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

作     者：Chang-Feng Lu Lei YU Yun Jing Yun-Feng Zhang Ji Ke Lu Chang-Feng;Yu Lei;Jing Yun;Zhang Yun-Feng;Ke Ji

作者机构：Department of Neurology Beijing Tongren Hospital Capital Medical University Beijing 100730 China Department of Thoracic Surgery Beijing Tongren Hospital Capital Medical University Beijing 100730 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2018年第131卷第8期

页      面：927-932页

核心收录：

学科分类：1007[医学-药学(可授医学、理学学位)] 090602[农学-预防兽医学] 1002[医学-临床医学] 09[农学] 0906[农学-兽医学] 10[医学] 

基　　金：This study was supported by a grant of the High-level Talent Grants of Beijing Health Bureau 

主　　题：Myasthenia Gravis Prognosis Radiotherapy Thymectomy Thymoma 

摘      要：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.