title: Pleural recurrence of thymoma: surgical resection followed by hyperthermic intrathoracic perfusion chemotherapy†.
abstract: OBJECTIVE
  Recurrences of thymoma are described in 10-30% of cases up to 10 years after surgical resection. Herein we report our experience with surgical removal of pleural recurrences followed by hyperthermic intrathoracic perfusion chemotherapy (HITHOC).
  
  
  METHODS
  We prospectively collected data of patients with pleural recurrence of thymoma who underwent surgery followed by HITHOC. After thoracotomy had been closed, drainages were connected to a dedicated perfusion machine, pleural space was filled with saline solution, progressively heated up to 42.5°C. At this time, chemotherapeutic agents (Doxorubicin and Cisplatin) were injected and perfusion lasted 60 min.
  
  
  RESULTS
  In the period 2005-2012, 13 consecutive patients have been treated (8 males, 5 females, mean age 46 years). Initial Masaoka-Koga stage was 2 IIa, 5 IIb, 5 III, 1 IVa. Disease-free interval was 47.2 months on average [standard deviation (SD): 25.5]. Nine patients presented paraneoplastic syndromes (8 myasthenia gravis and 1 red cell aplasia). Complete resection was achieved in all cases except one. HITHOC was successfully performed in all cases and no signs or symptoms of toxicity were recorded in the perioperative period. With a mean follow-up period of 64.6 months (SD: 32.5), 1 patient died for toxicity following systemic chemotherapy, another one died disease-free, 4 patients developed pleural relapses (2 ipsilateral, 2 contralateral) and 1 mediastinal and abdominal nodal metastases. Mean survival was 58 months [SD: 34.4), median survival by the Kaplan-Meier method was not reached while 5-year actuarial survival was 92%.
  
  
  CONCLUSIONS
  HITHOC was shown to be feasible and safe. In terms of efficacy, it seems promising but multicentre studies and a longer follow-up period are required to ascertain its effectiveness.
authors: Division of Thoracic Surgery, Department of Surgical Medical Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy.
authors: Marcello Carlo
authors: MC
authors: Ambrogi
authors: Division of Thoracic Surgery, Department of Surgical Medical Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy stylianoskorasidis@gmail.com.
authors: Stylianos
authors: S
authors: Korasidis
authors: Cardiac Thoracic and Vascular Department, Cisanello Hospital, Pisa, Italy.
authors: Marco
authors: M
authors: Lucchi
authors: Cardiac Thoracic and Vascular Department, Cisanello Hospital, Pisa, Italy.
authors: Olivia
authors: O
authors: Fanucchi
authors: Division of Thoracic Surgery, Department of Surgical Medical Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy.
authors: Silvia
authors: S
authors: Giarratana
authors: Cardiac Thoracic and Vascular Department, Cisanello Hospital, Pisa, Italy.
authors: Franca
authors: F
authors: Melfi
authors: Division of Thoracic Surgery, Department of Surgical Medical Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy.
authors: Alfredo
authors: A
authors: Mussi
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant / Q000379:methods; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000295:instrumentation / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods; D013945:Thymoma / Q000556:secondary* / Q000628:therapy*; D013953:Thymus Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin; D002945:Cisplatin
keywords: Chemotherapy; Hyperthermia; Pleural recurrence; Thymoma