title: [Radical pleurectomy and hyperthermic intrathoracic chemotherapy for treatment of thymoma with pleural spread].
abstract: BACKGROUND
  Patients with pleural thymoma spread (Masaoka stage IV a) should be treated within a multimodal treatment regime. However, the extent of local surgical resection to achieve optimal tumour control remains controversial.
  
  
  METHODS
  Prospective analysis between September 2008 and April 2013 of all patients with a Masaoka stage IV a thymoma, who underwent radical pleurectomy/decortication (P/D) followed by hyperthermic intrathoracic chemotherapy (HITHOC).
  
  
  RESULTS
  A total of 11 patients (male n = 7; mean age 46.5 ± 11.4 years) with a primary stage IV a thymoma (n = 3) or thymoma with pleural relapse (n = 8) were included after successful transsternal thymoma resection. WHO histological classification was: B1 n = 1, B2 n = 6, B3 n = 3 and C n = 1. A radical P/D (5/11; 45 %) was extended with resection of the pericardium and diaphragm in 6/11 (55 %) patients. After surgical resection (91 % complete macroscopic R0/R1-resection) the HITHOC with cisplatin (100 mg/m2 body surface area (BSA) n = 7; 150 mg/m2 BSA n = 4) was performed for one hour at 42 °C. Operative revision was necessary in two patients (chylo- and hematothorax) with one patient also requiring temporary renal replacement therapy due acute renal failure (cisplatin 150 mg/m2 BSA). 30-day mortality was 0 %. Local recurrence (pulmonary n = 1, paravertebral n = 2) was documented in 3/10 (30 %) patients after R0/R1 resection. After a mean follow-up of 23 months the overall median survival was 27 months and 82 % (9/11) patients are still alive at the end of the study period.
  
  
  CONCLUSIONS
  Masaoka stage IV a thymoma could be safely treated with lung-sparing radical P/D and HITHOC with cisplatin in a multimodality treatment regime. Early results with respect to recurrence and survival are encouraging, but further studies are warranted and we have to await long-term results.
authors.affiliation: Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Ried
authors.forename: R
authors.initials: R
authors.lastname: Neu
authors.forename: B
authors.initials: B
authors.lastname: Schalke
authors.forename: Z
authors.initials: Z
authors.lastname: Sziklavari
authors.forename: H-S
authors.initials: HS
authors.lastname: Hofmann
mesh_terms: D000328:Adult; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D010994:Pleura / Q000601:surgery*; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D011446:Prospective Studies; D015996:Survival Rate; D013945:Thymoma / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D013953:Thymus Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D002945:Cisplatin