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Chun SG, Rimner A, Amini A, Chang JY, Donington J, Edelman MJ, Geng Y, Gubens MA, Higgins KA, Iyengar P, Movsas B, Ning MS, Park HS, Rodrigues G, Wolf A, Simone CB. American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma. JAMA Oncol 2023:2805042. [PMID: 37186595 DOI: 10.1001/jamaoncol.2023.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Importance Thymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management. Objective To develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma. Evidence Review Case variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. Variants and procedures were evaluated by the panel using modified Delphi methodology. Agreement/consensus was defined as less than or equal to 3 rating points from median. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures. Findings The ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs. Conclusions and Relevance The ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.
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Affiliation(s)
- Stephen G Chun
- The University of Texas MD Anderson Cancer Center, Houston
| | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Arya Amini
- City of Hope National Medical Center, Duarte, California
| | - Joe Y Chang
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Martin J Edelman
- Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania
| | - Yimin Geng
- The University of Texas MD Anderson Cancer Center, Houston
| | - Matthew A Gubens
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | | | - Puneeth Iyengar
- The University of Texas at Southwestern Medical Center, Dallas
| | | | - Matthew S Ning
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - George Rodrigues
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Andrea Wolf
- Mount Sinai Health System, New York, New York
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Dai H, Lan B, Li S, Huang Y, Jiang G, Tian J. Prognostic CT features in patients with untreated thymic epithelial tumors. Sci Rep 2023; 13:2910. [PMID: 36801902 PMCID: PMC9939415 DOI: 10.1038/s41598-023-30041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/14/2023] [Indexed: 02/21/2023] Open
Abstract
To determine the prognostic CT features in patients with untreated thymic epithelial tumors (TETs). Clinical data and CT imaging features of 194 patients with pathologically confirmed TETs were retrospectively reviewed. The subjects included 113 male and 81 female patients between 15 and 78 years of age, with a mean age of 53.8 years. Clinical outcomes were categorized according to whether relapse, metastasis or death occurred within 3 years after the first diagnosis. Associations between clinical outcomes and CT imaging features were determined using univariate and multivariate logistic regression analyses, while the survival status was analyzed by Cox regression. In this study, we analyzed 110 thymic carcinomas, 52 high-risk thymomas and 32 low-risk thymomas. Percentages of poor outcome and patient death in thymic carcinomas were much higher than those in patients with high-risk and low-risk thymomas. In the thymic carcinomas groups, 46 patients (41.8%) experienced tumor progression, local relapse or metastasis and were categorized as having poor outcomes; vessel invasion and pericardial mass were confirmed to be independent predictors by logistic regression analysis (p < 0.01). In the high-risk thymoma group, 11 patients (21.2%) were categorized as having poor outcomes, and the CT feature pericardial mass was confirmed to be an independent predictor (p < 0.01). In survival analysis, Cox regression showed that CT features of lung invasion, great vessel invasion, lung metastasis and distant organ metastasis were independent predictors for worse survival in the thymic carcinoma group (p < 0.01), while lung invasion and pericardial mass were independent predictors for worse survival in high-risk thymoma group. No CT features were related to poor outcome and worse survival in the low-risk thymoma group. Patients with thymic carcinoma had poorer prognosis and worse survival than those with high-risk or low-risk thymoma. CT can serve as an important tool for predicting the prognosis and survival of patients with TETs. In this cohort, CT features of vessel invasion and pericardial mass were related to poorer outcomes in those with thymic carcinoma and pericardial mass in those with high-risk thymoma. Features including lung invasion, great vessel invasion, lung metastasis and distant organ metastasis indicate worse survival in thymic carcinoma, whereas lung invasion and pericardial mass indicate worse survival in high-risk thymoma.
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Affiliation(s)
- Haiyang Dai
- Department of Medical Imaging, Huizhou Municipal Central Hospital, No. 41, North Eling Road, Huizhou, 516001, People's Republic of China.
| | - Bowen Lan
- grid.470066.3Department of Medical Imaging, Huizhou Municipal Central Hospital, No. 41, North Eling Road, Huizhou, 516001 People’s Republic of China
| | - Shengkai Li
- grid.470066.3Department of Medical Imaging, Huizhou Municipal Central Hospital, No. 41, North Eling Road, Huizhou, 516001 People’s Republic of China
| | - Yong Huang
- grid.440144.10000 0004 1803 8437Department of Radiology, Shandong Tumor Hospital, No.44, Jiyan Road, Jinan, 250117 People’s Republic of China
| | - Guihua Jiang
- grid.413405.70000 0004 1808 0686Department of Radiology, Guangdong Second Provincial General Hospital, No.466, Xingang Road, Guangzhou, 510317 People’s Republic of China
| | - Junzhang Tian
- grid.413405.70000 0004 1808 0686Department of Radiology, Guangdong Second Provincial General Hospital, No.466, Xingang Road, Guangzhou, 510317 People’s Republic of China
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Failure patterns for thymic carcinoma with completed resection and postoperative radiotherapy. Radiother Oncol 2023; 178:109438. [PMID: 36481384 DOI: 10.1016/j.radonc.2022.109438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/14/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the pattern and risk factors of disease failure in patients with thymic carcinoma after complete resection and postoperative radiotherapy (PORT). MATERIALS AND METHODS We retrospectively analyzed 127 patients with thymic carcinoma who underwent PORT after complete resection between 2003 and 2020 in our center. Data on clinical characteristics and radiation fields were collected. Failure patterns were recorded as locoregional (disease appearing in the tumor bed or regional lymph nodes), pleural, or distant failure (including hematogenous metastasis and nonregional lymph node metastasis). RESULTS All patients underwent tumor bed irradiation. During a median follow-up period of 64 months, disease failure was observed in 51 patients (40.2 %). The 5-year disease-free survival (DFS) and overall survival rates were 58.9 % and 85.0 %, respectively. The sequence of failure patterns was distant (n = 41, 32.3 %), pleural (n = 28, 22.0 %), and locoregional failure (n = 19, 15.0 %). Of the locoregional failure patients, failures occurred in-field in three patients (2.4 %), marginal failure in one patient (0.8 %), out-of-field failure in nine patients (7.1 %), synchronous in-field and out-of-field failures in two patients (1.6 %), synchronous marginal and out-of-field failures in two patients (1.6 %), and unknown failure fields in two patients (1.6 %). Multivariate analysis showed that Masaoka stage (hazard ratio [HR], 3.88; p = 0.000) and adjuvant chemotherapy (HR, 0.47; p = 0.015) were independent predictors of DFS. CONCLUSION The most common failure was distant, the Masaoka stage and adjuvant chemotherapy were independent predictors of DFS, and low locoregional failure-supported tumor bed irradiation was sufficient for patients with thymic carcinoma after complete resection.
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Wang J, Liu Y, Zhuang W, Zhao Y. Modified subcostal arch xiphoid thoracoscopic expanded thymectomy for thymic carcinoma: a case report and review of literature. J Cardiothorac Surg 2022; 17:234. [PMID: 36088333 PMCID: PMC9463808 DOI: 10.1186/s13019-022-01981-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/20/2022] [Indexed: 11/10/2022] Open
Abstract
Thymic neoplasms are a relatively uncommon tumor, with the anterior mediastinum being the most common. Median sternotomy is the procedure of choice for the treatment of thymomas. With the advent of thoracoscopy, an increasing number of countries are adopting the right thoracic approach for the treatment of thymomas, but there are still no clear surgical standards or modalities to treat thymic carcinoma. We propose a modified subxiphoid subcostal arch thoracoscopic enlarged thymectomy to treat thymic carcinoma based on various reviews. We have also reviewed the relevant literature on the subject of evidence-based medicine. The evaluation of CD70 in combination with CD5 and CD117 or preferentially expressed antigen in melanoma in combination with CD5 and CD117 may help to diagnose thymic squamous cell carcinoma (TSCC) more accurately. The modified thoracoscopic expanded thymic resection under the costal arch of the xiphoid process is not only suitable for TSCC but also for thymic cyst, thymoma, locally invasive thymoma, and thymic carcinoma.
