title: Multimodality therapy for patients with invasive thymoma disseminated into the pleural cavity: the potential role of extrapleural pneumonectomy.
abstract: BACKGROUND
  The optimal treatment method for thymoma with pleural dissemination remains controversial. We analyzed our experience with a multimodality approach and evaluated the role of extrapleural pneumonectomy (EPP) in the treatment of disseminated thymoma.
  
  
  METHODS
  Multimodality therapy was used to treat 11 consecutive patients with invasive thymoma disseminated into the pleural cavity. Disease was stage IVa in 9 and stage IVb disease with lymph node metastasis in 2. Our treatment strategy for those patients was induction chemotherapy with cisplatin, doxorubicin, and methylprednisolone (CAMP therapy), followed by thymectomy combined with resection of the visible disseminated nodules and postoperative radiotherapy. EPP was applied for 4 patients who had chemoresistant tumors or pleural refractory recurrence.
  
  
  RESULTS
  Eight patients underwent induction chemotherapy. The response rate to CAMP was 85%. Thymectomy with or without the resection of disseminated pleural tumors was performed in 7 patients and EPP in 3. Postoperative radiotherapy was administered in 6. All patients except 1 with EPP had recurrence: pleural recurrence in 7, lung in 1, and multiple organs in 2. Nine patients were retreated with chemotherapy, radiotherapy, pulmonary metastasectomy, or pleurectomy. One underwent EPP for pleural recurrence. Consequently, among the 7 patients without EPP, only 1 was alive without disease and 4 were alive with pleural recurrence. In contrast, 3 of the 4 patients with EPP had no local failure and were alive without recurrence.
  
  
  CONCLUSIONS
  In multimodality therapy for thymoma with pleural dissemination, EPP offers good local control and may lead to cure.
authors.affiliation: Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Matsuguma
authors.forename: Rie
authors.initials: R
authors.lastname: Nakahara
authors.forename: Haruko
authors.initials: H
authors.lastname: Suzuki
authors.forename: Akiko
authors.initials: A
authors.lastname: Ui
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kondo
authors.forename: Yukari
authors.initials: Y
authors.lastname: Kamiyama
authors.forename: Seiji
authors.initials: S
authors.lastname: Igarashi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Mori
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kodama
authors.forename: Kohei
authors.initials: K
authors.lastname: Yokoi
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D013953:Thymus Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*