Intra-Thoracic Chemo-Hyperthermia for pleural recurrence of thymoma

•Thymic tumors are rare malignancies with frequent pleural dissemination.•Intra-Thoracic Chemo-Hyperthermia is conducted during cytoreductive surgery procedure.•Intra-Thoracic Chemo-Hyperthermia led to prolonged local control in thymic tumors.•No major safety issues were observed after Intra-Thoracic Chemo-Hyperthermia.

BackgroundPleural recurrences are a hallmark of thymomas, and represent a challenge for multidisciplinary management. The purpose of this study was to assess the feasibility and the results in terms of morbidity, mortality and survival rates, of Intra-Thoracic Chemo-Hyperthermia (ITCH) for the treatment of pleural recurrences of thymomas.MethodsRetrospective analysis of 19 consecutives patients between 1997 and 2015 treated by surgical cytoreduction (pleurectomy) followed by ITCH with 25 mg/m2 of mitomycin, and 50 mg/m2 of Cisplatin.ResultsThere were 8 men and 11 women with a median age of 44 years. ITCH was combined with pleurectomy alone in 4 (22%) patients, pleurectomy and wedge resections in 14 (74%) patients; 1 (5%) patient had a pleuropneumonectomy. There were no perioperative deaths, and 5 patients (26%) presented with postoperative complication, including 3 (16%) cases related to chemotherapy (one case of reversible grade 2 bone marrow aplasia, and 2 cases of reversible, acute kidney failure). The median length of stay in intensive care unit and hospital were 1 day and 10 days, respectively. After a median follow-up period of 39 months (range 10-127 months), median disease-free survival was 42 months. Five patients (26%) died during follow-up.ConclusionsOur data indicate that ITCH is a feasible option for selected patients with pleural recurrence of thymomas. ITCH clearly provides long local control, without major safety issues, and prolonged survival may be achieved in selected patients. This therapeutic option should be discussed at a multidisciplinary tumor board.