title: Thymoma: clinical experience from a tertiary care institute from North India.
abstract: BACKGROUND
  Thymomas are the most common tumors of the mediastinum. They have varied presentation ranging from asymptomatic incidental mediastinal masses to locally extensive tumor with compressive symptoms and distant metastases. The authors present our institute's experience in combined modality management of thymomas.
  
  
  METHODS
  We retrospectively reviewed 36 patients of thymoma treated in our institute from January 2004 to December 2010. Clinical characteristics and treatment modality in form of surgery, radiotherapy (RT) and chemotherapy (CCT) were noted. Statistical analysis was done with regard to progression free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis.
  
  
  RESULTS
  A total of 17 patients had associated Myasthenia gravis and 3 patients had associated Cushing syndrome. Masaoka Stage 4a was the most common stage (13 patients) followed by stage 3 (10 patients), stage 2 (9 patients) and stage 1 (4 patients). Twenty seven patients underwent primary surgery, out of which 20 received adjuvant RT and five received both RT and CCT. Of nine non-surgical cases, four received only palliative RT whereas 5 received systemic CCT followed by local mediastinal RT. Overall, 23 patients had complete response while 13 had partial response. 1 patient had local recurrence. Three year PFS was 60% and 3 year OS was 83%.
  
  
  CONCLUSIONS
  Most common presentation in our series was locally advanced tumors. Most of these patients require adjuvant mediastinal radiation, which helps in significant loco-regional control. Systemic CCT benefits in inoperable, advanced and high-risk tumors. Risk-adapted and multimodality approach is the need of the hour to achieve good control rates while minimizing treatment related toxicity.
authors.affiliation: Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Narendra
authors.initials: N
authors.lastname: Kumar
authors.forename: Ritesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Anjan
authors.initials: A
authors.lastname: Bera
authors.forename: Sushmita
authors.initials: S
authors.lastname: Ghoshal
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kapoor
authors.forename: B D
authors.initials: BD
authors.lastname: Radotra
authors.forename: Suresh Chander
authors.initials: SC
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D063128:Tertiary Health Care / Q000379:methods; D013945:Thymoma / Q000473:pathology / Q000628:therapy*; D013953:Thymus Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult