Nonsurgical management of malignant thymoma

BACKGROUND: Thymoma is a rare tumor entity. Surgery remains the mainstay of treatment, but radiation and chemotherapy also have been applied widely in both the adjuvant and the palliative setting. The objective of this study was to review briefly the clinical trials available in the current literature utilizing nonsurgical oncologic treatment (radiotherapy and chemotherapy) either in patients with advanced (i.e., locally inoperable) or metastatic thymoma or as an adjunct to surgery. METHODS: A computerized (MEDLINE) and a manual search was performed to identify articles published on this topic between 1965-1998. Only articles with an English abstract were reviewed for inclusion; information abstracted included histologic proof of diagnosis, number of patients, dose and modality of treatment, assessment of response, response rate, survival duration, and side effects. RESULTS: Seventy-one trials were identified subsequently. These included 51 chemotherapy studies in a total of 410 patients (including 19 single agent trials and 32 combination chemotherapy trials) and 20 radiotherapy studies. In the adjuvant setting, radiation appeared to result in a higher survival rate compared with historic controls as well as excellent local control in patients with advanced stage of disease, whereas no apparent benefit was observed in patients with Masaoka et al. classified Stage I disease. The large majority of chemotherapeutic studies were case reports or Phase II trials of advanced disease, whereas no prospectively randomized trials were performed. Response rates were relatively heterogeneous and ranged between 24% and 100%, not including the results published in single case reports, and response rates >50% have been found consistently with the application of polychemotherapy. In the absence of randomized trials, multimodality approaches using induction chemotherapy followed by resection and consecutive radiation have produced highly promising results in terms of resectability and long term survival, even in patients with advanced disease. CONCLUSIONS: To the authors' knowledge, there is no standard approach to advanced thymoma apart from surgery (i.e., total resection whenever possible). Despite reports of long term disease control, symptomatic palliation, and encouraging survival data, the majority of studies involved only a small number of patients and were performed in a Phase II approach. Large scale, randomized trials to elucidate the potential of multimodality approaches clearly are needed, and patients with thymoma should be included in such studies.     

Treatment of malignant thymoma

PURPOSE OF REVIEW: The present review reports findings in the field of epithelial tumors originating from the thymus from the past year and discusses these findings in the context of the literature. RECENT FINDINGS: Epithelial tumors of the thymus are relatively common tumors of the anterior superior mediastinum. Thymomas are usually slowly growing tumors, and their prognosis depends on the macroscopic and microscopic invasion of surrounding tissues. Thymic carcinomas are more aggressive and less common tumors than thymomas and have been increasing in frequency in recent years. Surgery is the mainstay treatment of thymic malignancies, and complete resection represents the best prognostic factor in this disease. Postoperative radiotherapy may be indicated in tumors with invasion of surrounding tissues, but it is controversial in early-stage thymomas. Combination chemotherapy has been employed in several small studies and in advanced disease has been demonstrated to produce a 50-80% objective response rate. Neoadjuvant chemotherapy or external beam radiotherapy have been used with success in patients with tumors that are not readily resectable. Novel antiproliferative systemic agents are being investigated, based on a better understanding of the biology of these tumors. SUMMARY: A better understanding of the clinical behavior of thymomas versus thymic carcinomas and systemic therapies targeted to biologically validated targets in these diseases will help improve efficacy of treatment.     

恶性胸腺瘤的临床病理特点

目的 探讨恶性胸腺瘤的形态特点、临床分期、治疗等与预后的关系。方法 回顾分析诊治的６４例恶性胸腺上皮肿瘤,按照Ｌｅｖｉｎｅ等提出的恶性胸腺瘤的标准分为Ⅰ型和Ⅱ型,参照Ｍｕｌｌｅｒ－Ｈｅｒｍｅｌｉｎｋ等提出的组织学分型标准对ＭＴ进行分类,依Ｍａｓａｏｋａ提示的标准进行临床分期。 ＭＴ４１例,ＴＣ２３例。ＭＴ中无一例髓质型及混合型。皮质为主型、皮质型、分化好前胸腺癌、鳞癌及淋巴产癌５年生存率分别为７５     

Multimodal treatment for stage IVA thymoma: a proposable strategy

A retrospective review of a series of consecutive patients was carried out to evaluate the feasibility and the efficacy of a multimodal treatment in the management of stage IVA thymoma at first diagnosis. From 1998 to 2008, 18 patients affected by stage IVA thymoma underwent neoadjuvant chemotherapy, surgery and subsequent mediastinal radiation therapy. There were 10 males and 8 females, mean age 54.5 years (range 29-68). Not specific symptoms were present in 12 cases and thymus-related syndromes were reported in 4. Histological subtypes were 1 AB, 2 B1, 4 B2, 7 B3, 1 mixed B1-B2, 1 mixed B1-B3 and 2 mixed B2-B3 thymomas. Neoadjuvant chemotherapy (4 courses of cisplatin-based chemotherapy) was well tolerated in all cases. Those patients demonstrating clinical response at restaging (16/18) received surgical resection: "en-bloc" thymoma, residual thymic tissue and tumour involved organs resection was carried out together with the pleural implants removal. Complete macroscopic resection was achieved 10/16 patients (64%). Postoperative mortality and morbidity were null and 24%, respectively. Adjuvant radiation therapy consisted of 45-54 Gy administered by a 6 MV linear accelerator to the whole mediastinum and previous tumour bed. Mean follow-up was 82±33 months (range 31-143); overall survival was 85% and 53% at 5- and 10-years. Disease-related survival of the entire cohort was 100% and 58% at 5- and 10-years, whereas freedom from relapse survival for patients submitted to complete resection was 58% and 42% at 5- and 10-years. Disease-related survival when complete and not complete resection were considered were 100% and 52% and 72% and 0% at 5- and 10-years respectively (p=0.048). Multimodal management based on induction chemotherapy, subsequent surgery and postoperative mediastinal radiation allows a good complete resection rate and it is demonstrated to be a safe and effective treatment to warrant a good long-term survival in stage IVA thymoma patients.     

61例恶性胸腺瘤患者治疗分析

目的:探讨恶性胸腺瘤的治疗方法及其疗效.方法:回顾分析61例恶性胸腺瘤的临床资料.按治疗方法分为完全切除组32例,部分切除组26例和探查组3例,每组中均有放疗和非放疗患者.以术后5年复发率和生存率做为疗效指标进行分析.结果:术后放疗患者5年复发率低于同组未放疗患者,5年存活率高于未放疗患者,大部切除结合放疗组与完全切除结合放疗组的5年复发率(P=0.926),生存率(88.9% vs 86.4%)之间无显著差异.结论:胸腺恶性肿瘤因浸润性生长,多不能完全切除,术后结合放疗有助于控制局部复发和提高存活率.     

61例恶性胸腺瘤患者治疗分析

目的：探讨恶性胸腺瘤的治疗方法及其疗效。方法：回顾分析61例恶性胸腺瘤的临床资料。按治疗方法分为完全切除组32例，部分切除组26例和探查组3例，每组中均有放疗和非放疗患者。以术后5年复发率和生存率做为疗效指标进行分析。结果：术后放疗患者5年复发率低于同组未放疗患者，5年存活率高于未放疗患者，大部切除结合放疗组与完全切除结合放疗组的5年复发率（P=0．926），生存率（88．9％VS86．4％）之间无显著差异。结论：胸腺恶性肿瘤因浸润性生长，多不能完全切除，术后结合放疗有助于控制局部复发和提高存活率。     

Current management of thymoma.

Patients with thymoma present rarely even on active thoracic surgery services. These patients may suffer from many associated conditions but the most common is myasthenia gravis. Aggressive surgical resection is the mainstay of initial therapy. Radiation therapy has a role in patients who are left with retained neoplasm after surgical resection. Recurrence may occur at prolonged intervals but should be treated aggressively.     

Clinical management of thymoma patients

Thymoma and thymic carcinomas are rare epithelial tumors that arise from the thymus gland. Current management depends on staging, with surgery being the mainstay of therapy for stages I and II disease. Combined modality therapy, including radiation and chemotherapy, is recommended for patients who have invasive and metastatic disease. Relapse has been documented decades after initial therapy with options for treating recurrent advanced stage disease. Prospective studies have been limited, and current studies aim to evaluate novel treatment options.     

State-of-the-art classification and multimodality treatment of malignant thymoma

Thymomas are the most common tumors of the anterior mediastinum. Classification, treatment options and understanding of the pathophysiology of thymoma have changed over the past years. It is hoped that novel therapeutic strategies will lead to a survival benefit in these patients. It has turned out that patients with thymoma are best treated with multimodality therapy. In this review, a pathologist, an immunologist, a surgeon, a radiotherapist, a pneumologist and oncologists discuss the current status of classification and strategies for the treatment of thymoma patients.     

Retrovesical soft-tissue metastasis of malignant thymoma: case report

Malignant thymomas are usually confined to the mediastinum at the time of diagnosis and follow-up. Distant metastasis is distinctly rare. This is the first clinical case report of a thoracic malignant thymoma with distant soft-tissue metastasis that involves the retrovesical area to include the seminal vesicle.     

恶性胸腺瘤合并上腔静脉综合征的外科治疗

为了总结恶性胸腺瘤合并上腔静脉综合征(superiorvenacavasyndrome,SVCS)的外科治疗经验,回顾性分析30例恶性胸腺瘤患者的临床资料。手术采用胸骨正中劈开切口;术中尽量切尽肿瘤及受侵组织;术后局部放疗加含DDP的全身化疗。围手术期无死亡病例;失访3例,5例分别于术后20~31个月死亡,22例存活至今。初步研究结果提示,手术治疗是恶性胸腺瘤合并SVCS的首选方法,术后应辅助局部放疗及全身化疗。     

Radition therpay control of nine patients with malignant thymoma.

Malignant thymoma is a relatively rare condition and a review of the literature reveals approximately 100 reported cases. Only a small percentage of these have been treated with megavoltage radiation therapy; therefore, it is difficult to find the necessary information to establish a proper time-dose relationship for treatment. This report deals with the radiation therapy and survival data concerning nine patients treated for malignant thymoma during a ten year period at the Medical University of South Carolina. Megavoltage irradiation in the dose range of 3500-4800 rads was employed in all patients. All gross tumor was completely resected in only three patients, two had a biopsy only, and the remaining four had subtotal resections. Local tumor control has been 100% with the average follow-up being 5.5 years and a minimum of 30 months. Three patients are dead; one from intercurrent disease, one from myasthenia gravis, and one from radiation injury to the spinal cord. One patient is alive with metastatic disease controlled by chemotherapy. The technique of radiation therapy is outlined, as well as suggested treatment policy.     

Chemotherapy of malignant thymoma. Case report and review of the literature

The authors report the case of a patient with malignant thymoma unresponsive to combination chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP] and cisplatin/VP-16) who subsequently achieved clinical response to continuous daily prednisone. A review of the literature indicates that prednisone and cisplatin are the most active agents in the treatment of malignant thymoma.     

Myasthenic crisis following cisplatin chemotherapy in a patient with malignant thymoma

Malignant thymomas are associated with numerous autoimmune disorders including myasthenia gravis. Myastenia gravis is characterized by antibodies against the acetylcholine receptors located on the neuromuscular junction of the skeletal muscle. We present a case with malignant thymoma who developed myasthenia crisis while he was treated with cisplatin chemotherapy.