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Shiiya H, Ujiie H, Hida Y, Kato T, Kaga K, Wakasa S, Kikuchi E, Shinagawa N, Okada K, Ito YM, Matsuno Y. Elevated serum CYFRA 21-1 level as a diagnostic marker for thymic carcinoma. Thorac Cancer 2021; 12:2933-2942. [PMID: 34581013 PMCID: PMC8563155 DOI: 10.1111/1759-7714.14158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
Background No useful tumor markers have been identified for the diagnosis of thymic carcinomas. Serum cytokeratin 19 fragment, measured using the CYFRA 21‐1 immunoassay, is used as a tumor marker for squamous cell carcinomas in various malignant tumors. Here, we evaluated the value of CYFRA 21‐1 in diagnosing thymic carcinoma. Methods We retrospectively reviewed 94 patients with pathological diagnoses of thymic carcinoma or thymoma (32 and 62 patients, respectively) who were referred to our departments between January 2000 and March 2019. Primary outcomes included tumor marker levels and their diagnostic accuracy. Results Patients with thymic carcinoma were significantly more likely to be male (thymic carcinoma, 68.8%; thymoma, 40.3%; p = 0.02), have an advanced TNM stage (p < 0.01), and a significantly higher CYFRA 21‐1 level than those with thymoma (thymic carcinoma: median = 4.2 ng/ml; interquartile range [IQR] = 2.1–6.1 ng/ml vs. thymoma: median = 1.2 ng/ml; IQR = 0.9–1.7 ng/ml; p < 0.01). Receiver operating characteristic curves demonstrated that the area under the curve for CYFRA 21‐1 to distinguish thymic carcinoma from thymoma was 0.86 (95% confidence interval [CI]: 0.74–0.93; cutoff = 2.7 ng/ml; sensitivity = 68.8%; specificity = 95.2%). Multivariable analysis demonstrated that CYFRA 21‐1 (odds ratio = 25.6; 95% CI: 4.6–141.6; p < 0.01) was an independent predictor for thymic carcinoma after adjusting for TNM stage. Conclusions Serum CYFRA 21‐1 level may help in diagnosing thymic carcinoma.
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Affiliation(s)
- Haruhiko Shiiya
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideki Ujiie
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuhiro Hida
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Kato
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kichizo Kaga
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiki Kikuchi
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naofumi Shinagawa
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazufumi Okada
- Biostatistics Division, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Biostatistics Division, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido University, Sapporo, Japan
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Gao L, Wang C, Liu M, Fang W, Lv C, Fu X. Adjuvant chemotherapy improves survival outcomes after complete resection of thymic squamous cell carcinoma: a retrospective study of 116 patients. Interact Cardiovasc Thorac Surg 2021; 33:550-556. [PMID: 34148094 DOI: 10.1093/icvts/ivab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of adjuvant chemotherapy (ACT) for thymic squamous cell carcinoma after completely resection. METHODS Patients with thymic squamous cell carcinoma treated with complete resection between January 2009 and December 2016 were retrospectively identified. Kaplan-Meier analysis was used to summarize the time-to-event variables. Univariable and multivariable Cox proportional hazards regression analyses were performed. RESULTS A total of 116 patients were analysed with 44 patients in the non-ACT group and 72 patients in the ACT group. No significant difference was found in the 5-year recurrence-free survival (RFS) rate (58.1% vs 51%, P = 0.33) or the 5-year overall survival (OS) rate (77.7% vs 67.1%, P = 0.26) between the ACT group and the non-ACT group. Masaoka stage was the only independent prognostic factor for both RFS and OS. Subgroup analysis showed significant improvement in 5-year RFS for Masaoka stage II patients (P = 0.035) and 5-year OS (P = 0.036) for Masaoka stage III patients when comparing ACT with non-ACT. No chemotherapy-related death occurred. The most frequent adverse effect higher than grade 3 was neutropenia. CONCLUSIONS For completely resected thymic squamous cell carcinoma, ACT significantly improved the 5-year RFS in Masaoka stage II patients and the 5-year OS in Masaoka stage III patients.
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Affiliation(s)
- Lanting Gao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Changlu Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mina Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Changxing Lv
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Wu J, Wang Z, Jing C, Hu Y, Yang B, Hu Y. The incidence and prognosis of thymic squamous cell carcinoma: A Surveillance, Epidemiology, and End Results Program population-based study. Medicine (Baltimore) 2021; 100:e25331. [PMID: 33847631 PMCID: PMC8052076 DOI: 10.1097/md.0000000000025331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/19/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Thymic carcinoma represents a rare type of malignant mediastinal tumor and has been the subject of controversy. Although independent prognostic factors related to thymic carcinoma have been investigated previously, few studies have focused specifically on the survival outcomes associated with thymic squamous cell carcinoma (TSCC). This study aims at presenting a survival analysis in this rare malignant disease at population level. METHODS We extracted the data of 216 patients with TSCC recorded from 1973 to 2015 from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The patients' demographic features, clinical traits, and treatment factors were analyzed in order to identify prognostic factors, which correlate overall survival using the Kaplan-Meier method as well as a multivariate Cox regression model, for TSCC. RESULTS The majority of patients were male, Caucasian, married, and insured. Furthermore, 58.3%, 54.6%, and 59.7% of patients TSCC underwent surgery, radiotherapy, and chemotherapy respectively. In a multivariate analysis, age of diagnosis (hazard ratio [HR]: 1.022, 95% confidence interval [CI]: 1.003-1.040, P = .020), surgical treatment (HR: 0.282, 95% CI: 0.164-0.484, P = .000), and stage (regional vs distant HR: 0.532, 95% CI: 0.324-0.872, P = .013; localized vs distant HR: 0.297, 95% CI: 0.133-0.664, P = .003) correlated with increased overall survival, whereas adjuvant therapy, including chemotherapy and radiotherapy, did not correlate with survival. Among surgically treated patients, age of diagnosis and stage were associated with better overall survival, while chemotherapy and radiotherapy did not contribute significantly to overall survival. CONCLUSION Surgery, age of diagnosis, and stage were associated with better overall survival among TSCC.
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Yang X, Zhao K, Li C, Yang Y, Guo C, Pu Y, Liu L. Thymic Squamous Cell Carcinoma: A Population-Based Surveillance, Epidemiology, and End Result Analysis. Front Oncol 2020; 10:592023. [PMID: 33415074 PMCID: PMC7783386 DOI: 10.3389/fonc.2020.592023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/20/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives Thymic squamous cell carcinoma (TSCC) is a rare neoplasm that has been sparsely cited in the literature. The aim of this study was to determine disease characteristics and prognostic factors of patients in a Surveillance, Epidemiology, and End Results (SEER) analysis. Methods Cases from 1990-2016 were retrieved from the SEER database and demographics, treatments, and survival outcomes were analyzed. Results The TSCC accounted for 72.4% of the thymic carcinomas and 7.2% of thymic tumors. The 276 patients (165 men) selected for analysis had a median age of 65 (24-85) years, and 201 patients were diagnosed with Masaoka-Koga stage III/IV. The median survival of TSCC was 59 months with a 49.0% 5-year OS rate, a better prognosis than lymphoepithelioma-like carcinoma (32.1%) and undifferentiated carcinoma (33.3%). Multivariate analysis revealed the Masaoka-Koga stage (p = 0.003) and surgical types (complete resection, incomplete resection, and none; p < 0.001) were determinants of survival. Complete resection had the best prognosis with a 72.7% 5-year OS rate. Chemotherapy was an independent protective factor (HR = 0.555, 95% CI 0.347-0.886; p = 0.014) though poor survival was showed in univariate analysis. And the survival benefit of chemotherapy was validated in PSM analysis (3-year OS rate was 77.7% with chemotherapy vs. 52.8% without chemotherapy; p = 0.014). Conclusions TSCC was frequently diagnosed in older patients with advanced Masaoka-Koga stage and had more favorable survival than other subtypes of thymic carcinomas. Complete resection is the preferred treatment. Masaoka-Koga stage and chemotherapy had a strong association with prognosis.
