A 25-year thymoma treatment review

Most thymomas are stage I or II at presentation, and they have a good progn osis with surgical treatment. Higher stage thymomas are less common and the ir treatment is more problematic. Our center tends to attract patients with higher stage thymomas for treatment. We reviewed our experience and contra sted it with other published series. A 25-year retrospective record review of thymomas was done. 38 patients were treated. Median age was 49 years. Fo ur had myasthenia gravis. Masaoka staging was: stage 1 - 9; stage II - 6; s tage III - 15; stage IVa - 4; stage IVb - 4. Resection was done in 25 patie nts (21 had R0 resection), chemotherapy was given to 15 patients, and 27 pa tients received radiotherapy. Overall median survival was 55 months. Overal l 5 and 10-year survivals were 30% and 18%. 5-year survival by stage was: s tage I - 75%; stage II - 50%; stage III/IV - 23%. Negative prognostic facto rs on univariate analysis included presence of symptoms at presentation (p = 0.02), unresectable tumor (p = 0.06), stage III/IV (p = 0.04), and diseas e recurrence after resection (p = 0.0001). On multivariate analysis, only s tage (p = 0.04) and recurrence (p = 0.0001) were independent predictors of survival. All patients who recurred after resection eventually died of dise ase. Our overall treatment results are disappointing, but we had higher sta ge patients than reported by most other centers. Early stage thymomas are s uitable for complete surgical resection, and the prognosis is favorable. Ho wever, higher stage thymomas (stage III and higher) pose problems for compl ete surgical resection and their prognosis is poor. Newer multimodality tre atment approaches are indicated for higher stage thymomas.