美国放射学会胸腺癌多学科治疗中放射治疗适当使用标准

SCI 19 May 2023

American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma

 (JAMA oncology, IF: 33.006)

Chun SG, Rimner A, Amini A, Chang JY, Donington J, Edelman MJ, Geng Y, Gubens MA, Higgins KA, Iyengar P, Movsas B, Ning MS, Park HS, Rodrigues G, Wolf A, Simone CB 2nd. American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma. JAMA Oncol. 2023 May 15. doi: 10.1001/jamaoncol.2023.1175. Epub ahead of print. PMID: 37186595.r

Corresponding Author: Stephen G. Chun, MD, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX77030 (sgchun@mdanderson.org).

Importance 重要性

Thymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management.

胸腺癌是罕见的，由于缺乏前瞻性数据，其肿瘤学治疗存在争议。因此，多学科共识指南对于指导肿瘤学治疗至关重要。

Objective 目的  

To develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma.

制定常见胸腺癌治疗的多学科专家共识指南。

Evidence review 证据综述  

Case variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. Variants and procedures were evaluated by the panel using modified Delphi methodology. Agreement/consensus was defined as less than or equal to 3 rating points from median. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures.

由15名成员组成的多学科美国放射学会（ARS）胸部适当使用标准（AUC）专家小组开发了涵盖I至IV期胸腺癌的病例变体，以解决治疗争议。对1980年至2021年的英语医学文献进行了全面综述，为共识指南提供信息。专家组使用修改后的德尔菲研究法对变体和程序进行了评估。一致/共识被定义为与中位数相差小于或等于3个评分。随后，ARS执行委员会批准了共识建议，并根据既定的ARS程序征求公众意见。

Findings 发现  

The ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs.

ARS胸部AUC小组确定了89个相关参考文献，并对所有胸腺癌评估程序达成共识。由于胸腺癌的浸润性，微创胸腺切除术通常被认为是不合适的（无论分期如何）。人们一致认为，常规分级放射（每天1.8-2 Gy）辅助剂量为45至60 Gy，根治剂量为60至66 Gy是合适的，选择性淋巴结放射是不合适的。在放射技术方面，专家组建议使用调强放射治疗或质子治疗（而不是三维适形放射治疗），以减少对心脏和肺部的辐射暴露。

Conclusions and relevance 结论和相关  

The ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.

ARS胸部AUC小组已经为胸腺癌的各种表现制定了多学科共识指南，这可能是该主题中引用最多的。

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