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Affiliation(s)
- Xudong Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Kejia Zhao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Chuan Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Yanbo Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Yi Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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Abstract
BACKGROUND Metastatic and unresectable thymoma (T) or thymic carcinoma (TC) have limited treatment options, especially after first line. METHODS Patients with unresectable or recurrent thymic tumors who used minimum one dose of nivolumab at any line of treatment were evaluated retrospectively. Even though nivolumab was administered 3mg/kg dosage in PRIMER study, due to toxicity and financial concerns, we used low dose regimen mostly. RESULTS Among 46 unresectable and recurrent thymic epithelial tumors; 8 patients with TC (n = 3), T (n = 4) and mixt histology (n = 1) were reviewed. Three patients had myasthenia gravis history that had to be controlled before treatment. Four patients showed moderate (n = 2) or severe (n = 2) adverse events with nivolumab treatment. Interestingly, two severe adverse events were occurred at first dose even with 40 mg nivolumab and required cessation of treatment permanently. The median number of nivolumab received was four (range: 1-18). Best response was partial response. Two patients progressed at the 3rd and 5th month of treatment. Best duration of response for one patient with TC and one patient with T-B2 were 9 and 14 months, respectively. Median survival time after nivolumab was 7.4 months (range: 2-22.1). CONCLUSIONS After the results of the previous study could be supported by randomized prospective studies with more number of patients, nivolumab may be considered as an option in patients with thymic epithelial tumors who have received multiple line treatments. However, given the high rate of severe toxicities, there is need to find out a reliable marker to prediction patients who will derive benefit or exhibit toxicity.
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Affiliation(s)
- Naziye Ak
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
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Miyata R, Hamaji M, Omasa M, Miyahara S, Aoyama A, Takahashi Y, Sumitomo R, Huang CL, Hijiya K, Nakagawa T, Yokoyama Y, Kawakami K, Sonobe M, Ikeda M, Fujinaga T, Suga M, Hirota S, Kojima F, Bando T, Takahashi M, Terada Y, Shoji T, Katakura H, Muranishi Y, Miyahara R, Date H. The treatment and survival of patients with postoperative recurrent thymic carcinoma and neuroendocrine carcinoma: a multicenter retrospective study. Surg Today 2020; 51:502-510. [PMID: 32776294 DOI: 10.1007/s00595-020-02102-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE There are few data available on the outcomes of postoperative recurrent thymic carcinoma (TC) and thymic neuroendocrine carcinoma (TNEC). The aim of this study is to evaluate the treatment and survival in patients with recurrent TC and TNEC after undergoing surgical resection. METHODS A retrospective chart review was performed using our multicenter database to identify patients with a postoperative recurrence of TC and TNEC from 1995 to 2018. The clinicopathological factors were reviewed and the survival outcomes were analyzed. RESULTS Sixty patients were identified among 152 patients who underwent resection of TC and TNEC. The median follow-up period from the first recurrence was 14.8 months (range 0-144). The 5-year post-recurrence survival was 23% for the whole cohort. According to a univariable analysis, advanced stage [hazard ratio (HR) 2.81, 95% confidence interval (CI) 1.09-9.54], interval between primary surgery and recurrence (HR 0.97, 95% CI 0.95-0.99), any treatment for recurrence (HR: 0.27, 95% CI 0.13-0.58) and chemotherapy for recurrence (HR: 0.46, 95% CI 0.22-0.95) were significant factors related to post-recurrence survival. CONCLUSIONS Chemotherapy rather than surgery appears to be the mainstay treatment for managing patients with postoperative recurrent TC and TNEC and it may also be considered in multidisciplinary management. Further studies with a larger sample size are required to confirm our findings.
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Affiliation(s)
- Ryo Miyata
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Mitsugu Omasa
- Department of Thoracic Surgery, Nishi-Kobe Medical Center, 5-7-1 Koujidai, Nishi-ku, Kobe, 651-2273, Japan
| | - So Miyahara
- Department of Thoracic Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jyounan-ku, Fukuoka, 814-0180, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kobe City Medical Centre General Hospital, 2-1-1 Minatojima-minamicho, Chuo-ku, Kobe, 650-0047, Japan
| | - Yutaka Takahashi
- Department of Thoracic Surgery, Kobe City Medical Centre General Hospital, 2-1-1 Minatojima-minamicho, Chuo-ku, Kobe, 650-0047, Japan
| | - Ryota Sumitomo
- Department of Thoracic Surgery, Kitano Hospital, The Tazuke Kofukai Medical Institute, 2-4-20 Ougimachi, Osaka, 530-8480, Japan
| | - Cheng-Long Huang
- Department of Thoracic Surgery, Kitano Hospital, The Tazuke Kofukai Medical Institute, 2-4-20 Ougimachi, Osaka, 530-8480, Japan
| | - Kyoko Hijiya
- Department of Thoracic Surgery, Shizuoka Municipal Hospital, 10-93 Outemachi, Aoi-ku, Shizuoka, 420-8630, Japan
| | - Tatsuo Nakagawa
- Department of Thoracic Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 632-8552, Japan
| | - Yuhei Yokoyama
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kenzo Kawakami
- Department of Thoracic Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-0022, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555, Japan
| | - Masaki Ikeda
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takuji Fujinaga
- Department of Thoracic Surgery, Nagara Medical Center, 1300-7 Nagara, Gifu, 502-8558, Japan
| | - Michiharu Suga
- Department of Thoracic Surgery, Takatsuki Red Cross Hospital, 1-1-1 Abumo, Takatsuki, Osaka, 569-1045, Japan
| | - Shinya Hirota
- Department of Thoracic Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Toru Bando
- Department of Thoracic Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Mamoru Takahashi
- Department of Thoracic Surgery, Kyoto-Katsura Hospital, 17 Yamadahirao-cho, Nishigyo-ku, Kyoto, 615-8256, Japan
| | - Yasuji Terada
- Department of Thoracic Surgery, Kyoto-Katsura Hospital, 17 Yamadahirao-cho, Nishigyo-ku, Kyoto, 615-8256, Japan
| | - Tsuyoshi Shoji
- Department of Thoracic Surgery, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Hiromichi Katakura
- Department of Thoracic Surgery, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Yusuke Muranishi
- Department of Thoracic Surgery, Kyoto City Hospital, 1-2 Mibuhigashitakada-cho, Nakagyo-ku, Kyoto, 604-8845, Japan
| | - Ryo Miyahara
- Department of Thoracic Surgery, Kyoto City Hospital, 1-2 Mibuhigashitakada-cho, Nakagyo-ku, Kyoto, 604-8845, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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11
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Cui TX, Dai JG, Li JM, Qian JD, Li GH, Sun JG. Safety and efficacy of INTRABEAM intraoperative radiotherapy for invasive thymoma. Medicine (Baltimore) 2020; 99:e20964. [PMID: 32629705 PMCID: PMC7337413 DOI: 10.1097/md.0000000000020964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Intraoperative radiotherapy (IORT) has been used to treat different residual solid tumors after tumor removal and has shown many advantages over other treatment methods. However, the use of IORT for invasive thymoma has not been reported. Therefore, in this study, we tried to determine the safety and efficacy of INTRABEAM IORT for the treatment of invasive thymoma.Among the patients admitted to our hospital from September to December 2016 who were diagnosed with invasive thymoma, 14 were selected as study subjects. With medical histories taken beforehand, 8 of these patients were diagnosed with Masaoka stage IIA and 6 with Masaoka stage IIB; furthermore, 5 of the patients were diagnosed with myasthenia gravis (MG). INTRABEAM radiation (8-10 Gy, low energy) was delivered to the postoperative tumor bed of each patient during surgery. The intra- and postoperative complications were observed and evaluated, and the improvement in symptoms was assessed. An additional 23 patients with stage II thymoma undergoing radical surgery from April to August 2016 were chosen as the control group.One month after the operation, only 1 patient in the IORT group had cough, increased levels of leucocytes and neutrophils, and pulmonary inflammation on chest computed tomography. Reactive inflammation and pleural effusion in the 2 groups were similar (P > .05). There was no significant difference between the 2 groups in the improvement of myasthenia gravis (P > .05). Postoperative chest computed tomography and routine blood examination at 3 and 12 months showed that all the patients recovered, with normal hemogram levels and no pulmonary fibrosis around the radiation field. In addition, ultrasonic cardiography and electrocardiography demonstrated no significant difference before or after surgery within the IORT group. At the end of the follow-up, all the patients were alive, no relapse or remote metastasis was observed in the IORT group, and 2 inpatients in the control group had experienced relapse at 24 and 26 months. There was a significant difference in disease-free survival between the 2 groups (P = .00).It is safe to administer low-energy INTRABEAM IORT at a dose of approximately 10 Gy in patients with stage II invasive thymoma. INTRABEAM IORT does not significantly increase operation- or radiation-related complications and has no significant effect on vital organs such as the lungs and heart. Its long-term efficacy is worth expecting.
