title: Feasibility of multimodality therapy including extended resections in stage IVA thymoma.
abstract: OBJECTIVE
  Extended resections for advanced-stage thymomas are not commonly performed because of the potential morbidity in the face of unclear survival or palliative benefit. We reviewed our experience with multimodality treatment for Masaoka stage IVA thymomas for feasibility and outcomes.
  
  
  METHODS
  We conducted a retrospective review of a single-institution surgical database. Data included patient demographics, preoperative staging and treatment, perioperative events, pathologic findings, and postoperative outcomes.
  
  
  RESULTS
  During the period from 1996 to 2006, 18 patients who had Masaoka stage IVA thymoma underwent surgical resection. All patients received preoperative chemotherapy. Four patients with extensive pleural involvement underwent concomitant extrapleural pneumonectomy and postoperative hemithoracic radiation. Complete resection was achieved in 12 (67%) patients. There was no operative mortality. With a median follow-up of 32.2 months (range 1.4-129.9 months), 3-year, 5-year, and 10-year survivals were 91%, 78%, and 65%, respectively, and median survival has not yet been reached.
  
  
  CONCLUSIONS
  Multimodality therapy including extended surgical resection can be performed in select patients with stage IVA thymoma with low morbidity and mortality and can result in excellent long-term survival.
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: James
authors.initials: J
authors.lastname: Huang
authors.forename: Nabil P
authors.initials: NP
authors.lastname: Rizk
authors.forename: William D
authors.initials: WD
authors.lastname: Travis
authors.forename: Venkatraman E
authors.initials: VE
authors.lastname: Seshan
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Bains
authors.forename: Joseph
authors.initials: J
authors.lastname: Dycoco
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Downey
authors.forename: Raja M
authors.initials: RM
authors.lastname: Flores
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Park
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D011013:Pneumonectomy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013908:Thoracotomy; D013945:Thymoma / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D013953:Thymus Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome