title: Induction chemotherapy, cytoreductive surgery and intraoperative hyperthermic pleural irrigation in patients with stage IVA thymoma.
abstract: The optimal treatment for Masaoka stage IVA thymoma remains controversial. Whilst extrapleural pneumonectomy (EPP) has been proposed, we sought to examine the results of our institutional preference for induction chemotherapy, cytoreductive surgery and intraoperative hyperthermic pleural irrigation. We undertook a retrospective study of patients undergoing surgery for Masaoka stage IVA thymoma following induction chemotherapy over a three-year period at our institution. Between February 2007 and February 2010, 42 patients underwent surgery for thymoma. Six patients underwent surgery with intent to perform cytoreductive surgery and intraoperative hyperthermic pleural irrigation. Complete cytoreductive surgery was not feasible in one patient and thymectomy only was performed. One patient had re-operation for recurrent disease 24 months after the first operation and there were therefore seven procedures undertaken in six patients during the study period. There were no in-hospital deaths. Median follow-up was 18.8 months (range 1.5-31.9 months). One patient died 14 months postoperatively from an acute cardiovascular event. The four remaining patients are alive and well with no evidence of disease recurrence. Multimodality therapy consisting of induction chemotherapy and cytoreductive surgery is a safe, feasible treatment for stage IVA thymoma. Our experience suggest that full pleurectomy is an alternative to EPP.
authors.affiliation: Department of Thoracic Surgery, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Belcher
authors.forename: Timothy
authors.initials: T
authors.lastname: Hardwick
authors.forename: Rohit
authors.initials: R
authors.lastname: Lal
authors.forename: Stuart
authors.initials: S
authors.lastname: Marshall
authors.forename: James
authors.initials: J
authors.lastname: Spicer
authors.forename: Loic
authors.initials: L
authors.lastname: Lang-Lazdunski
mesh_terms: D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008131:London; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D035422:Pleural Cavity; D010997:Pleural Neoplasms / Q000556:secondary / Q000628:therapy*; D011206:Povidone-Iodine / Q000008:administration & dosage; D012086:Reoperation; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D013908:Thoracotomy; D013934:Thymectomy; D013945:Thymoma / Q000556:secondary / Q000628:therapy*; D013953:Thymus Neoplasms / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011206:Povidone-Iodine