Induction Chemoradiotherapy Followed by Resection for Locally Advanced Masaoka Stage III and IVA Thymic Tumors

Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
The Annals of thoracic surgery (Impact Factor: 3.85). 03/2008; 85(2):385-9. DOI: 10.1016/j.athoracsur.2007.08.051
Source: PubMed

ABSTRACT The treatment of locally advanced thymic tumors is not uniform. Recently, several centers have reported the results of induction chemotherapy followed by resection and then radiation. Our center adopted an alternative strategy and treated locally advanced thymic tumors with induction chemoradiotherapy in an effort to maximize the intensity of the induction therapy.
A retrospective review was performed of 10 patients with locally advanced thymic tumors treated from 1997 to 2006. Seven patients were clinically staged as Masaoka stage III and 3 as stage IVA. The treatment plan included two cycles of cisplatin and etoposide with concurrent radiation. Patients then had resection followed by postoperative chemotherapy if they were judged to be at high risk for relapse.
Four patients had a partial radiographic response to induction therapy and 6 had no response. Eight patients had a R0 resection and 2 had a R1 resection. Four patients had substantial (>90%) necrosis in the resected specimen. There was no postoperative mortality. Seven patients had two more cycles of chemotherapy. The median follow-up was 41 months. Three patients had recurrences. The 5-year estimated survival was 69% (95% confidence interval: 32% to 100%).
Induction therapy for locally advanced thymic tumors with cisplatin, etoposide, and radiation is well tolerated, with many patients having a partial radiographic response. The majority of patients can undergo a complete resection with this treatment. The survival of these patients compares favorably with those undergoing other induction regimens. Further efforts to maximize the intensity of induction therapy for locally advanced thymic tumors is warranted. We have initiated a multicenter phase 2 clinical trial (NCT00387868) to prospectively test this concept.

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Available from: Panos Fidias, Sep 25, 2014
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    • "However, the residual tumor after chemoradiotherapy in the present case remained inoperable because of the involvement of large vessels. Based on several previous reports [2, 3, 4, 5, 6, 7, 8, 9], chemoradiotherapy followed by surgery may contribute to a better clinical outcome in certain patients with locally advanced thymic cancer. Further clinical experience and studies are required. "
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    ABSTRACT: Little information is available about the usefulness of concurrent chemoradiotherapy for locally advanced thymic carcinoma due to a rare anterior mediastinal tumor. We experienced a case of locally advanced thymic carcinoma that responded well to concurrent thoracic radiotherapy combined with cisplatin plus vinorelbine chemotherapy. The patient showed remarkable tumor regression and has remained disease free for over 4 years following combined therapy. Concurrent chemoradiotherapy seems to be effective for locally advanced thymic carcinoma, and cisplatin plus vinorelbine could be an alternative chemotherapy regimen in combination with thoracic radiotherapy in patients with thymic carcinoma.
    Case Reports in Oncology 01/2014; 7(1):65-9. DOI:10.1159/000358380
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    • "Neoadjuvant chemotherapy can increase the likelihood of resectable disease for patients who are otherwise eligible for surgery. Potential induction regimens include chemotherapy alone (17, 18), radiation alone (19, 20), and combined chemotherapy and radiation (3). Chemotherapeutic regimens are generally cisplatin-based; regimens used in prior studies have included cyclophosphamide, doxorubicin, cisplatin, and prednisone or cisplatin and etoposide (18, 21). "
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    ABSTRACT: Although historically thymoma and thymic carcinoma have been treated surgically, radiation therapy also has an important role, either as postoperative therapy to reduce the risk of mediastinal recurrence or as part of definitive treatment for patients who cannot undergo surgery. Induction chemotherapy and molecular targeted agents may also be appropriate for thymic carcinoma, the behavior of which resembles non-small-cell lung carcinoma more than that of thymoma or invasive thymoma and is increasingly being treated like lung cancer. We present here a review of current therapies for thymic malignancies and briefly discuss the potential benefits from novel technologies for such treatment.
    Frontiers in Oncology 01/2014; 3:330. DOI:10.3389/fonc.2013.00330
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    • "En général, la chimiothérapie précède la radiothérapie, mais des expériences de stratégies inverses ont été rapportées [13] [25] [26]. Un schéma concomitant avec l'association cisplatine—étoposide a été évalué dans un contexte d'induction pour des TET de stades III—IVa, avec 40 % de réponses objectives et 80 % de résections complètes [31]. "
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    ABSTRACT: Epithelial tumours of the thymus include thymomas, thymic carcinomas and neuro-endocrine tumours. Rare, they nevertheless represent 20% of all mediastinal tumours and 50% of those located in the anterior mediastinum. Thymomas, in particular, can be associated to auto-immune disorders, among which predominates myasthenia gravis. Their clinical behaviour varies widely, from a relative indolence to the potential of lymph node and/or systematic metastases. However, even patients with an invasive disease may have a long clinical history, explaining that a 10-year or 20-year survival from diagnosis does not imply a definitive cure. In daily practice, both the clinical Masaoka's staging system and the WHO histological classification condition the treatment strategies and allow to anticipate the prognosis. The initial treatment, as well as that of the recurrence, is based mainly on a complete resection. Postoperative radiotherapy is systematically added to the treatment of invasive tumours and/or to those with an aggressive histological subtype. Inoperable or metastatic tumours require a cisplatine and anthracyclin-based chemotherapy, followed by radical surgery and/or radiotherapy.
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