Multimodal treatment of thymic carcinoma: Report of nine cases

Thymic carcinoma (TC) is thymic epithelial tumor which differs from thymoma because of its rarity, agressiveness and poor prognosis. We studied nine patients with TC according to the WHO (World Health Organization) criteria. Three of these nine patients had stage III disease and six patients had stage IV disease with the classification of Masaoka. Epidermoid TC was the most common subtype. Six patients received VIP chemotherapy comprising cisplatin, ifosfamide, uromitexan and etoposide. Five patients underwent surgical resection, preceded by neoadjuvant chemotherapy for four patients. After surgery, one patient received adjuvant radiotherapy and two patients received adjuvant radiochemotherapy. Six deaths were related to TC progression. The survival time ranged from 1 to 54 months with a median survival of 20 months for the group as a whole. Our descriptive study, based on nine stages III and IV TC, shows a documented efficacy of multimodal treatment (neoadjuvant chemotherapy, surgery and adjuvant treatment). VIP protocol was used for neoadjuvant chemotherapy. High-dose cisplatin (120 mg/m2 cycle), ifosfamide (6 g/m2 cycle) and etoposide (450 mg/m2 cycle) achieved better results than VIP (cisplatin 80 mg/m2 cycle), ifosfamide (4.8 g/m2 cycle) and etoposide (300 mg/m2 cycle). Surgical resection remains the main step in the treatment of TC and the modalities of adjuvant treatment must be defined in further studies.