284 2007 13(4) 中醫藥配合放射線及化學治療胸腺癌的病例報告 陳明和 梁文哲 吳蓉茹 邱瑞發 嘉義基督教醫院中醫部 42 : 3 0.2~1.5% 10~20% Levine Rosai 1978 (invasive thymic tumor) (thymomas) (thymic carcinomas) (1) (2) (05) 2765041 7030 539 2007. 11. 10 E-mail c158@cych.org.tw
285 (3) (4) ** 42 165cm 67kg4214*** 94 12 16 96 7 20 42 91 9 squamous cell carcinoma stageiv 78 7/20 (- ) ( )(-) (-)(-) B C(-) (-)(+) 910918 lung left lower lobe frozen sectionsquamous cell carcinoma. mediastinum frozen section biopsyfibroadipose tissue with carcinoma (see micro); pericardium frozen section biopsy- fibrosis. microscopic finding:lll nodule show alveolar parenchyma with sequamous
286 2007 13(4) cell carcinoma. Moderately differentiated. BP: 130/76 mmhg. TPR: 36.8 0 C/86/20. Conscious: clear. E4V5M6. HEENT: supple neck and normal eyes, ears, nose, and throat. No jugular vein engorgement, No lymphadenopathy. Thyroid enlargement (-). Eyes: sclera: icteric (-); conjuctiva: pale(-); pupil size: isocoria (+). Chest: symmetric expansion, wheezing (-), B.S: rale; LLL decreased. Heart: RHB with mark murmur. Echo: MVP. Abdomen: soft /ovoid with normoactive B.S.; without tenderness,distension. Extremities: freely movable without pitting edema. 91/9/9 Thymic squamous carcinoma with lung metastasis s/p op. 91/9~91/11 post-op R/T and concurrent C/T 91/12~92/3 PAC x 4; 92/3~92/9 oral UFUR 92/9~92/12 disease progression with bone metastasis s/p R/T+ Navelbine + gemcitiabine x 6 93/12~94/5 disease progression s/p weekly CPT-11+ Lipo-DOX x 15 95/2~95/6 disease progression with multiple bone metastasis s/p Taxol + Tarceva x 12. 96/1~96/3 bone pain, start biweekly FL 48hr x 4. 96/4 Taxotere + Cisplantin x 2. 96/6 Left rib cage metastasis s/p R/T + Taxotere x 3. 2400 5600 78 7g 1g 1g 1g 1g 0.8g TID*7
287 ; 5 3 3 2 --- 4 3 3 --- 2 1.5 --- 2 --- 8 2 95/04/28 WBC 2.9K Thymic CA & Lung metastasis,s/p left lung lobectomy + CCRT R/T(72th) for left pleural & pelvic bony metastasis 6 5 1 1 1 TIDx7 95/05/12 Thymic CA & Lung metastasis,s/p left lung lobectomy + CCRT,R/T(72th) for left pleural & pelvic bony metastasis 6 5 1 1 1 1 TIDx7 4 3 2 (CCRT) 95/05/29 WBC 2.9K 4.3K Ditto
288 2007 13(4) 6 5 1 1 1 1 TIDx7 4 3 2 95/09/25 WBC 4.3K 5.6K H.S. murmur, Ditto 6 6 1 1 1 1 TIDx7 96/05/24 Ditto 6 6 1 1 1 1 TIDx7 96/06/23 96/1 CT LT pleural metastasis BP: 81/54mmHg H.S. murmur, 6 6 1 1 1 1 TIDx7 96/07/20 Hb 11.7 6 6 1 1 1 1 TIDx7
289 100.3 p<0.01 0.2~1.5 % (anterior mediastinum), (1) Masaoka Stage I: Completely encapsulated tumor without microscopic capsular invasion. Stage II: (1) Microscopic capsular invasion into the surrounding fatty tissue or mediastinal pleura. (2) Microscopic invasion into the capsule. Stage III: Macroscopic invasion into the neighboring organ (pericardium, great vessels,or lung). Stage IV: (a) Pleural or pericardial dissemination. (b) Lymphatic or hematogenous metastasis. (epithelial cells) (lymphocytes)( T ) WHO 1999 (thymic epithelial tumors) A B C (a) type A spindle cell type medullary type thymoma (b) type AB mixed type(a B ) (c) type B B1 B2 B3 (B1) lymphocyte-rich type, lymphocytic
290 2007 13(4) type, predominantly cortical type, or organoid type (B2) cortical type (B3) epithelial type, squamoid type,or atypical thymoma, welldifferentiated thymic carcinoma. (d) type C thymic carcinoma. a)+b) CDDP ADOC(ADR CDDP VCR CYC) PVB(CDDP VP-16 BLM) (5) (6 ) (6)
291 (1) (2) (3) (4) (5) (7) 1992 2005 29 p=0.017 p= 0.046 26 78.3% 15.3% (8) (9) (10) 74 (11) stage(iv) 78 95/4 2900 5600 95/9 96/6
292 2007 13(4) BP:81/54 2007 10 10 1993 412-413 Tierney LM, Mcphee SJ, Papadakis MA: Current Medical Diagnosis & Treatment 1998, McGraw-Hill Companies, USA, 1998: 97;968-970 1992 883-884 1996 639-649 - 2003 102-105 2000 108-111 2000 253-262 2007 14(2) 75-81 Eng TY, Fuller CD, Jagiradar J, Bains Y,Thomas CR: Thymic carcinoma: state of the art review, Int J Radiat Oncol Biol Phys,2004; 59: 654-664 Acta Cardiologic Sinica 2006 22(2) 112-116 2005 30(3) 189-192
293 Treatment of Thymic Carcinoma with the Combination of Chinese Medicine, Radiotherapy and Chemotherapy: A Case Report Min-Ho Chen, Wen-Che Liang, Jung-Ju Wu, Jui-Fa Chiu Chiayi Christian Hospital Chinese Medicine Department Abstract This 42 year-old male patient suffered from thymic carcinoma with multiple metastasis. He had received surgical operation and many courses of chemotherapy with radiation therapy. He visited our Chinese medicine department due to dull pain over left thoracic region. Thymic carcinoma has been recognized in Chinese medical theories as phlegm node, aggregation-accumulation, scrofula. This diagnosis was heat toxin blocking the lung and affecting spleen, stomach, liver and kidney. The therapeutic principles were soothing the liver, counteracting heat toxin, resolving phlegm and drying dampness. The medicinals for fortifying the spleen, harmonizing the stomach, directing qi downward to relieve hiccup, tonifying the kidney, nourishing blood, relaxing sinews and activating collaterals were also used. In this successful case, we found that the combination of Chinese medicine, chemotherapy and radiotherapy was a good treatment for thymic carcinoma. This combined treatment would successful control the thymic carcinoma and significantly reduce the side effect of chemotherapy and radiotherapy. Key words: thymic carcinoma, radiotherapy, chemotherapy, Chinese medicine.