title: Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: a phase II, multi-institutional clinical trial.
abstract: OBJECTIVE
  To determine the response rate, toxicity, and rate of complete resection after induction chemoradiotherapy for locally advanced thymic tumors, which were defined by specific radiographic criteria.
  
  
  METHODS
  A single-arm, pilot trial was conducted at 4 institutions. Patients with thymoma or thymic carcinoma who met specific criteria on computed tomography were accrued. Induction therapy consisted of 2 cycles of cisplatin and etoposide combined with 45 Gy of thoracic radiotherapy. Patients underwent computed tomography and positron emission tomography before and after induction therapy and then resection was attempted. Postoperative chemoradiotherapy was administered in selected patients. The primary endpoint was the pathologic response to induction therapy. The secondary endpoints were toxicity, surgical complications, radiographic response, and the rate of R0 resection.
  
  
  RESULTS
  A total of 22 patients were accrued during a 5-year period (1 patient withdrew before starting induction therapy). Of the 22 patients, 21 completed induction therapy, and 9 (41%) experienced grade 3 or 4 toxicity. A total of 10 patients had a partial radiographic response and 11 had stable disease. Of the 21 patients, 17 (77%) underwent an R0 resection, 3 (14%) an R1 resection, and 1 (5%) underwent debulking. Eight patients sustained surgical complications (36%), and two patients (9%) died postoperatively. Of the 21 patients, 13 (62%) had either thymic carcinoma or B3 thymoma and 15 (71%) had either Masaoka stage III or IV disease. No patient had a complete pathologic response, but 5 specimens (24%) had <10% viable tumor.
  
  
  CONCLUSIONS
  The present induction chemoradiotherapy protocol, which used specific computed tomography inclusion criteria to successfully select locally advanced thymic tumors, appeared to be tolerable and resulted in a high rate of complete surgical resection.
authors.affiliation: Daniel and Gloria Blumenthal Cancer Center, Paramus, NJ; Division of Thoracic Surgery, Department of Surgery, The Valley Hospital, Valley Health System, Ridgewood, NJ; The International Thymic Malignancy Interest Group, Ardsley, NY. Electronic address: korsro@valleyhealth.com.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Korst
authors.affiliation: The International Thymic Malignancy Interest Group, Ardsley, NY; Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, Methodist Hospital, Houston, Tex.
authors.forename: Shanda
authors.initials: S
authors.lastname: Blackmon
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Mass.
authors.forename: Noah
authors.initials: N
authors.lastname: Choi
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Mass.
authors.forename: Panos
authors.initials: P
authors.lastname: Fidias
authors.affiliation: The International Thymic Malignancy Interest Group, Ardsley, NY; Departments of Medicine and Medical Biophysics, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Liu
authors.affiliation: The International Thymic Malignancy Interest Group, Ardsley, NY; Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Marx
authors.affiliation: The International Thymic Malignancy Interest Group, Ardsley, NY; Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
authors.forename: Cameron
authors.initials: C
authors.lastname: Wright
authors.affiliation: Daniel and Gloria Blumenthal Cancer Center, Paramus, NJ.
authors.forename: Susan
authors.initials: S
authors.lastname: Mock
authors.affiliation: Daniel and Gloria Blumenthal Cancer Center, Paramus, NJ.
authors.forename: John R
authors.initials: JR
authors.lastname: Rutledge
authors.affiliation: The International Thymic Malignancy Interest Group, Ardsley, NY; Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009361:Neoplasm Invasiveness; D009656:North America; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D013934:Thymectomy / Q000009:adverse effects / Q000401:mortality; D013945:Thymoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / 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
chemical_list: D005047:Etoposide; D002945:Cisplatin
keywords: 13; CPR; CT; ITMIG; International Thymic Malignancy Interest Group; PET; SUV(max); WHO; World Health Organization; complete pathologic response; computed tomography; maximum standardized uptake value; positron emission tomography