NEOADJUVANT CHEMOTHERAPY WITH ADRIAMYCIN, CISPLATIN, VINCRISTINE AND CYCLOPHOSPHAMIDE (ADOC) IN INVASIVE THYMOMAS - RESULTS IN 6 PATIENTS

Background: Locally advanced malignant thymomas are usually radically resectable in about 60% of stage III but hardly ever in stage IVA. Neo adjuvant chemotherapy followed by surgery could improve both resection rate and curability. Cisplatin containing regimens have repeatedly be en found to be highly active in advanced disease, with overall respons e rates ranging from 80%-90%. Patients and methods. 3 patients with st age III and 3 with stage IVA invasive thymomas, according to Masaoka s taging, entered the study. Histology was: lymphoepithelial 4 cases, ep ithelial 2 cases. 4 cycles of the ADOC scheme - Adriamycin (40 mg/sqm) , cisplatin (50 mg/sqm) on day 1, vincristine (0.6 mg/sqm) on day 2, a nd cyclophosphamide (700 mg/sqm) on day 3, every 21 days - were admini stered to 5 patients, while 1 patient received 5 cycles. Results: 5/6 patients (83.3%) attained partial responses and underwent radical surg ery followed by two further ADOC cycles. The disease-free intervals we re 5+, 6+, 15+, 16+, 26+ months. One patient showing stable disease at the end of the fifth cycle was referred to radiotherapy. Toxicity was tolerable: grade III (WHO) nausea/vomiting and leukopenia grade III o ccurred in 2 patients each.Conclusions: These results suggest that the ADOC scheme is active as a neoadjuvant approach in invasive thymoma s tages III and IVA, rendering possible radical resectability in 83% of patients.