Original article
General thoracic
Advanced Stage Thymomas and Thymic Carcinomas: Results of Multimodality Treatments

https://doi.org/10.1016/j.athoracsur.2004.12.047Get rights and content

Background

With the aim of evaluating the results of multidisciplinary approaches, we reviewed our experience in multimodality treatment of advanced stage (III and IVA) thymic tumors.

Methods

From 1976 to 2003, 56 patients with Masaoka stage III and IVA thymic tumors underwent a multimodality treatment. Thirty-six patients underwent neoadjuvant chemotherapy, surgery, and postoperative radiotherapy; 20 patients were treated by primary surgery and postoperative radiotherapy (n = 12), chemotherapy (n = 1) or chemoradiotherapy (n = 7). The neoadjuvant or adjuvant chemotherapy consisted of three courses of cisplatin, epidoxorubicin, and etoposide every 3 weeks. Adjuvant radiotherapy consisted of 45 Gy for complete resections or 60 Gy for incomplete resections.

Results

The preoperative diagnosis of invasive thymomas was performed in a total of 29 cases: 15 by mediastinotomy, 6 by video-assisted thoracoscopic surgery, and 8 by fine-needle aspiration. In 27 cases no diagnosis was available, but in most of them a thymus-related syndrome was present. Thirty-four patients are still alive (31 disease-free), and 22 have died (2 disease-free). Ten-year survival was 48% and 45.7% for stage III and IVA thymomas, respectively. The presence of myasthenia gravis (p = 0.04) and neoadjuvant chemotherapy (p = 0.004) affected survival significantly.

Conclusions

The multimodality treatment of stage III and IVA thymic tumors allows a good long-term outcome; the neoadjuvant chemotherapy improves the resectability rate and the survival of both stages of the disease.

Section snippets

Material and Methods

We analyzed 56 patients with thymic tumors (of 210 resected during the same period) who underwent a multimodality treatment between 1976 and 2003. The diagnosis of thymic tumor was reviewed and confirmed by our pathologists (F.B., G.F.) according to the World Health Organization classification [17]. Collection of data and follow-up were performed by review of medical charts and phone contact or examination of all patients. There were 35 men and 21 women, with a mean age of 53.3 years (range, 25

Results

Thirty-six patients had no thymus-related syndrome, 14 had myasthenia gravis, 4 had red cell aplasia, 1 had hypogammaglobulinemia, and 1 had multiple syndromes (myasthenia gravis, red cell aplasia, thrombocytopenia, and rheumatologic syndrome). The preoperative diagnosis of thymoma was performed in 29 patients: in 15 cases by mediastinotomy, in 6 by video-assisted thoracoscopic surgery, and in 8 by computed tomography or ultrasound biopsy. In 15 cases the myasthenia gravis or red cell aplasia

Comment

Although surgery remains the mainstay in the treatment of thymoma [2, 19], the best strategy and which multimodality treatment should be adopted in the more advanced and invasive tumors have yet to be determined. In this study we analyzed 56 patients with stage III and IVA thymic tumors, aiming to compare the results of different multimodality treatments. Despite the fact that the study is not randomized, the series (single-institution experience) is remarkable, and some important concerns can

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