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Affiliation(s)
| | - Ji-gang Dai
- Department of Thoracic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jing-meng Li
- Department of Thoracic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
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Predictive Features of Thymic Carcinoma and High-Risk Thymomas Using Random Forest Analysis. J Comput Assist Tomogr 2020; 44:857-864. [PMID: 31996651 DOI: 10.1097/rct.0000000000000953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the predictive features of thymic carcinomas and high-risk thymomas using random forest algorithm. METHODS A total of 137 patients with pathologically confirmed high-risk thymomas and thymic carcinomas were enrolled in this study. Three clinical features and 20 computed tomography features were reviewed. The association between computed tomography features and pathological patterns was analyzed by univariate analysis and random forest. The predictive efficiency of the random forest algorithm was evaluated by receiver operating characteristic curve analysis. RESULTS There were 92 thymic carcinomas and 45 high-risk thymomas in this study. In univariate analysis, patient age, presence of myasthenia gravis, lesion shape, enhancement pattern, presence of necrosis or cystic change, mediastinal invasion, vessel invasion, lymphadenopathy, pericardial effusion, and distant organ metastasis were found to be statistically different between high-risk thymomas and thymic carcinomas (all P < 0.01). Random forest suggested that tumor shape, lymphadenopathy, and the presence of pericardial effusion were the key features in tumor differentiation. The predictive accuracy for the test data and whole data was 94.73% and 96.35%, respectively. Further receiver operating characteristic curve analysis showed the area under the curve was 0.957 (95% confidence interval, 0.986-0.929). CONCLUSIONS The random forest model in the present study has high efficiency in predictive diagnosis of thymic carcinomas and high-risk thymomas. Tumor shape, lymphadenopathy, and pericardial effusion are the key features for tumor differentiation. Thymic tumors with irregular shape, the presence of lymphadenopathy, and pericardial effusion are highly indicative of thymic carcinomas.
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13
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Wei YF, Chu CY, Chang CC, Lin SH, Su WC, Tseng YL, Lin CC, Yen YT. Different pattern of PD-L1, IDO, and FOXP3 Tregs expression with survival in thymoma and thymic carcinoma. Lung Cancer 2018; 125:35-42. [PMID: 30429036 DOI: 10.1016/j.lungcan.2018.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/28/2018] [Accepted: 09/06/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The expression of immune checkpoint ligand PD-L1 has been reported in various tumors. The expression of IDO and FOXP3 Tregs are considered to be associated with tumor-induced tolerance and poor outcome. Their prognostic role in surgically treated thymoma and thymic carcinoma, however, has not been investigated. MATERIALS AND METHODS Tissue microarray (TMA) blocks comprised of 100 surgically treated thymomas and 69 surgically treated thymic carcinomas were conducted. Tissue sections were incubated with primary antibodies against PD-L1 (clone E1L3N, 1:100), IDO (clone 10.1, 1:50), and FOXP3 (clone 236 A/E7, 1:50). Comparisons for categorical variables were performed using χ2 test and Fisher's exact test. Survival analysis was established using Kaplan-Meier method and log-rank test. Univariate and multivariate analyses were performed using Cox regression model. RESULTS AND CONCLUSIONS High expression of PD-L1, IDO, and FOXP3 Tregs were identified in 36 (36%), 13 (13%), and 16 (16%) thymoma patients, respectively. High expression of PD-L1, IDO, and FOXP3 Tregs was associated with higher grade of tumor histology (P < 0.001, P = 0.007, and 0.014, respectively). High expression of PD-L1 was also associated with advanced Masaoka staging (P < 0.001). In patients with thymic carcinoma, high expression of PD-L1, IDO, and FOXP3 Tregs were identified in 25 (36%), 10 (14%), and 20 (29%) patients, respectively. Complete resection, low expression of IDO, and high expression of FOXP3 Tregs were associated with better overall survival (P = 0.001, 0.004, and 0.032, respectively), and progression-free survival (P < 0.001, P = 0.026, and 0.047, respectively) in multivariate analysis. In surgically treated thymoma, high PD-L1 expression was associated with advanced Masaoka staging. High PD-L1, IDO, and FOXP3 Tregs expression was associated with high grade histology. In surgically treated thymic carcinoma, significant survival benefit was noted in patients with complete resection, low IDO expression, and high FOXP3 Tregs expression.
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Affiliation(s)
- Yu-Feng Wei
- Division of Chest Medicine, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chang-Yao Chu
- Division of Surgical Pathology, Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wu-Chou Su
- Division of Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chung Lin
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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14
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Cabezón-Gutiérrez L, Khosravi-Shahi P, Custodio-Cabello S, García-Martos M, Palka-Kotlowska M, Franco-Moreno AI. Metastatic Thymic Carcinoma with Long Survival After Treatment with Sunitinib. Cureus 2018; 10:e2982. [PMID: 30237943 PMCID: PMC6141057 DOI: 10.7759/cureus.2982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Thymic carcinomas are the most aggressive histological subtype of thymic tumors with limited data to guide correct management. No standard treatments are available for patients with advanced thymic carcinoma after progressing while on platinum-based chemotherapy. We present a case of a patient with metastatic thymic carcinoma with an unusual response and favorable evolution after receiving treatment with sunitinib, obtaining a progression-free survival of 23 months, much higher than reported to date. We review the literature on the efficacy of sunitinib in metastatic thymic carcinoma after progression to first-line treatment with platinum combinations.
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15
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Hayes SA, Huang J, Golia Pernicka J, Cunningham J, Zheng J, Moskowitz CS, Ginsberg MS. Radiographic Predictors of Resectability in Thymic Carcinoma. Ann Thorac Surg 2018. [PMID: 29534953 DOI: 10.1016/j.athoracsur.2018.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to assess preoperative computed tomography characteristics of thymic carcinomas and to investigate which features could predict an incomplete surgical resection. A secondary aim was to correlate preoperative imaging features with Masaoka stage. METHODS In this study, approved by our Institutional Review Board, two readers retrospectively reviewed preoperative computed tomography scans at our tertiary referral oncology center between 1994 and 2014. Imaging features analyzed included tumor morphology, infiltration of surrounding mediastinal fat, loss of surrounding fat plane, degree of contact between tumor and great vessels, and associated pulmonary or pleural abnormality. Surgical and pathologic records were reviewed for completeness of surgical resection and Masaoka stage. RESULTS Forty-one patients were included, with Masaoka stage I (n = 3), stage II (n = 4), stage III (n = 12), and stage IV (n = 22). Twenty-one patients (51%) had a complete surgical resection. Ten had microscopic residual disease (R1) with involved surgical margins at pathology, and 10 patients had macroscopic residual disease (R2) at surgery. In addition to lesion size, the feature associated with incomplete surgical resection was the degree of tumor contact with adjacent mediastinal vessels on the preoperative computed tomography image (p = 0.038). Many of the more common features associated with incomplete resection were also more likely to be present in patients with late Masaoka stage (III/IV), including infiltration of the mediastinal fat, which was present in all 34 patients with Masaoka stage III/IV compared with 5 patients (71%) with stage I/II (p = 0.03). CONCLUSIONS Preoperative computed tomography imaging features may help to identify patients at risk for an incomplete surgical resection.
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Affiliation(s)
- Sara A Hayes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - James Huang
- Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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16
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Zhai Y, Hui Z, Ji W, Wang X, Liang J, Mao Y, Luo Y, Zou S, Lv J, Zhou Z, Chen D, Zhang H, Xiao Z, Wang L, Feng Q. A Single-Center Analysis of the Treatment and Prognosis of Patients With Thymic Carcinoma. Ann Thorac Surg 2017; 104:1718-1724. [DOI: 10.1016/j.athoracsur.2017.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 06/03/2017] [Accepted: 06/06/2017] [Indexed: 11/24/2022]
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17
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Filosso PL, Ruffini E, Solidoro P, Roffinella M, Lausi PO, Lyberis P, Oliaro A, Guerrera F. Neuroendocrine tumors of the thymus. J Thorac Dis 2017; 9:S1484-S1490. [PMID: 29201451 DOI: 10.21037/jtd.2017.10.83] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Primary neuroendocrine tumors of the thymus (NETTs) are rare and biologically very aggressive neoplasms, usually located in the anterior mediastinal space. They are more frequently observed in males, in their fourth/fifth decades of life. In 50% of cases, NETTs are associated with endocrinopaties [Cushing's syndrome, acromegaly or Multiple Endocrine Neoplasia-1 (MEN-1) syndrome]. NETTs very often present with invasion of the surrounding mediastinal anatomical structures. Surgery, even in advanced stages, is the mainstay of treatment: a compete resection through a median sternotomy or a combined access (sternotomy + thoracotomy) should be always attempted. Induction chemotherapy (± radiotherapy) is usually administered in advanced neoplasms, with the aim to achieve tumor shinkage, increasing, therefore, the chance to obtain a complete resection. Postoperative radiotherapy (± chemotherapy) is administered in case of invasive lesions, or incomplete resections. NETTs long-term outcome is poor, even in case of completely resected tumors, due to high risk of recurrence or distant metastases development. Prognosis mainly depends on tumor stage, invasivity, completeness of resection, possible association with endocrinopaties and recurrence/distant metastases development.
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Affiliation(s)
- Pier Luigi Filosso
- Department of Surgical Sciences, University of Torino, Corso Dogliotti, Torino, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, University of Torino, Corso Dogliotti, Torino, Italy
| | - Paolo Solidoro
- San Giovanni Battista Hospital, Service of Pulmonology, Via Genova, Torino, Italy
| | - Matteo Roffinella
- Department of Surgical Sciences, University of Torino, Corso Dogliotti, Torino, Italy
| | - Paolo Olivo Lausi
- Department of Surgical Sciences, University of Torino, Corso Dogliotti, Torino, Italy
| | - Paraskevas Lyberis
- Department of Surgical Sciences, University of Torino, Corso Dogliotti, Torino, Italy
| | - Alberto Oliaro
- Department of Surgical Sciences, University of Torino, Corso Dogliotti, Torino, Italy
| | - Francesco Guerrera
- Department of Surgical Sciences, University of Torino, Corso Dogliotti, Torino, Italy
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18
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Liu Q, Fu X, Su X, Wang X, Zhang Y, Yang H, Hu Y, Wen J, Fu J. Elevated pretreatment serum lactate dehydrogenase level predicts inferior overall survival and disease-free survival after resection of thymic carcinoma. J Thorac Dis 2017; 9:4550-4560. [PMID: 29268525 DOI: 10.21037/jtd.2017.10.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The prognostic significance of serum lactate dehydrogenase (LDH) level in thymic carcinoma (TC) remains unclear. Therefore, we evaluated the role of pretreatment serum LDH level in the prognosis for TC in this study. Methods Sixty consecutive surgical patients were analyzed in this study with pathologic confirmed TC in Sun Yat-sen University Cancer Center from June 1996 to June 2014. Results The cut-off value of LDH was 210.50 IU/L. In both univariate analysis and multivariable analysis, only pretreatment serum LDH level (P=0.027) and pathological Masaoka stage (P=0.041) were associated with overall survival (OS). In univariate analysis, pretreatment serum LDH level, tumor size, postoperative radiotherapy (PORT) and pathological Masaoka stage were associated with disease-free survival (DFS) (all P<0.050). Multivariable analysis showed that LDH level (P=0.001), PORT (P=0.001) and pathological Masaoka stage (P=0.038) were independently prognostic factors of DFS. This study also revealed that male patients and larger tumor size had a significantly higher rate of elevated pretreatment serum LDH level than in the other groups. Conclusions In conclusion, pretreatment serum LDH level was an independent prognosis factor of OS and DFS for patients with TC.
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Affiliation(s)
- Qianwen Liu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiayu Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiaodong Su
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xin Wang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yijun Zhang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hong Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yi Hu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jing Wen
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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Sinclair G, Martin H, Fagerlund M, Samadi A, Benmakhlouf H, Doodo E. Adaptive hypofractionated gamma knife radiosurgery in the acute management of large thymic carcinoma brain metastases. Surg Neurol Int 2017; 8:95. [PMID: 28607829 PMCID: PMC5461566 DOI: 10.4103/sni.sni_391_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 03/09/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Brain metastases often lead to serious neurological impairment and life threatening states. Their acute management remains complex, particularly in the case of rare malignancies with aggressive evolution. In large single lesions, open surgery followed by radiation to the surgical cavity is widely regarded as the best approach; yet in many cases, microsurgery is not feasible due to the lesion's critical location and/or the number of brain metastases present. We report the effects of adaptive hypofractionated gamma knife radiosurgery in the acute management of critically located thymic carcinoma metastases. CASE DESCRIPTION A 50-year-old male with metastatic thymic carcinoma was treated with radiosurgery for two large supratentorial brain metastases (M3 and M4) adjacent to eloquent areas and one smaller cerebellar metastasis (M2). M3 and M4 were treated with adaptive hypofractionated gamma knife radiosurgery, showing a dramatic volume reduction 4 weeks after treatment completion without radiation-induced side effects. Thirteen months later, two new small, threatening supratentorial lesions (M5-M6) were treated with the same technique. Interestingly, M2 (treated with standard single fraction) and M5-M6 developed local adverse radiation events. The patient's general and neurological status remained next to normal by the time of paper submission. CONCLUSION The application of adaptive hypofractionated radiosurgery in this acute setting proved effective in terms of rapid tumor ablation, with salvage of neurological functionality and limited toxicity. We have called the overall procedure rapid rescue radiosurgery (RRR). A systematic study of past and ongoing RRR-treatments is warranted and in progress.
