title: Resection and heated pleural chemoperfusion in patients with thymic epithelial malignant disease and pleural spread: a single-institution experience.
abstract: OBJECTIVE
  Our objective was to evaluate whether resection and heated pleural chemoperfusion (HPCP) is an effective treatment for de novo stage IVa thymoma (DNT) and thymic carcinoma (TC) and for thymoma with pleural relapse (TPR).
  
  
  METHODS
  A retrospective study was conducted of patients undergoing resection and HPCP in 1 center. HPCP with cisplatinum ± doxorubicin (adriamycin) was performed for 60 minutes using a standard roller pump and a modified heat exchanger to a maximal intrapleural temperature of 43°C. Follow-up included at least 1 annual computed tomographic scan until death or March 2012.
  
  
  RESULTS
  Thirty-five patients, 17 DNT, 14 TPR, and 4 TC, completed 42 intended treatments and were followed up for 4 to 202 months (median, 62 months). Seven patients had repeated HPCP at an interval of 2 to 12 years. There was no systemic toxicity. Ninety-day mortality was 2.5%. Major and minor morbidity occurred in 12% each. Five-, 10-, and 15-year overall survivals for DNT, TPR, and TC were 81%, 73%, 58% (DNT), 67%, 56%, 28% (TPR), and 0%, 0%, 0% (TC). Five- and 10-year progression-free survival was 61%, 43% for DNT and 48%, 18% for TPR. Presently, 11 of 17 DNT patients are alive (6, no evidence of disease), and 8 of 14 TPR are alive (6, no evidence of disease). Median survival for thymoma was 157 months. Overall survival was unrelated to any preoperative or intraoperative variable. Progression-free survival was improved in R0 compared with R1-2 resection (P < .001). Local control achieved in 21 (57%) of 37 procedures in thymoma patients was related only to completeness of resection (P = .015).
  
  
  CONCLUSIONS
  (1) Lung-sparing resection and HPCP is feasible and safe. (2) In thymoma with pleural spread it offers excellent survival despite moderate pleural control. (3) Preliminary results with stage IVa TC are disappointing.
authors.affiliation: Department of Thoracic Surgery, Sheba Medical Center, Tel Hashomer, Israel. ayellin@sheba.health.gov.il
authors.forename: Alon
authors.initials: A
authors.lastname: Yellin
authors.forename: David A
authors.initials: DA
authors.lastname: Simansky
authors.forename: Ronny
authors.initials: R
authors.lastname: Ben-Avi
authors.forename: Marina
authors.initials: M
authors.lastname: Perelman
authors.forename: Nona
authors.initials: N
authors.lastname: Zeitlin
authors.forename: Yael
authors.initials: Y
authors.lastname: Refaely
authors.forename: Alon
authors.initials: A
authors.lastname: Ben-Nun
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002945:Cisplatin / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013945:Thymoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D013953:Thymus Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004317:Doxorubicin; D002945:Cisplatin