Surgical Treatment of Single and Multiple Thymoma Recurrences

Overview

Journal Gen Thorac Cardiovasc Surg

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2019 Oct 23

PMID 31637673

Citations 4

Authors

Angelo Carretta

Paola Ciriaco

Piergiorgio Muriana

Alessandro Bandiera

Giampiero Negri

Affiliations

Soon will be listed here.

Abstract

Objectives: A significant number of patients with thymoma develop a recurrence after surgery. The results of previous studies analyzing therapeutic strategies in the treatment of recurrences have been controversial. Aim of the study was to evaluate the role of surgery in the treatment of thymoma recurrences assessing prognostic factors related with survival.

Methods: Between January 1993 and September 2018, 27 of 161 patients had a recurrence after complete thymoma resection. Twenty-one (13%) underwent surgical treatment of the recurrence. Primary tumor stage was: I in a patient, IIa in five, IIb in nine and III in six. The recurrence was regional in all patients and both regional and distant in four. WHO histological classification was: A in two patients, B1 in two, B2 in seven and B3 in 10 patients.

Results: Median disease-free survival from surgical treatment of the primary tumor and recurrence was 44 months (1-124). Thirty-eight operations were performed (range 1-5). Complete resection rate was 66%. Adjuvant radiotherapy and chemotherapy after surgical treatment of recurrences were performed respectively in ten and nine patients, including eight patients with multiple recurrences. Five and 10-year tumor-specific survival from recurrence was, respectively, 79% and 66%. Survival analysis showed a significant correlation between survival and WHO classification, with a significantly lower survival in patients with B3 tumors in comparison with A to B2 tumors (p = 0.026).

Conclusions: Long-term survival was observed following surgical treatment of thymoma recurrences. These results were observed even after multiple recurrences when surgical treatment was performed within a multimodality oncological approach.

Citing Articles

Postoperative radiotherapy for thymic epithelial tumors: a narrative review.

Kishi N, Matsuo Y Mediastinum. 2024; 8:40.

PMID: 39161587 PMC: 11330913. DOI: 10.21037/med-23-38.

Acute myeloid leukemia post‑cytotoxic therapy following chemotherapy for thymoma: A case report.

Manabe M, Tani Y, Inano N, Hagiwara Y, Sogabe N, Nanno S Med Int (Lond). 2024; 4(1):9.

PMID: 38283133 PMC: 10811442. DOI: 10.3892/mi.2024.133.

A Large Thymoma Resected via Left Antero-lateral Thoracotomy.

Savu C, Melinte A, Gibu A, Hallabrin I, Zafiu A, Tudor V Cancer Diagn Progn. 2022; 1(4):363-370.

PMID: 35403149 PMC: 8988950. DOI: 10.21873/cdp.10048.

Outcomes of thymoma after multimodal therapy and determinants of survival: A 16-year experience of a tertiary cancer center.

Ak N, Toker A, Kara M, Ozkan B, Ulker M, Kaba E Turk Gogus Kalp Damar Cerrahisi Derg. 2022; 29(4):487-495.

PMID: 35096446 PMC: 8762900. DOI: 10.5606/tgkdc.dergisi.2021.20529.

References

Ruffini E, Mancuso M, Oliaro A, Casadio C, Cavallo A, Cianci R . Recurrence of thymoma: analysis of clinicopathologic features, treatment, and outcome. J Thorac Cardiovasc Surg. 1997; 113(1):55-63. DOI: 10.1016/S0022-5223(97)70399-4. View

Tseng Y, Tseng Y, Tang E, Goan Y . A new application for argon beam coagulation: the thymoma patient with pleural recurrence. J Thorac Dis. 2018; 10(5):E355-E358. PMC: 6006104. DOI: 10.21037/jtd.2018.04.114. View

Monden Y, Nakahara K, Iioka S, Nanjo S, Ohno K, Fujii Y . Recurrence of thymoma: clinicopathological features, therapy, and prognosis. Ann Thorac Surg. 1985; 39(2):165-9. DOI: 10.1016/s0003-4975(10)62558-1. View

Kato T, Iwano S, Taniguchi T, Kawaguchi K, Fukui T, Ishiguro F . The contact length between the tumor contour and the lung on computed tomography is a risk factor for pleural recurrence after complete resection of thymoma. Gen Thorac Cardiovasc Surg. 2015; 63(6):343-8. DOI: 10.1007/s11748-015-0525-z. View

