Induction Therapy versus Initial Surgery in Advanced Thymic Tumors: Perioperative and Oncological Outcome.
BackgroundDespite the intense debate concerning management of advanced thymic tumors, no specific oncological strategies have been yet recommended. We report our 13 years' experience to investigate this issue.MethodsFrom 01/2001 to 12/2013, the clinical data of 28 patients treated for Masaoka stages III-IV thymic tumors were retrospectively reviewed. Eleven potentially nonresectable patients (Group A) underwent induction chemotherapy plus surgery, while immediate surgery was performed in 17 patients (Group B). The endpoint was to compare the two groups on (1) surgical resectability; (2) postoperative course; (3) disease-free survival; and (4) overall survival.ResultsBoth groups were comparable in terms of age, gender, clinical stage, clinical tumor size, histology, and adjuvant therapy. Length of surgery was statistically longer in Group A (p= 0.015). Combined surgery and R0 resection was similarly performed in both groups (p= 0.14 andp= 0.99, respectively). The 3-year overall survival was 71.4% for Group A and 93.3% for Group B (p= 0.84). On the other hand, 3-year disease-free survival was 40.5 and 53.7% for Group A and B, respectively (p= 0.67). At multivariate analysis, gender was the strongest predictor for recurrence (hazard ratio = 5.71 [1.22; 26.67],p= 0.03).ConclusionOur results suggest that induction therapy allows obtaining acceptable clinical responses as well as resectability, survival, and recurrence rates. In selected patients with "clinically resectable" stage III-IV cancers, surgery (as first step of a multimodality therapy) could be a feasible treatment option.
Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy.
Giovanni
G
Leuzzi
Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy.
Gabriele
G
Alessandrini
Scientific Direction, Regina Elena National Cancer Institute - IFO, Rome, Italy.
Isabella
I
Sperduti
Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy.
Daniele
D
Forcella
Division of Pathology, Regina Elena National Cancer Institute - IFO, Rome, Italy.
Mirella
M
Marino
Division of Medical Oncology, Regina Elena National Cancer Institute - IFO, Rome, Italy.
Anna
A
Ceribelli
Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy.
Francesco
F
Facciolo
D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013934:Thymectomy / Q000009:adverse effects / Q000401:mortality; D013953:Thymus Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult