Multimodality Treatment for Thymic Carcinoma: Review of 11 Cases at a Single Institute

Hisao Higo, Keiichi Fujiwara, Go Makimoto, Yuhei Tokimasa, Nobuhisa Kameyama, Mizuho Matsushita, Kammei Rai, Ken Sato, Takuo Shibayama, Toshiro Yonei, Akio Andou, Toshio Sato

Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Okayama, Japan.
Department of Respiratory Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan.

DOI: 10.4236/jct.2013.43091                

Abstract

Background: We reported our experience with thymic carcinomas and review their clinical features, treatment strategies, and prognoses. Methods: From April 1998 to November 2012, 11 patients pathologically diagnosed with thymic carcinoma and treated in our hospital were investigated. Results: There were 7 men and 4 women, with a median age of 62 years (range, 35 - 72). According to the Masaoka staging system, 3 patients had stage II, 1 stage III disease, 3 stage IVa disease and 4 stage IVb disease. Ten patients had squamous cell carcinoma, whereas 1 had large cell neuroendocrine carcinoma (LCNEC). We performed surgery or multimodality therapy including surgery as the initial therapy for 8 patients. Of the non-surgical cases, 1 patient received chemoradiotherapy and survived for over 6 years without recurrence, whereas 2 received palliative care. Three of 4 patients who underwent complete resection survived without disease recurrence, whereas only 1 patient with LCNEC survived in the incomplete resection group. Multimodality therapy with cisplatin and docetaxel was provided to 3 patients, and recurrence has not been observed in any of the cases. Conclusions: Favorable outcomes could be achieved in patients with thymic carcinoma who underwent intensive treatment. In particular, surgery combined with cisplatin and docetaxel plus thoracic irradiation may be an attractive approach for thymic carcinoma.

Keywords

Thymic Carcinoma; Multimodality Treatment; Cisplatin; Docetaxel

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	K. Kondo and T. Monden, “Therapy for Thymic Epithelial Tumors: A Clinical Study of 1320 Patients from Japan,” The Annals of Thoracic Surgery, Vol.76, No. 3, 2003, pp. 878-884. doi:10.1016/S0003-4975(03)00555-1
[2]	S. Suster and J. Rosai, “Thymic Carcinoma. A Clinicopathologic Study of 60 Patients,” Cancer, Vol. 67, No. 4, 1991, pp. 1025-1032. doi:10.1002/1097-0142 (19910215)67:4<1025::AID-CNCR2820 670427>3.0.CO;2-F
[3]	K. Ogawa, T. Toita, T. Uno, et al., “Treatment and Prognosis of Thymic Carcinoma: A Retrospective Analysis of 40 Cases,” Cancer , Vol. 94, No. 12, 2002, pp. 3115-3119. doi:10.1002/cncr.10588
[4]	A. Masaoka, Y. Monden, K. Nakahara, et al., “Follow-Up Study of Thymomas with Special Reference to Their Clinical Stages,” Cancer, Vol. 48, No. 11, 1981, pp. 2485-2492. doi:10.1002/1097-0142(19811201)48:11<2485::AID-CNCR2820481123>3.0.CO;2-R
[5]	W. D. Travis, E. Brambilla, H. K. Muller-Hermelink, et al., “World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart,” International Agency for Research on Cancer Press, Lyon, 2004, pp. 146 -151.
[6]	Y. Segawa, K. Kiura, N. Takigawa, et al., “Phase III Trial Comparing Docetaxel and Cisplatin Combination Chemotherapy with Mitomycin, Vindesine, and Cisplatin Combination Chemotherapy with Concurrent Thoracic Radiotherapy in Locally Advanced Non-Small-Cell Lung Cancer, OLCSG 0007,” Journal of Clinical Oncology, Vol. 28, No. 20, 2010, pp. 3299-3306. doi:10.1200/ JCO.2009.24.7577
[7]	C. Y. Lee, M. K. Bae, I. K. Park, et al., “Early Masaoka Stage and Complete Resection Is Important for Prognosis of Thymic Carcinoma: A 20-Year Experience at a Single Institution,” European Journal Cardio-Thoracic Surgery, Vol. 36, No. 1, 2009, pp. 159-162. doi:10.1016/j.ejcts.2009.02.019
[8]	M. Lucchi, A. Mussi, F. Basolo, et al., “The Multimodality Treatment of Thymic Carcinoma,” European Journal Cardio-Thoracic Surgery, Vol. 19, No. 5, 2001, pp. 566-569. doi:10.1016/S1010-7940(01)00666-2
[9]	G. Cardillo, F. Carleo, R. Giunti, et al., “Predictors of Survival in Patients with Locally Advanced Thymoma and Thymic Carcinoma (Masaoka Stages III and IVa),” European Journal Cardio-Thoracic Surgery, Vol. 37, No. 4, 2010, pp. 819-823. doi:10.1016/j.ejcts.2009.11.001
[10]	G. L. Lemma, J. W. Lee, S. C. Aisner, et al., “Phase II Study of Carboplatin and Paclitaxel in Advanced Thymoma and Thymic Carcinoma,” Journal of Clinical Oncology, Vol. 29, No. 15, 2011, pp. 2060-2065. doi:10.1200/JCO.2010.32.9607
[11]	T. Koizumi, Y. Takabayashi, S. Yamagishi, et al., “Chemotherapy for Advanced Thymic Carcinoma: Clinical Response to Cisplatin, Doxorubicin, Vincristine, and Cyclophosphamide (ADOC Chemotherapy),” American Journal of Clinical Oncology, Vol. 25, No. 3, 2002, pp. 266-268. doi:10.1097/00000421-200206000-00012
[12]	S. Igawa, H. Murakami, T. Takahashi, et al., “Efficacy of Chemotherapy with Carboplatin and Paclitaxel for Unresectable Thymic Carcinoma,” Lung Cancer, Vol. 67, No. 2, 2010, pp. 194-197. doi:10.1016/j.lungcan.2009.03.031
[13]	Y. Okuma, Y. Hosomi, Y. Takagi, et al., “Cisplatin and Irinotecan Combination Chemotherapy for Advanced Thymic Carcinoma: Evaluation of Efficacy and Toxicity,” Lung Cancer, Vol. 74, No. 3, 2011, pp. 492-496. doi:10.1016/j.lungcan.2011.05.013
[14]	M. Yano, H. Sasaki, T. Yokoyama, et al., “Thymic Carcinoma: 30 Cases at a Single Institution,” Journal of Thoracic Oncology, Vol. 3, No. 3, 2008, pp. 265-269. doi:10.1097/JTO.0b013e3181653c71
[15]	M. Abiko and T. Satoh. “Effect of Preoperative Concurrent Chemo-Radiotherapy for Thymic Carcinoma,” Kyobu Geka, Vol. 55, No. 11, 2002, pp. 965-970.
[16]	A. Morio, K. Nakahara, Y. Ohse, et al., “Efficacy of Induction Chemoradiotherapy in Thymic Cancer: Report of a Successful Case and Review of the Literature,” International Journal of Clinical Oncology, Vol. 7, No. 3, 2002, pp. 201-204. doi:10.1007/s101470200030
[17]	S. Toyooka, K. Kiura, K. Shien, et al., “Induction Chemoradiotherapy Is Superior to Induction Chemotherapy for the Survival of Non-Small-Cell Lung Cancer Patients with Pathological Mediastinal Lymph Node Metastasis,” Interactive CardioVascular and Thoracic Surgery, Vol. 15, No. 6, 2012, pp. 954-960. doi:10.1093/icvts/ivs412