title: Management and outcomes of relapse after treatment for thymoma and thymic carcinoma.
abstract: BACKGROUND
  Although surgery is the mainstay of treatment for thymic tumors, recurrence is common despite resection. The optimal approach to the management of disease relapse after treatment for thymic tumors remains unclear.
  
  
  METHODS
  This study is a retrospective analysis of a single-institution experience assessing treatment patterns and outcomes in patients with recurrence or disease progression after surgical treatment for thymic tumors. Data included demographics, stage, treatment, pathologic findings, and postoperative outcomes.
  
  
  RESULTS
  From 1995 to 2006, 120 patients had initial resection of a thymic tumor at our institution, of which 112 had recurrence data available. Twenty-five patients developed recurrence or progression of disease after their initial resection (10 thymic carcinoma, 15 thymoma). Median follow-up was 51.4 months. Higher Masaoka stages predominated (I: 0; II: 4; III: 8; IV: 13). Eleven patients (44%) underwent surgery for their relapse with curative intent, while 14 (56%) were managed nonsurgically. Surgery was considered when disease was intrathoracic, unilateral, and technically resectable. The 11 patients receiving surgery had a total of 16 reoperations (range 1 to 4). An R0 re-resection was obtained in half of cases (8 of 16, 50%) but the majority of operative patients (9 of 11, 82%) recurred again. The 5-year overall survival of the 25 patients with recurrent or persistent disease was 58% (median survival = 82 months). Kaplan-Meier curves demonstrate a trend (p = 0.08) toward improved overall survival in patients treated with surgery versus those treated nonoperatively (median survival = 156 months versus 50 months). Patients with thymoma demonstrated a trend (p = 0.12) toward improved survival for over thymic carcinoma (median survival = 90 months versus 35 months).
  
  
  CONCLUSIONS
  Treatment of patients with recurrent or progressive thymic tumors is associated with long-term survival. Despite the historical enthusiasm for re-resection, the majority of patients will recur again, therefore reoperation should be considered only in selected patients.
authors: Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors: Matthew J
authors: MJ
authors: Bott
authors: Hanghang
authors: H
authors: Wang
authors: William
authors: W
authors: Travis
authors: Gregory J
authors: GJ
authors: Riely
authors: Manjit
authors: M
authors: Bains
authors: Robert
authors: R
authors: Downey
authors: Valerie
authors: V
authors: Rusch
authors: James
authors: J
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D012189:Retrospective Studies; D013945:Thymoma / Q000401:mortality / Q000601:surgery*; D013953:Thymus Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome