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Editorial

Multimodality Therapy for Locally Advanced Thymomas: State of the Art or Investigational Therapy?

^a Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
^b Thoracic Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
^c Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York

^_* Address correspondence to Dr Rusch, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-868, New York, NY 10021 (Email: ruschv@mskcc.org).

The first 300 words of the full text of this article appear below.

Because thymic tumors are uncommon and can have a relatively indolent course, there is debate regarding the optimal treatment for patients with these tumors. Our management of patients with thymic tumors has been derived from a small, retrospective series of patients given heterogeneous treatments. Early stage and complete resection are consistently associated with better outcomes [1, 2]. Surgical resection is recommended as the first, and often only, therapy in most patients with a well-circumscribed thymic tumor that is clearly resectable. The optimal management of locally advanced thymic tumors that invade the adjacent organs or have spread to the pleural space is less clear.

In this issue, Wright and colleagues [3] reviewed their experience with 10 patients who had Masaoka stage III or IVA thymomas or thymic carcinomas and who were treated over a 10-year period with preoperative concurrent chemoradiation followed by resection. Using an induction regimen of cisplatin and etoposide with concurrent radiation, they were able to achieve an impressive R0 resection rate of 80%, with no postoperative mortalities and a 5-year estimated overall survival of 69%. A 40% radiographic partial response rate was observed in these 10 patients who completed all of the therapy.

Induction chemotherapy with a variety of chemotherapy regimens given without concurrent RT for treatment of locally advanced thymic tumors has been reported by a number of groups. Resectability rates in these series have ranged from 25% to 76%, and survival rates have been reported to be as high as 90% at 10 years [4–7]. The rate of pathologic complete responses averaged just 13%. Similarly, at least two prospective studies of preoperative chemotherapy have been reported resulting in a 57% to 76% R0 resection rate and up to a 95%, 5-year survival [8].

This report by Wright and . . . [Full Text of this Article]

Related Article

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

Cameron D. Wright, Noah C. Choi, John C. Wain, Douglas J. Mathisen, Thomas J. Lynch, and Panos Fidias
Ann. Thorac. Surg. 2008 85: 385-389. [Abstract] [Full Text] [PDF]