title: Multimodality treatment of thymoma: a prospective study.
abstract: BACKGROUND
  Thymomas are a heterogeneous group of tumors. Treatment of invasive lesions is not well standardized. The aim of this study is to propose a clinicopathologically based protocol for multimodality therapy.
  
  
  METHODS
  Between 1965 and 1988, we operated on 83 patients with thymoma who did not receive standardized adjuvant therapy. In 1989, on the basis of the retrospective analysis of the data, we started a multimodality therapy protocol and used it for 65 patients. Twelve patients had medullary thymoma (11 stage I and 1 stage II), 13 had mixed type (6 stage I and 7 stage II), and 40 had cortical thymoma (4 stage I, 11 stage II, 12 stage III, and 13 stage IV). We considered three groups. Group I (n = 18 patients), benign thymoma, included stage I and II medullary and stage I mixed thymomas; radical resection with no adjuvant therapy was performed. Group II (n = 22), invasive thymoma, included stage I and II cortical and stage II mixed thymomas; postoperative chemotherapy plus radiotherapy was always administered. Group III (n = 25), malignant thymoma, comprised stage III and IV cortical thymomas and stage III mixed thymomas; resectable stage III lesions were removed, and highly invasive stage III and stage IV lesions underwent biopsy, neoadjuvant chemotherapy, and surgical resection; postoperative chemotherapy and radiotherapy was administered to all patients.
  
  
  RESULTS
  The 8-year survival rate for patients in stages I, II, III, and IV was 95%, 100%, 92%, and 68%, respectively. Patients with medullary thymoma had a 92% 8-year survival rate; those with mixed type, 100%; and those with cortical thymoma, 85%. Group I had an 8-year survival rate of 94%; group II, 100%; and group III, 76%. Survival was compared with that of patients operated on before 1989: differences were not significant for group I; survival improved in group II (100% versus 81%; p = not significant); and group III showed significant improvement (76% versus 43%; p < 0.049).
  
  
  CONCLUSIONS
  Multimodality treatment with neoadjuvant chemotherapy and adjuvant chemotherapy plus radiotherapy may improve the results of radical resection and the survival of patients with invasive and malignant thymoma.
authors.affiliation: Department of Thoracic Surgery, University of Rome La Sapienza, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Venuta
authors.forename: E A
authors.initials: EA
authors.lastname: Rendina
authors.forename: E O
authors.initials: EO
authors.lastname: Pescarmona
authors.forename: T
authors.initials: T
authors.lastname: De Giacomo
authors.forename: M L
authors.initials: ML
authors.lastname: Vegna
authors.forename: P
authors.initials: P
authors.lastname: Fazi
authors.forename: I
authors.initials: I
authors.lastname: Flaishman
authors.forename: E
authors.initials: E
authors.lastname: Guarino
authors.forename: C
authors.initials: C
authors.lastname: Ricci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D013945:Thymoma / Q000401:mortality / Q000628:therapy*; D013953:Thymus Neoplasms / Q000401:mortality / Q000628:therapy*