Download PDF
Thorac Cardiovasc Surg 2017; 65(03): 234-243
DOI: 10.1055/s-0035-1564890
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Induction Therapy versus Initial Surgery in Advanced Thymic Tumors: Perioperative and Oncological Outcome

Giovanni Leuzzi
1   Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
,
Gabriele Alessandrini
2   Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute – IFO, Rome, Italy
,
Isabella Sperduti
3   Scientific Direction, Regina Elena National Cancer Institute – IFO, Rome, Italy
,
Daniele Forcella
2   Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute – IFO, Rome, Italy
,
Mirella Marino
4   Division of Pathology, Regina Elena National Cancer Institute – IFO, Rome, Italy
,
Anna Ceribelli
5   Division of Medical Oncology, Regina Elena National Cancer Institute – IFO, Rome, Italy
,
Francesco Facciolo
2   Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute – IFO, Rome, Italy
› Author Affiliations
Further Information

Publication History

18 June 2015

24 August 2015

Publication Date:
21 October 2015 (online)

    Permissions and Reprints All articles of this category

Abstract

Background Despite 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.

Methods From 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.

Results Both 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 and p = 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).

Conclusion Our 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.

Keywords

induction therapy - thymic tumors - multimodality therapy - advanced thymoma
 

  • References

  • 1 Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. Lyon, France: IARC Press; 2004
    Google Scholar
  • 2 Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg 2003; 76 (3) 878-884 , discussion 884–885
    CrossrefPubMedGoogle Scholar
  • 3 Margaritora S, Cesario A, Cusumano G , et al. Thirty-five-year follow-up analysis of clinical and pathologic outcomes of thymoma surgery. Ann Thorac Surg 2010; 89 (1) 245-252 , discussion 252
    CrossrefPubMedGoogle Scholar
  • 4 Thomas Jr CR, Wright CD, Loehrer PJ. Thymoma: state of the art. J Clin Oncol 1999; 17 (7) 2280-2289
    CrossrefPubMedGoogle Scholar
  • 5 Wright CD, Choi NC, Wain JC, Mathisen DJ, Lynch TJ, Fidias P. Induction chemoradiotherapy followed by resection for locally advanced Masaoka stage III and IVA thymic tumors. Ann Thorac Surg 2008; 85 (2) 385-389
    CrossrefPubMedGoogle Scholar
  • 6 Kim ES, Putnam JB, Komaki R , et al. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer 2004; 44 (3) 369-379
    CrossrefPubMedGoogle Scholar
  • 7 Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981; 48 (11) 2485-2492
    CrossrefPubMedGoogle Scholar
  • 8 Regnard JF, Magdeleinat P, Dromer C , et al. Prognostic factors and long-term results after thymoma resection: a series of 307 patients. J Thorac Cardiovasc Surg 1996; 112 (2) 376-384
    CrossrefPubMedGoogle Scholar
  • 9 Blumberg D, Port JL, Weksler B , et al. Thymoma: a multivariate analysis of factors predicting survival. Ann Thorac Surg 1995; 60 (4) 908-913 , discussion 914
    CrossrefPubMedGoogle Scholar
  • 10 Venuta F, Rendina EA, Longo F , et al. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thorac Surg 2003; 76 (6) 1866-1872 , discussion 1872
    CrossrefPubMedGoogle Scholar
  • 11 Giaccone G, Musella R, Bertetto O, Donadio M, Calciati A. Cisplatin-containing chemotherapy in the treatment of invasive thymoma: report of five cases. Cancer Treat Rep 1985; 69 (6) 695-697
    PubMedGoogle Scholar
  • 12 Macchiarini P, Chella A, Ducci F , et al. Neoadjuvant chemotherapy, surgery, and postoperative radiation therapy for invasive thymoma. Cancer 1991; 68 (4) 706-713
    CrossrefPubMedGoogle Scholar
  • 13 Lucchi M, Ambrogi MC, Duranti L , et al. Advanced stage thymomas and thymic carcinomas: results of multimodality treatments. Ann Thorac Surg 2005; 79 (6) 1840-1844
    CrossrefPubMedGoogle Scholar
  • 14 Rea F, Marulli G, Di Chiara F , et al. Multidisciplinary approach for advanced stage thymic tumors: long-term outcome. Lung Cancer 2011; 72 (1) 68-72
    CrossrefPubMedGoogle Scholar
  • 15 Korst RJ, Bezjak A, Blackmon S , et al. Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: a phase II, multi-institutional clinical trial. J Thorac Cardiovasc Surg 2014; 147 (1) 36-44 , 46.e1
    CrossrefPubMedGoogle Scholar
  • 16 Park S, Ahn MJ, Ahn JS , et al. A prospective phase II trial of induction chemotherapy with docetaxel/cisplatin for Masaoka stage III/IV thymic epithelial tumors. J Thorac Oncol 2013; 8 (7) 959-966
    CrossrefPubMedGoogle Scholar
  • 17 Cardillo G, Carleo F, Giunti R , et al. Predictors of survival in patients with locally advanced thymoma and thymic carcinoma (Masaoka stages III and IVa). Eur J Cardiothorac Surg 2010; 37 (4) 819-823
    CrossrefPubMedGoogle Scholar
  • 18 Sung YM, Lee KS, Kim BT, Choi JY, Shim YM, Yi CA. 18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups. J Nucl Med 2006; 47 (10) 1628-1634
    PubMedGoogle Scholar
  • 19 Weissferdt A, Moran CA. The impact of neoadjuvant chemotherapy on the histopathological assessment of thymomas: a clinicopathological correlation of 28 cases treated with a similar regimen. Lung 2013; 191 (4) 379-383
    CrossrefPubMedGoogle Scholar
  • 20 Leo F, Pelosi G, Sonzogni A, Chilosi M, Bonomo G, Spaggiari L. Structural lung damage after chemotherapy fact or fiction?. Lung Cancer 2010; 67 (3) 306-310
    CrossrefPubMedGoogle Scholar
  • 21 Marulli G, Lucchi M, Margaritora S , et al. Surgical treatment of stage III thymic tumors: a multi-institutional review from four Italian centers. Eur J Cardiothorac Surg 2011; 39 (3) e1-e7
    CrossrefPubMedGoogle Scholar
  • 22 Ried M, Guth H, Potzger T , et al. Surgical resection of thymoma still represents the first choice of treatment. Thorac Cardiovasc Surg 2012; 60 (2) 145-149
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Ishibashi H, Suzuki T, Suzuki S , et al. Estrogen inhibits cell proliferation through in situ production in human thymoma. Clin Cancer Res 2005; 11 (18) 6495-6504
    CrossrefPubMedGoogle Scholar