title: Multidisciplinary treatment for advanced invasive thymoma with cisplatin, doxorubicin, and methylprednisolone.
abstract: OBJECTIVE
  Advanced invasive thymomas are not usually manageable by surgical resection and radiotherapy. We reviewed our experience with a multidisciplinary approach and evaluated chemotherapy in the treatment of invasive thymoma.
  
  
  METHODS
  Seventeen consecutive patients with invasive thymoma were treated with multimodality therapy consisting of chemotherapy, surgery, and/or radiotherapy. Four patients had stage III disease with superior vena cava invasion, nine had stage IVa disease, and four had stage IVb disease. The chemotherapy regimen consisted of cisplatin, doxorubicin, and methylprednisolone (CAMP). Chemotherapy was administered in a neoadjuvant setting to the 14 patients and in an adjuvant setting to the remaining three patients. Surgical resection was intended in all patients. After those treatments, chemotherapy and/or radiation therapy were performed.
  
  
  RESULTS
  All but one of the 14 patients with induction chemotherapy responded to the CAMP therapy, and the response rate was 92.9%. Seven of these patients underwent complete remission after surgical resection and chemoradiotherapy, and the others underwent partial remission. All three patients treated with surgical resection and then chemotherapy with or without radiotherapy also achieved complete remission. Tumor progression after multimodality therapy occurred in 10 patients. After retreatment, eight of these patients were alive at the time of analysis, with a median survival time after recurrence of 30 months. The 5- and 10-year overall survival rates for all patients were both 80.7%. The major side effect of CAMP therapy was acceptable neutropenia.
  
  
  CONCLUSIONS
  CAMP therapy was highly effective for invasive thymomas, and the multimodality therapy containing this chemotherapy brought about good disease control in the majority of patients. We believe that this multidisciplinary treatment with CAMP therapy, surgery, and radiotherapy is a justifiable initial treatment for patients with advanced invasive thymoma. Furthermore, appropriate treatments are essential for the long-term survival of patients with recurrences after multimodality therapy.
authors.affiliation: Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan. k-yokoi@med.nagoya-u.ac.jp
authors.forename: Kohei
authors.initials: K
authors.lastname: Yokoi
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Matsuguma
authors.forename: Rie
authors.initials: R
authors.lastname: Nakahara
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kondo
authors.forename: Yukari
authors.initials: Y
authors.lastname: Kamiyama
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Mori
authors.forename: Naoto
authors.initials: N
authors.lastname: Miyazawa
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D015996:Survival Rate; D013945:Thymoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D013953:Thymus Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D004317:Doxorubicin; D002945:Cisplatin; D008775:Methylprednisolone