title: Outcomes of thymoma treated with multimodality approach: a tertiary cancer center experience of 71 patients.
abstract: OBJECTIVE
  To explore the demographics and clinical outcome of patients with thymoma treated with a multimodality approach at our institute.
  
  
  METHODS
  A total of 71 patients with thymoma (Masaoka stage II-IV and WHO subtype AB-B3) treated from 1999-2013 were included in this retrospective analysis. Age, stage, WHO subtypes, details of surgery, radiotherapy, and chemotherapy were noted. Progression-free survival (PFS) was estimated using Kaplan-Meier method and SPSS (version 21.0) was used for statistical analysis.
  
  
  RESULTS
  Male:female ratio was 56:15 with median age at presentation of 41 years. Stage-wise distribution was 6:46:19 for stage II, stage III, and stage IV, respectively. A total of 31 patients (44%) had associated myasthenia gravis and 3 had pure red cell aplasia. A total of 57 patients (80%) underwent radical thymectomy and all of these patients received adjuvant radiotherapy. A total of 15 patients and 7 patients received adjuvant chemotherapy and neoadjuvant chemotherapy, respectively. At median follow-up of 19.3 months (range 7.9-72.3 months), 2-year and 3-year PFS rate for the entire cohort was 78.3% and 57.1%, respectively. On univariate analysis, surgery (hazard ratio [HR] 3.881; 95% confidence interval [CI] 1.784-19.220; p = 0.006) and stage (HR 5.457; 95% CI 1.567-18.996; p = 0.0001) were significant prognostic factors and association with myasthenia gravis (HR 0.404; 95% CI 0.151-1.078; p = 0.078) trended towards better PFS. Stage retained its prognostic significance (HR 5.501; 95% CI 2.076-14.573; p = 0.0006) on multivariate analysis.
  
  
  CONCLUSIONS
  Multimodality management of locally advanced thymoma yields decent survival outcomes. Masaoka stage is an independent prognostic factor for survival and radical surgery should be contemplated in all cases of locoregionally limited thymoma.
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - India.
authors.forename: Pramod K
authors.initials: PK
authors.lastname: Julka
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - India.
authors.forename: Daya N
authors.initials: DN
authors.lastname: Sharma
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Mallick
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - India.
authors.forename: Ajeet K
authors.initials: AK
authors.lastname: Gandhi
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - India.
authors.forename: Nikhil P
authors.initials: NP
authors.lastname: Joshi
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - India.
authors.forename: Kunhi P
authors.initials: KP
authors.lastname: Haresh
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - India.
authors.forename: Subhash
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - India.
authors.forename: Goura K
authors.initials: GK
authors.lastname: Rath
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000401:mortality; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D013934:Thymectomy; D013945:Thymoma / Q000401:mortality / Q000628:therapy*; D013953:Thymus Neoplasms / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome