Original article: general thoracicResection and perfusion thermochemotherapy: a new approach for the treatment of thymic malignancies with pleural spread
Section snippets
Patients and methods
From February 1995 to February 2000, 59 patients with thymic malignancies underwent operation in Sheba Medical Center. Forty three patients were in stages I–III. There were 16 patients in stage IV-a. One of them was found to have an unresectable tumor at operation and therefore, did not undergo hyperthermic pleural perfusion (HPP). Fifteen patients underwent resection combined with intraoperative HPP with cisplatinum. There were 11 men and 4 women. Patients’ age ranged from 20 to 67 years
Results
Complete resection (R0) was achieved in 10 patients, R1 in 2, and R2 in 3 patients. There were no technical problems during the perfusion period. Neither hemodynamic nor respiratory instability was noticed. The maximal systemic temperature reached 38°C with an increase of 0.7°C to 3.2°C (median, 2.0°C). Creatine clearance, which was measured before and postoperatively, was found unchanged in all patients. There was no neurologic toxicity.
One patient was found on the fifth postoperative day to
Comment
Thymic malignancies are the most common anterior mediastinal tumors. Nevertheless, the presentation of those neoplasms with pleural spread (stage IV-a) is quite rare, ranging from 3.5% to 21.5% in different series 4, 13, 14, 15, 16(Table 2). Thymoma with pleural spread (stage IV-a) carries a high risk for locoregional recurrence and poor outcome. Five-year survival rates were reported to range between 33% and 46% in different series 5, 6. The prognosis of thymic carcinoma is even poorer;
References (21)
- et al.
Cortical versus medullary thymomasa useful morphologic distinction?
Hum Pathol
(1988) - et al.
Recurrence of thymomaanalysis of clinicopathologic features, treatment, and outcome
J Thorac Cardiovasc Surg
(1997) - et al.
Thymoma. A multivariate analysis of factors predicting survival
Ann Thorac Surg
(1995) - et al.
Thymoma. Results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients
J Thorac Cardiovasc Surg
(1988) - et al.
Chemotherapy, and operation for invasive thymoma
J Thorac Cardiovasc Surg
(1993) - et al.
Prognostic factors and long-term results after thymoma resectiona series of 307 patients
J Thorac Cardiovasc Surg
(1996) - et al.
Thymomatreatment and prognosis
Int J Radiat Oncol Biol Phys
(1992) - et al.
J. Maxwell Chamberlain Memorial Paper. Role of staging in prognosis and management of thymoma
Ann Thorac Surg
(1991) - et al.
Thymomaresults of a multicentric retrospective series of 149 non-metastatic irradiated patients and review of the literature. FNCLCC trialists. Federation Nationale des Centres de Lutte Contre le Cancer
Radiother Oncol
(1995) - et al.
Thymic carcinoma. Ten years’ experience in twenty patients
J Thorac Cardiovasc Surg
(1994)
Cited by (63)
Intensity Modulated Radiation Therapy for Pleural Recurrence of Thymoma: A Prospective Phase 2 Study
2021, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :These cases indicate that even a highly aggressive approach such as EPP cannot assure a curative effect for pleural recurrence and may result in high morbidity and poor quality of life. Many authors prefer to perform a lung-sparing surgery with adjuvant chemoradiotherapy rather than extensive EPP.6,11-13 Such multidisciplinary regimens, which preserve major lung function, result in similar survival times.
Intra-Thoracic Chemo-Hyperthermia for pleural recurrence of thymoma
2017, Lung CancerPeritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy?
2016, Journal of Visceral SurgeryPeritoneal carcinomatosis originating from unusual primary cancers: Is there a role for HIPEC?
2016, Journal de Chirurgie VisceraleLong-term results after treatment for recurrent thymoma a multicenter analysis
2014, Journal of Thoracic OncologyCitation Excerpt :Regarding pleural implants as manifestations of recurrent thymoma, the treatment remains controversial due to the unpredictable natural history of this tumor.16 In such cases, a strategy of care based on multimodal treatment (cytoreductive surgery followed by hyperthermic intrapleural chemotherapy or adjuvant chemotherapy) has been proposed and this achieved encouraging results.21,22 Our analysis failed to identify any significant differences in term of outcomes between surgery and chemo/radiotherapy, even if a positive trend was observed in patients with intrathoracic disease treated with surgery with respect to patients treated with radio and/or chemotherapy alone.