Multidisciplinary approach for advanced stage thymic tumors: long-term outcome.
BACKGROUND
In advanced stage thymic tumors complete surgical resection is not always achievable. Although surgery remains the cornerstone of therapy, there is growing evidence that multimodality treatment increases resectability and reduces the incidence of local and systemic relapses.


METHODS
Between 1980 and 2008, 75 patients with stages III (n = 51), IVA (n = 18) and IVB (n = 6) thymic tumors were treated. Twenty-six patients had A-AB-B1 and 49 B2-B3-C histotype. Thirty-eight (50.6%) patients considered not radically resectable at preoperative workup, received induction chemotherapy; postoperatively 37 (49.3%) had radiotherapy, 25 (33.3%) chemoradiotherapy and 4 (5.3%) chemotherapy.


RESULTS
No perioperative mortality was recorded. Sixty-one (81.3%) had complete resection (CR) and 14 (18.7%) incomplete resection (IR). CR was lower in patients who received induction chemotherapy (73.7% vs 89.2%, p = 0.02). In 11 (14.7%) cases a vascular procedure was carried out. Overall 5- and 10-year survivals were 70% and 57%, respectively. Five and 10-year tumor-related survival was 78% and 70%. Ten-year survival was better for CR vs IR resection (62% vs 28%; p = 0.003) and for type A-AB-B1 vs B2-B3-C (60% vs 53%; p = 0.03). No statistical difference was found between stage III and IV (10-year survival: 63% and 43%; p = 0.42) and induction vs no induction chemotherapy (10-year survival: 52% vs 56%; p = 0.54). At multivariate analysis CR (p = 0.001) and type A-AB-B1 (p = 0.04) were independent predictors of better survival. During follow-up, 34.4% of CR developed tumor recurrence.


CONCLUSIONS
Multimodality treatment of stages III and IV thymic tumors guarantees good disease control and provides high survival and acceptable recurrence rates.
Rea
Federico
F
Department of Cardio-Thoracic and Vascular Sciences, Division of Thoracic Surgery, University of Padova, Italy.
Marulli
Giuseppe
G
Di Chiara
Francesco
F
Schiavon
Marco
M
Perissinotto
Egle
E
Breda
Cristiano
C
Favaretto
Adolfo Gino
AG
Calabrese
Fiorella
F
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D016019:Survival Analysis; D013953:Thymus Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents