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Federico Venuta
Erino A. Rendina
Tiziano De Giacomo
Edoardo Mercadante
Giorgio F. Coloni
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Ann Thorac Surg 2003;76:1866-1872
© 2003 The Society of Thoracic Surgeons

Original article: general thoracic

Long-term outcome after multimodality treatment for stage III thymic tumors

Federico Venuta, MDa*, Erino A. Rendina, MDa, Flavia Longo, MDb, Tiziano De Giacomo, MDa, Marco Anile, MDa, Edoardo Mercadante, MDa, Luigi Venturac, Mattia F. Osti, MDd, Federico Francioni, MDa, Giorgio F. Coloni, MDa

a Department of Thoracic Surgery, University of Rome "La Sapienza," Rome, Italy
b Department of Oncology, University of Rome "La Sapienza," Rome, Italy
c Department of Statistics, University of Rome "La Sapienza," Rome, Italy
d Department of Radiotherapy, University of Rome "La Sapienza," Rome, Italy

* Address reprint requests to Dr Venuta, Department of Thoracic Surgery, University of Rome "La Sapienza," Policlinico Umberto I, V.le del Policlinico, Rome 00161, Italy
e-mail: sofed{at}libero.it

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

BACKGROUND: Surgery remains the cornerstone of therapy for thymic tumors, but the optimal treatment for advanced, infiltrative lesions is still controversial. The introduction of multimodality protocols has substantially modified survival and recurrence rate. We reviewed our 13-year prospective experience with multimodality treatment of stage III thymoma and thymic carcinoma.

METHODS: Since 1989 we have prospectively used a multimodality approach in 45 stage III thymic tumors. Sixteen patients (35%) had myasthenia gravis. Twenty-three patients (51%) had pure or predominantly cortical thymoma (group 1), 11 (24.5%) had well-differentiated thymic carcinoma (group 2), and 11 (24.5%) had thymic carcinoma (group 3). Tumors that were not considered radically resectable at preoperative workup underwent biopsy and induction chemotherapy (15 patients, 33%) followed by surgical resection; all patients were referred for adjuvant chemoradiotherapy.

RESULTS: No operative mortality was recorded; 1 treatment-related death during adjuvant chemotherapy was observed in group 1. Complete resection was feasible in 91% of patients in groups 1 and 2 and 82% in group 3. The overall 10-year survival was 78%. Ten-year survival for groups 1 and 2 was 90% and 85%, respectively; 8-year survival for group 3 was 56%. During follow-up, tumor recurrence was noted in 3 patients (13%) from group 1, 3 (27%) from group 2, and 3 (27%) from group 3.

CONCLUSIONS: Multimodality treatment with induction chemotherapy (when required) and adjuvant chemoradiotherapy offers encouraging results for stage III thymic tumors; the outcome is more favorable for cortical thymoma and well-differentiated thymic carcinoma.




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