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Affiliation(s)
- Georges Sinclair
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Heather Martin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Fagerlund
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Amir Samadi
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Hamza Benmakhlouf
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ernest Doodo
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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20
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Trimodality Therapy for an Advanced Thymic Carcinoma With Both Aorta and Vena Cava Invasion. Ann Thorac Surg 2017; 102:e139-41. [PMID: 27449450 DOI: 10.1016/j.athoracsur.2016.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/16/2015] [Accepted: 01/04/2016] [Indexed: 11/23/2022]
Abstract
A case of locally advanced thymic carcinoma that was successfully resected with the great vessels after chemoradiation therapy is reported. A 57-year-old man with Masaoka stage III thymic carcinoma received two cycles of cisplatin/docetaxel and 60 Gy irradiation. The response was stable disease with 19% size reduction, and a radical resection with the ascending aorta and superior vena cava with the patient under circulatory arrest with the use of cardiopulmonary bypass was performed. The postoperative course was uneventful, and the patient has been free of disease for 28 months. Trimodality therapy with use of a cardiovascular surgical procedure might be a valuable option in locally advanced thymic carcinoma.
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21
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Shepherd A, Riely G, Detterbeck F, Simone CB, Ahmad U, Huang J, Korst R, Rajan A, Rimner A. Thymic Carcinoma Management Patterns among International Thymic Malignancy Interest Group (ITMIG) Physicians with Consensus from the Thymic Carcinoma Working Group. J Thorac Oncol 2016; 12:745-751. [PMID: 27876674 DOI: 10.1016/j.jtho.2016.11.2219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Thymic carcinomas are rare epithelial malignancies with limited data to guide management. METHODS To identify areas of agreement and variability in current clinical practice, a 16-question electronic survey was given to members of the International Thymic Malignancy Interest Group (ITMIG). Areas of controversy were discussed with the Thymic Carcinoma Working Group and consensus was achieved, as described. RESULTS A total of 100 ITMIG members responded. There was general agreement regarding the role for multimodality therapy with definitive surgical resection in physically fit patients with advanced but resectable disease. Areas of controversy included the need for histologic confirmation before surgery, the role of adjuvant therapy, the optimal first-line chemotherapy regimen, and the recommended treatment course for marginally resectable disease with invasion into the great vessels, pericardium, and lungs. CONCLUSIONS The results of the questionnaire provide a description of the management of thymic carcinoma by 100 ITMIG members with a specific interest or expertise in thymic malignancies. Although there was agreement in some areas, clinical practice appears to vary significantly. There is a great need for collaborative research to identify optimal evaluation and treatment strategies. Given the need for multimodality therapy in many cases, a multidisciplinary discussion of the management of patients with thymic carcinoma is critical.
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Affiliation(s)
- Annemarie Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory Riely
- Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University, New Haven, Connecticut
| | - Charles B Simone
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Usman Ahmad
- Department Thoracic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - James Huang
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert Korst
- Department Thoracic Surgery, Valley Hospital, New Jersey
| | - Arun Rajan
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Athanasiou E, Michalopoulou-Manoloutsiou E, Bobos M, Hatzibougias DI, Zarogoulidis P, Katsikogiannis N, Sarika E, Karapantzos I, Barbetakis N, Paliouras D, Chatzinikolaou F, Charalampidis C, Kougioumtzi I, Kolettas A, Bakas A, Tzelepi K, Kalaitzis E, Tsakiridis K. Coincidence of thymoma and breast cancer and in a 56-year-old female patient. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:446. [PMID: 27999780 DOI: 10.21037/atm.2016.11.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present a case of a 56-year-old female, with a familial history of breast, lung and brain cancer, which revealed a breast tumor, located in the upper outer quadrant of the left breast. During the routinely staging examinations, a 15 cm intrathoracic tumor was found in the upper left mediastinum, penetrating the pericardium and a smaller tumor, in the left side of parietal pleura. Core biopsies from both lesions, revealed a lobular carcinoma of the breast classic type, grade II (e-cadherin-, ER+, PR+, Her-2-, Ki-67 10%) and a B3 thymoma (CK19+, CD5+) penetrating the pericardium and the left lung. A synchronous removal of both tumors was scheduled, including median sternotomy and left intrapericardial pneumonectomy, followed by a modified radical left mastectomy and a sentinel lymph node biopsy. The postoperative course was uneventful. This case advocates that thymoma patients appear to have a predisposition towards developing additional neoplasms, as breast carcinoma. Clinicians should be aware of the increased incidence of extrathymic cancers, occurring in thymoma patients.
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Affiliation(s)
| | | | | | | | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolos Katsikogiannis
- Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Eirini Sarika
- Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ilias Karapantzos
- Ear, Nose and Throat Department, "St. Luke's", Private Hospital, Panorama, Thessaloniki, Greece
| | - Nikolaos Barbetakis
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - Dimitrios Paliouras
- Thoracic Surgery Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | | | | | - Ioanna Kougioumtzi
- Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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Filosso PL, Yao X, Ruffini E, Ahmad U, Antonicelli A, Huang J, Guerrera F, Venuta F, van Raemdonck D, Travis W, Lucchi M, Rimner A, Thomas P, Weder W, Rocco G, Detterbeck F, Korst R. Comparison of outcomes between neuroendocrine thymic tumours and other subtypes of thymic carcinomas: a joint analysis of the European Society of Thoracic Surgeons and the International Thymic Malignancy Interest Group. Eur J Cardiothorac Surg 2016; 50:766-771. [PMID: 27032473 PMCID: PMC6279171 DOI: 10.1093/ejcts/ezw107] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 01/12/2016] [Accepted: 02/11/2016] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The latest World Health Organization (WHO) histological classification divides thymic epithelial tumours in thymomas and thymic carcinomas (TCs), the latter also including the neuroendocrine thymic tumours (NETTs). NETTs and other TC histotypes have been described to have a significantly lower survival than thymomas, but these two groups of tumours have rarely been compared directly. Using the European Society of Thoracic Surgeons and the International Thymic Malignancy Interest Group datasets, we wanted to study this issue. METHODS This is a retrospective multicentre cohort study of patients operated for TC. Outcome measures were overall survival (OS) and recurrence-free survival (RFS). OS was analysed using the Kaplan-Meier method and RFS was assessed using competing risk analysis. The association with clinical and prognostic factors for OS and RFS was evaluated with log-rank test and Gray's test, respectively. RESULTS A total of 1247 tumours (1042 TCs) were collected between 1984 and 2012. A R0 resection was performed in 363 TCs and in 52 NETTs. The median follow-up was 4.4 years for TCs and 4.1 years for NETTs. Owing to the missing values for survival information, a total of 728 TC patients and 132 NETTs were included in the OS analysis. Among them, 262 TC and 39 NETT patients died. The median OS was 6.6 years for TC and 7.5 years for NETTs. The overall 5-year survival rates were 60% for TC and 68% for NETTs; 10-year survival rates were 40% for TCs and 39% for NETTs (P = 0.19). Five-year RFS was 0.35 and 0.34 for TCs and NETTs (P = 0.36). On multivariate analysis, histology did not influence either OS (P = 0.79) or RFS (P = 0.59). CONCLUSIONS This represents the largest clinical series of TCs and NETTs collected. Despite the biological aggressiveness of these rare neoplasms, the 5-year survival rate after resection is over 60% and TCs and NETT showed a similar rate of survival and recurrences after surgery.
