Abstract
Background Despite the intense debate concerning management of advanced thymic tumors, no specific
oncological strategies have been yet recommended. We report our 13 years' experience
to investigate this issue.
Methods From 01/2001 to 12/2013, the clinical data of 28 patients treated for Masaoka stages
III–IV thymic tumors were retrospectively reviewed. Eleven potentially nonresectable
patients (Group A) underwent induction chemotherapy plus surgery, while immediate
surgery was performed in 17 patients (Group B). The endpoint was to compare the two
groups on (1) surgical resectability; (2) postoperative course; (3) disease-free survival;
and (4) overall survival.
Results Both groups were comparable in terms of age, gender, clinical stage, clinical tumor
size, histology, and adjuvant therapy. Length of surgery was statistically longer
in Group A (p = 0.015). Combined surgery and R0 resection was similarly performed in both groups
(p = 0.14 and p = 0.99, respectively). The 3-year overall survival was 71.4% for Group A and 93.3%
for Group B (p = 0.84). On the other hand, 3-year disease-free survival was 40.5 and 53.7% for Group
A and B, respectively (p = 0.67). At multivariate analysis, gender was the strongest predictor for recurrence
(hazard ratio = 5.71 [1.22; 26.67], p = 0.03).
Conclusion Our results suggest that induction therapy allows obtaining acceptable clinical responses
as well as resectability, survival, and recurrence rates. In selected patients with
“clinically resectable” stage III–IV cancers, surgery (as first step of a multimodality
therapy) could be a feasible treatment option.
Keywords
induction therapy - thymic tumors - multimodality therapy - advanced thymoma