Park B, Park J, Kim H, Choi Y, Kim K, Shim Y . Surgical management of locoregionally recurrent thymoma. Thorac Cancer. 2011; 2(4):196-200. DOI: 10.1111/j.1759-7714.2011.00072.x. View

Huang J, Detterbeck F, Wang Z, Loehrer Sr P . Standard outcome measures for thymic malignancies. J Thorac Oncol. 2010; 5(12):2017-23. DOI: 10.1097/JTO.0b013e3181f13682. View

Hamaji M, Ali S, Burt B . A meta-analysis of surgical versus nonsurgical management of recurrent thymoma. Ann Thorac Surg. 2014; 98(2):748-55. DOI: 10.1016/j.athoracsur.2014.04.028. View

Engels E . Epidemiology of thymoma and associated malignancies. J Thorac Oncol. 2010; 5(10 Suppl 4):S260-5. PMC: 2951303. DOI: 10.1097/JTO.0b013e3181f1f62d. View

Yano M, Sasaki H, Moriyama S, Hikosaka Y, Yokota K, Masaoka A . Number of recurrent lesions is a prognostic factor in recurrent thymoma. Interact Cardiovasc Thorac Surg. 2011; 13(1):21-4. DOI: 10.1510/icvts.2010.264036. View

10.

Wright C, Wain J, Wong D, Donahue D, Gaissert H, Grillo H . Predictors of recurrence in thymic tumors: importance of invasion, World Health Organization histology, and size. J Thorac Cardiovasc Surg. 2005; 130(5):1413-21. DOI: 10.1016/j.jtcvs.2005.07.026. View

11.

Regnard J, Zinzindohoue F, Magdeleinat P, Guibert L, Spaggiari L, Levasseur P . Results of re-resection for recurrent thymomas. Ann Thorac Surg. 1998; 64(6):1593-8. DOI: 10.1016/s0003-4975(97)01175-2. View

12.

Loehrer Sr P, Kim K, Aisner S, Livingston R, Einhorn L, Johnson D . Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. The Eastern Cooperative Oncology Group, Southwest Oncology Group, and Southeastern Cancer Study Group. J Clin Oncol. 1994; 12(6):1164-8. DOI: 10.1200/JCO.1994.12.6.1164. View

13.

Luo T, Zhao H, Zhou X . The clinical features, diagnosis and management of recurrent thymoma. J Cardiothorac Surg. 2016; 11(1):140. PMC: 5007840. DOI: 10.1186/s13019-016-0533-9. View

14.

Fiorelli A, DAndrilli A, Vanni C, Cascone R, Anile M, Diso D . Iterative Surgical Treatment for Repeated Recurrences After Complete Resection of Thymic Tumors. Ann Thorac Surg. 2016; 103(2):422-431. DOI: 10.1016/j.athoracsur.2016.08.086. View

15.

Margaritora S, Cesario A, Cusumano G, Lococo F, Porziella V, Meacci E . Single-centre 40-year results of redo operation for recurrent thymomas. Eur J Cardiothorac Surg. 2011; 40(4):894-900. DOI: 10.1016/j.ejcts.2011.01.025. View

16.

Abtin F, Suh R, Nasehi L, Han S, Hsu W, Quirk M . Percutaneous cryoablation for the treatment of recurrent thymoma: preliminary safety and efficacy. J Vasc Interv Radiol. 2015; 26(5):709-14. DOI: 10.1016/j.jvir.2014.12.024. View

17.

Kondo K, Monden Y . Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003; 76(3):878-84; discussion 884-5. DOI: 10.1016/s0003-4975(03)00555-1. View

18.

Xu C, Feng Q, Fan C, Zhai Y, Chen Y, Zhang H . Patterns and predictors of recurrence after radical resection of thymoma. Radiother Oncol. 2015; 115(1):30-4. DOI: 10.1016/j.radonc.2015.03.001. View

19.

Leuzzi G, Rocco G, Ruffini E, Sperduti I, Detterbeck F, Weder W . Multimodality therapy for locally advanced thymomas: A propensity score-matched cohort study from the European Society of Thoracic Surgeons Database. J Thorac Cardiovasc Surg. 2015; 151(1):47-57.e1. DOI: 10.1016/j.jtcvs.2015.08.034. View

20.

Ciccone A, Rendina E . Treatment of recurrent thymic tumors. Semin Thorac Cardiovasc Surg. 2005; 17(1):27-31. DOI: 10.1053/j.semtcvs.2004.12.004. View