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Affiliation(s)
| | - Xiaopan Yao
- Section of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Turin, Italy
| | - Usman Ahmad
- Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alberto Antonicelli
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - James Huang
- Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Federico Venuta
- Department of Thoracic Surgery, Fondazione Eleonora Lorillard Spencer Cenci, Policlinico 'Umberto I', University of Rome Sapienza, Rome, Italy
| | - Dirk van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven Belgium, Leuven, Belgium
| | - William Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pascal Thomas
- Department of Thoracic Surgery, Lung Transplantation & Diseases of the Esophagus Marseille, Aix-Marseille University & Hospitals System of Marseille (AP-HM), Marseille, France
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital, Zurich, Switzerland
| | - Gaetano Rocco
- Istituto Nazionale Tumori, IRCCS, Pascale Foundation, Naples, Italy
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Chen D, Meng X, Zhao Y, Wu S. Isolated splenic metastasis from a thymic carcinoma: A case report. Cancer Biol Ther 2016; 17:911-4. [PMID: 27413995 DOI: 10.1080/15384047.2016.1210738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Thymic carcinomas are rare tumors that arise in the anterior mediastinum. Most of these malignancies develop local metastases limited in the thorax. Splenic metastases from thymic carcinomas are extremely rare. Here we report a case of isolated splenic metastasis from a 38-year-old female patient with Stage IV thymic carcinoma, who was treated with chemoradiotherapy. At twenty-2 months follow-up, the patient was found to have an isolated spleen metastasis, which was treated by Cyberknife with a reduced size of the metastasis, representing a partial response. Although splenic metastasis is a rare phenomenon, physicians need to be aware of the possibility of such metastases.
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Affiliation(s)
- Dongmei Chen
- a Department of Radiation Oncology , Hospital of PLA, Clinical College, Anhui Medical University , Beijing , P.R. China.,b Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , P.R. China
| | - Xiangying Meng
- b Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , P.R. China
| | - Yaowei Zhao
- b Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , P.R. China
| | - Shikai Wu
- a Department of Radiation Oncology , Hospital of PLA, Clinical College, Anhui Medical University , Beijing , P.R. China.,b Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , P.R. China
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Shima H, Ozasa H, Tsuji T, Ajimizu H, Nomizo T, Yagi Y, Sakamori Y, Nagai H, Minamiguchi S, Kim YH, Mishima M. Response to chemotherapy with carboplatin plus albumin-bound paclitaxel in a patient with lymphoepithelioma-like thymic carcinoma: A case report. Mol Clin Oncol 2016; 4:715-718. [PMID: 27123268 PMCID: PMC4840747 DOI: 10.3892/mco.2016.803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022] Open
Abstract
Thymic carcinoma is a rare neoplasm with a poor outcome due to its aggressive characteristics. For patients who are not operable, radiation therapy and/or palliative chemotherapy are indicated. However, no optimal chemotherapy regimen has been established. The present study reports the case of a 22-year-old man with advanced lymphoepithelioma-like thymic carcinoma refractory to conventional chemotherapy with carboplatin plus solvent-based paclitaxel (sb-PAC) treatment. The patient was subsequently treated with carboplatin plus nanoparticle albumin-bound paclitaxel (nab-PAC). The treatment resulted in a partial response following three cycles of chemotherapy. Since only grade 3 neutropenia, but no other severe adverse effects, was observed, no dose reduction was required. To the best of our knowledge, the current study is the first to present the response to chemotherapy with carboplatin plus nab-PAC in a patient with lymphoepithelioma-like thymic carcinoma. Considering that no standard treatment has been established in thymic carcinoma, nab-PAC may merit further investigation in this rare, but aggressive disease.
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Affiliation(s)
- Hiroshi Shima
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hiroaki Ozasa
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takahiro Tsuji
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hitomi Ajimizu
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takashi Nomizo
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yoshitaka Yagi
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yuichi Sakamori
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hiroki Nagai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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Fu H, Gu ZT, Fang WT, Fu JH, Shen Y, Han YT, Yu ZT, Li Y, Tan LJ, Pang LW, Chen KN. Long-Term Survival After Surgical Treatment of Thymic Carcinoma: A Retrospective Analysis from the Chinese Alliance for Research of Thymoma Database. Ann Surg Oncol 2016; 23:619-625. [DOI: 10.1245/s10434-015-4825-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Clinical characteristics and outcomes for patients with thymic carcinoma: evaluation of Masaoka staging. J Thorac Oncol 2015; 9:1810-5. [PMID: 25393794 DOI: 10.1097/jto.0000000000000363] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Thymic carcinomas are rare cancers with limited data regarding outcomes, particularly for those patients with advanced disease. METHODS We identified patients with thymic carcinomas diagnosed between 1993 and 2012. Patient characteristics, recurrence-free survival (RFS), and overall survival (OS) were analyzed. RESULTS One hundred twenty-one patients with thymic carcinomas were identified. Higher Masaoka stage was associated with worse OS and RFS (5-year OS of 100%, 81%, 51%, 24%, and 17% for stage I, II, III, IVa, and IVb respectively, p < 0.001 and 5-year RFS of 80%, 28%, and 7% for stage I/II, III, and IV respectively, p < 0.001). Patients with stage IVb lymph node (LN) only disease had a better 5-year OS as compared with patients with distant metastasis (24% versus 7%, p = 0.025). Of the 61 patients with stage IVb disease, 22 of 29 patients (76%) with LN-only disease underwent curative intent resection versus 3 of 32 patients (9%) with distant metastasis. Twenty-two patients with LN involvement were treated with multimodality therapy. Three (14%) remain free of disease with long-term follow-up (range, 3.4+ years- to 6.8+ years). CONCLUSIONS We describe the clinical features of a large series of patients with thymic carcinoma in North America. The Masaoka staging system effectively prognosticated OS and RFS. Patients with stage IVb LN-only disease had significantly better OS as compared with patients with distant metastasis with a subset of patients sustaining long-term RFS with multimodality therapy. If validated, these data would support a revised staging system with subclassification of stage IVb disease into two groups.
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Nakajima J, Okumura M, Yano M, Date H, Onuki T, Haniuda M, Sano Y. Myasthenia gravis with thymic epithelial tumour: a retrospective analysis of a Japanese database. Eur J Cardiothorac Surg 2015; 49:1510-5. [DOI: 10.1093/ejcts/ezv380] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/28/2015] [Indexed: 11/14/2022] Open
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Mao Y, Wu S. Treatment and survival analyses of completely resected thymic carcinoma patients. Onco Targets Ther 2015; 8:2503-7. [PMID: 26392777 PMCID: PMC4574812 DOI: 10.2147/ott.s87222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To investigate the impact of chemotherapy and/or radiotherapy on disease-free survival (DFS) and overall survival (OS) rates of patients with thymic carcinoma after complete resection. METHODS Between 2001 and 2013, 54 patients with complete resection of thymic carcinoma in Hangzhou Cancer Hospital were retrospectively reviewed. The Kaplan-Meier method was used to evaluate the survival rates. The Cox proportional hazard model was used for multivariate analysis. RESULTS Among the 54 patients, Masaoka stage I was observed in seven patients, II in 22 patients, and III in 25 patients. Sixteen patients received adjuvant chemotherapy (six with chemotherapy alone and ten with radiotherapy and chemotherapy), 25 patients received adjuvant radiotherapy, and 13 patients did not receive radiotherapy and/or chemotherapy. The 5-year DFS and OS rates for all patients were 63.0% and 73.4%, respectively. Univariate analysis revealed that radiotherapy was significantly associated with DFS and OS (P=0.014 and P=0.029, respectively), while adjuvant chemotherapy was not (P=0.122 and P=0.373, respectively). Multivariate analysis showed that adjuvant radiotherapy increased DFS (P=0.041), but not OS (P=0.051). CONCLUSION Complete resection followed by adjuvant radiotherapy increased disease-free rates of thymic carcinoma patients.
