Multimodality treatments in locally advanced stage thymomas

BACKGROUND AND OBJECTIVESComplete surgical resection is the main goal in the treatment of thymoma, but is not always achievable in stage III and IVA thymoma because of local invasion of the neighboring organs or the presence of diffuse pleural or pericardial implants. We reviewed our experience in multimodality treatment of advanced stage (III and IVA) thymic tumors to evaluate the effectiveness and safety in patients with locally advanced unresectable thymoma.PATIENTS AND METHODSWe studied patients with newly diagnosed, histologically proven, unresectable malignant thymoma who underwent a multimodality treatment regimen that consisted of neoadjuvant chemotherapy (three courses of cisplatin and etoposide), followed by surgical resection, postoperative radiation therapy, and consolidation chemotherapy (three courses of cisplatin and etposide).RESULTSNine patients were consecutively enrolled from December 2001 to June 2007, and all were valuable for assessment. Disease responded to neoadjuvant chemotherapy completely in 1 patient (11%) and partially in 6 patients (66%) with an overall response of 77%. Two patients had a minor response (22%). Eight patients had surgical resection; 1 refused surgery. Tumors were removed completely in 5 patients (62.5%) and incompletely in 3 (37.5%). All patients received radiation therapy and consolidation chemotherapy. Seven patients were alive (77% at 4 years), with a median follow-up of 31 months, and 6 patients were disease free (66.6% disease-free survival at 4 years). The major side effect from neoadjuvant and consolidation chemotherapy was myelosup-pression.CONCLUSIONThe multimodality treatment of stage III and IVA thymic tumors by integration of surgery, radiotherapy, and chemotherapy, contributed to a good long-term outcome. The neoadjuvant chemotherapy improves the resectability rate and the survival of locally advanced stages of the disease.