B (χ2 = 4.631, P = 0.031). The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group B, respectively. The overall survival rates of 1-month subgroup, 3-month subgroup, and Group B were 88.8%, 83.3%, and 77.3%, respectively. Analysis on the Kaplan-Meier survival curves demonstrated that within 8 years after surgery, there was no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup and Group B, and between 3-month subgroup and Group B; over 8 years after surgery, the disease-free survival rates in 1-month subgroup, 3-month subgroup and Group B were 79.4%, 70.6%, and 55.3%, respectively. Conclusions: Adjuvant radiation within 1 month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing the possibility of postoperative myasthenic crisis, and raising cumulative probabilities of reaching CSR.

 

 Abstract in Chinese

合并有重症肌无力的胸腺瘤手术后放疗的价值

摘要

背景:长期以来,关于胸腺瘤完全切除后辅助性放射治疗的争论一直存在。重症肌无力(MG)和胸腺瘤的共存使得手术治疗更加复杂,术后辅助放射更具争议性。本研究的目的是探讨MG胸腺瘤患者术后纵隔放疗的价值。
方法:2003年到2014年, 181 例合并有MG和胸腺瘤患者在北京同仁医院行胸腔镜胸腺扩大切除术,其中24例未接受术后辅助放疗(B组),157例患者术后进行纵隔放疗(A组)。根据术后放射治疗的开始时间,将术后纵隔放疗患者分为3个亚组:1月内放疗组,n = 98;2月内放疗组,n = 7;3月后放疗组,n = 52。然后,我们利用生存率、术后肌无力危象发生率和完全缓解率(CSR)作为主要评价指标,对比纵隔放射治疗对不同组的影响。
结果:在术后肌无力危象发生方面,1月内放疗组和B组之间有显著性差异(X2=4.631, P=0.031)。达到CSR分别为:1月内放疗组为32.6%、3月后放疗组为25%,B组为22.7%。总生存率分别为:1月内放疗组为88.8%、3月后放疗组为83.3%,B组为77.3%。对比术后生存曲线表明,术后8年内各组间在总生存和无病生存方面无显著性差异。术后超过8年,1月内放疗组、3月后放疗组和B组的无病生存率分别是79.4%, 70.6%和55.3%。
结论:胸腺扩大切除术后一个月内放疗在降低术后肌无力危象的发生和提高术后MG完全缓解率方面具有一定价值。



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