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Affiliation(s)
- Yanjiao Mao
- Department of Radiotherapy Oncology, Hangzhou Cancer Hospital, Hangzhou, People's Republic of China
| | - Shixiu Wu
- Department of Radiotherapy Oncology, Hangzhou Cancer Hospital, Hangzhou, People's Republic of China
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Jung HY, Cho H, Chung JH, Bae SB, Lee JH, Lee HJ, Jang SH, Oh MH. A Rare Case of Primary Tubular Adenocarcinoma of the Thymus, Enteric Immunophenotype: A Case Study and Review of the Literature. J Pathol Transl Med 2015; 49:331-4. [PMID: 26040775 PMCID: PMC4508571 DOI: 10.4132/jptm.2015.04.16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/08/2015] [Accepted: 04/16/2015] [Indexed: 12/16/2022] Open
Abstract
Thymic carcinomas are uncommon malignant tumors, and thymic adenocarcinomas are extremely rare. Here, we describe a case of primary thymic adenocarcinoma in a 59-year-old woman. Histological examination of the tumor revealed tubular morphology with expression of cytokeratin 20 and caudal-type homeobox 2 according to immunohistochemistry, suggesting enteric features. Extensive clinical and radiological studies excluded the possibility of an extrathymic primary tumor. A review of the literature revealed only two global cases of primary tubular adenocarcinomas of the thymus with enteric immunophenotype.
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Affiliation(s)
- Hae Yoen Jung
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyundeuk Cho
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jin-Haeng Chung
- Department of Pathology and Respiratory Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Byoung Bae
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ji-Hye Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyun Ju Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Si-Hyong Jang
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Mee-Hye Oh
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Li W, Miao Z, Liu X, Zhang Q, Sun L, Li P, Liu W, Zhang L. Thymic carcinoma patients with myasthenia gravis exhibit better prognoses. Int J Clin Oncol 2015; 21:75-80. [PMID: 26138264 DOI: 10.1007/s10147-015-0862-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/10/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Thymic carcinoma is an aggressive mediastinal neoplasm with a poor prognosis, but the factors that contribute to its prognosis are not completely understood. Myasthenia gravis (MG) can coexist with thymic carcinoma with low incidence, but the effect MG has on thymic carcinoma prognosis is unknown. Here, we investigated the prognostic factors of thymic carcinoma and the influence of MG on patients with this disease. METHODS Between January 1996 and December 2012, 49 patients were diagnosed with thymic carcinoma and surgically treated at our institution. Clinical data and survival information were recorded and systematically reviewed. Kaplan-Meier survival curves were generated, and independent prognostic factors were identified by Cox's proportional hazard model. RESULTS Complete resection was achieved in 30 patients (61.2 %), and incomplete resection was performed on the other 19 patients (38.8 %). Six of the 49 patients with thymic carcinoma also presented with MG (12.2 %). Interestingly, these 6 patients exhibited much better prognoses when compared to the other 43 patients. Patients with MG also had significantly smaller tumors (P = 0.045), earlier Masaoka stage (P = 0.048), and higher complete resection rates (P = 0.042). However, multivariate analysis demonstrated that complete resection was the only independent predictor for overall survival (OS) (P < 0.001). CONCLUSIONS The OS of patients with thymic carcinoma depends on complete resection, but patients with MG also demonstrate improved prognoses. MG patients have higher rates of complete surgical resection, which may account for their better prognoses. Patients with MG have unique features that may aid in the clinical management of these patients.
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Affiliation(s)
- Wenya Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning Province, China
| | - Zhifeng Miao
- Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
| | - Xudong Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
| | - Qigang Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning Province, China
| | - Lei Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning Province, China
| | - Peiwen Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning Province, China
| | - Wenke Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning Province, China
| | - Lin Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning Province, China.
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Thymic carcinoma: a cohort study of patients from the European society of thoracic surgeons database. J Thorac Oncol 2015; 9:541-8. [PMID: 24736078 DOI: 10.1097/jto.0000000000000128] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Thymic carcinoma is a rare and aggressive thymic neoplasm. The European Society of Thoracic Surgeons developed a retrospective database collecting patients undergoing resection for thymic tumors from 1990 to 2010. METHODS Of 2265 patients with thymic tumors, there were 229 thymic carcinomas. Clinicopathological characteristics were analyzed including age, associated paraneoplastic diseases, stage (Masaoka-Koga), World Health Organization histologic subtypes, type of resection (total/subtotal/biopsy/no resection), tumor size, pre/postoperative treatments, and recurrence. Outcome measures included overall survival (OS), freedom from recurrence, and cumulative incidence of recurrence. RESULTS A complete resection was achieved in 140 patients (69%). Recurrence occurred in 54 patients (28%). Five- and 10-year OS rates were 0.61 and 0.37. Five- and 10-year freedom from recurrence rates were 0.60 and 0.43. Cumulative incidence of recurrence was 0.21 (3 yr), 0.27 (5 yr), and 0.32 (10 yr). Survival was better after surgical resection versus biopsy/no resection (p < 0.001), after complete resection versus subtotal resection (p < 0.001), and when using Masaoka-Koga system (stages I-II versus III versus IV) (p < 0.001). The use of multidisciplinary treatments resulted in a survival advantage which was significant in the surgery + radiotherapy group (p = 0.02). Incomplete resection (p < 0.0001) and advanced stage (Masaoka-Koga III-IV) (p = 0.02) had a negative impact on OS at multivariable analysis. Administration of adjuvant radiotherapy was beneficial in increasing OS (p = 0.02). CONCLUSIONS The results of our study indicate that patients with thymic carcinoma should undertake surgical resection whenever possible; a complete resection and early Masaoka-Koga stage are independent predictors of improved survival; our results also suggest that postoperative radiotherapy is beneficial in improving survival.
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Treglia G, Sadeghi R, Giovanella L, Cafarotti S, Filosso P, Lococo F. Is (18)F-FDG PET useful in predicting the WHO grade of malignancy in thymic epithelial tumors? A meta-analysis. Lung Cancer 2014; 86:5-13. [PMID: 25175317 DOI: 10.1016/j.lungcan.2014.08.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/10/2014] [Accepted: 08/11/2014] [Indexed: 12/27/2022]
Abstract
AIM To perform a systematic review and meta-analysis of published data on the role of fluorine-18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) in predicting the WHO grade of malignancy in thymic epithelial tumors (TETs). METHODS A comprehensive literature search of studies published up to March 2014 was performed. Data on maximum standardized uptake value (SUVmax) in patients with low-risk thymomas (A, AB, B1), high-risk thymomas (B2, B3) and thymic carcinomas (C) according to the WHO classification were collected when reported by the retrieved articles. The comparison of mean SUVmax between low-risk thymomas, high-risk thymomas and thymic carcinomas was expressed as weighted mean difference (WMD) and a pooled WMD was calculated including 95% confidence interval (95%CI). RESULTS Eleven studies were selected for the meta-analysis. The pooled WMD of SUVmax between high-risk and low-risk thymomas was 1.2 (95%CI: 0.4-2.0). The pooled WMD of SUVmax between thymic carcinomas and low-risk thymomas was 4.8 (95%CI: 3.4-6.1). Finally, the pooled WMD of SUVmax between thymic carcinomas and high-risk thymomas was 3.5 (95%CI: 2.7-4.3). CONCLUSIONS (18)F-FDG PET may predict the WHO grade of malignancy in TETs. In particular, we demonstrated a statistically significant difference of SUVmax between the different TETs (low-grade thymomas, high-grade thymomas and thymic carcinomas).
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Affiliation(s)
- Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Luca Giovanella
- Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Unit of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | | | - Filippo Lococo
- Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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