title: Induction therapy followed by surgical resection in Stage-III thimic epithelial tumors: Long-term results from a multicentre analysis of 108 cases.
abstract: BACKGROUND
  So far no specific oncological strategies have been validated for locally-advanced epithelial thymic tumors (TETs). We herein report the long-term results of a large multicentric experience adopting a multimodal treatment.
  
  
  METHODS
  From 01/1990 to 12/2010, the clinical data of 108 Masaoka Stage-III TETs patients surgically treated after induction therapy (IT) were retrospectively reviewed. Different IT-regimens were administered: ADOC (32 pts); PAC (38 pts); CEE (38 pts). Radiotherapy was concurrently used in 5 patients only. The end-points of the study were the evaluation of: (1) resectability; (2) overall long-term survival (LTS) and disease-free survival (DFS); and (3) independent prognostic factors. The Mann-Whitney and Fisher's exact tests were applied to test the associations. Survival analysis was performed by the Kaplan-Meier method and log-rank test.
  
  
  RESULTS
  Mean age and male/female ratio were 51 ± 13 years and 61/47, respectively. World Health Organization (WHO) histotype was: A in 6 pts (5.6%), AB in 18 (16.7%), B1 in 15 (13.9%), B2 in 26 (24.1%), B3 in 23 (21.3%), and thymic carcinoma in 20 (18.5%). Thirty-day mortality was 1.8%. A total of 81 (75%) had R0-resection, 11 (10.2%) R1 and 16 (14.8%) R2-resection. Adjuvant therapy was performed in 71 patients. During the follow-up a relapse of disease was observed in 38 pts(35.2%). Five-years DFS and LTS were 69.3% and 79.3%, respectively. At univariate analysis, WHO-type B3/C ("high-risk") TETs (p=0.001) and recurrence of disease (p=0.02) were predictors of poor LTS while only a slight correlation was found for R-status and "CHT-regimen type" (p=0.097 and p=0.067, respectively). At multivariate analysis WHO "high-risk" TETs (H.R.5.73;C.I.:1.77-18.57) and ADOC-regimen (H.R.2.84;C.I.:1.37-5.86) were independent predictors of poor survival.
  
  
  CONCLUSIONS
  A multimodal treatment for Stage-III thymic tumors may achieve a rewarding survival. WHO-Histology seems to be the most important prognostic factor.
authors.affiliation: Unit of Thoracic Surgery, San Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardillo
authors.affiliation: Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lucchi
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.affiliation: Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Infante
authors.affiliation: Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Leuzzi
authors.affiliation: Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mussi
authors.affiliation: Unit of Thoracic Surgery, San Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carleo
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute-IFO, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Facciolo
authors.affiliation: Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milano, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Voulaz
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.affiliation: Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Rapicetta
authors.affiliation: Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Electronic address: filippo_lococo@yahoo.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lococo
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D013953:Thymus Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Advanced thymic tumors; Induction therapy; Multimodality treatment; Thymic tumors