Objective To determine the response rate, toxicity, and rate of complete resection after induction chemoradiotherapy for locally advanced thymic tumors, which were defined by specific radiographic ...criteria. Methods A single-arm, pilot trial was conducted at 4 institutions. Patients with thymoma or thymic carcinoma who met specific criteria on computed tomography were accrued. Induction therapy consisted of 2 cycles of cisplatin and etoposide combined with 45 Gy of thoracic radiotherapy. Patients underwent computed tomography and positron emission tomography before and after induction therapy and then resection was attempted. Postoperative chemoradiotherapy was administered in selected patients. The primary endpoint was the pathologic response to induction therapy. The secondary endpoints were toxicity, surgical complications, radiographic response, and the rate of R0 resection. Results A total of 22 patients were accrued during a 5-year period (1 patient withdrew before starting induction therapy). Of the 22 patients, 21 completed induction therapy, and 9 (41%) experienced grade 3 or 4 toxicity. A total of 10 patients had a partial radiographic response and 11 had stable disease. Of the 21 patients, 17 (77%) underwent an R0 resection, 3 (14%) an R1 resection, and 1 (5%) underwent debulking. Eight patients sustained surgical complications (36%), and two patients (9%) died postoperatively. Of the 21 patients, 13 (62%) had either thymic carcinoma or B3 thymoma and 15 (71%) had either Masaoka stage III or IV disease. No patient had a complete pathologic response, but 5 specimens (24%) had <10% viable tumor. Conclusions The present induction chemoradiotherapy protocol, which used specific computed tomography inclusion criteria to successfully select locally advanced thymic tumors, appeared to be tolerable and resulted in a high rate of complete surgical resection.
Background The treatment of locally advanced thymic tumors is not uniform. Recently, several centers have reported the results of induction chemotherapy followed by resection and then radiation. Our ...center adopted an alternative strategy and treated locally advanced thymic tumors with induction chemoradiotherapy in an effort to maximize the intensity of the induction therapy. Methods A retrospective review was performed of 10 patients with locally advanced thymic tumors treated from 1997 to 2006. Seven patients were clinically staged as Masaoka stage III and 3 as stage IVA. The treatment plan included two cycles of cisplatin and etoposide with concurrent radiation. Patients then had resection followed by postoperative chemotherapy if they were judged to be at high risk for relapse. Results Four patients had a partial radiographic response to induction therapy and 6 had no response. Eight patients had a R0 resection and 2 had a R1 resection. Four patients had substantial (>90%) necrosis in the resected specimen. There was no postoperative mortality. Seven patients had two more cycles of chemotherapy. The median follow-up was 41 months. Three patients had recurrences. The 5-year estimated survival was 69% (95% confidence interval: 32% to 100%). Conclusions Induction therapy for locally advanced thymic tumors with cisplatin, etoposide, and radiation is well tolerated, with many patients having a partial radiographic response. The majority of patients can undergo a complete resection with this treatment. The survival of these patients compares favorably with those undergoing other induction regimens. Further efforts to maximize the intensity of induction therapy for locally advanced thymic tumors is warranted. We have initiated a multicenter phase 2 clinical trial ( NCT00387868 ) to prospectively test this concept.
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