The multimodality treatment of thymic carcinoma

Objectives: Thymic carcinoma is a rare neoplasm more invasive and with a po orer prognosis than ordinary thymoma. Complete curative resection is someti mes not possible, but good response rates to chemotherapy are reported in l iterature. We report our experience with seven cases of thymic carcinoma, w ho took part to a multimodality treatment including neoadjuvant chemotherap y, surgery and post-operative radiotherapy in our center. Methods: Since Ju ne 1989, seven previously untreated patients were enrolled. The primary che motherapy consisted of three courses of cisplatin (P; 75 mg/m(2) i.v., day 1), epidoxorubicin (E; 100 mg/m(2) i.v., day 1) and etoposide (VP16; 120 mg /m(2) i.v., days 1, 3 and 5), every 3 weeks. Surgery was performed followin g complete hematological recovery. After surgery, all patients underwent ra diation therapy to the tumor areas, operatively marked with clips, at doses of 45 (complete resection) or 60 Gy (incomplete resection). Results: The p re-operative diagnosis of thymic carcinoma was performed in four cases by a mediastinotomy, and in the remaining cases, by an ultrasound-guided (n = 2 ) or a computed tompography-guided (n = 1) fine needle aspiration. All pati ents responded (one completely) to the chemotherapy regimen. Surgical resec tion was complete in four cases (histological examination negative in one c ase). Three patients are still alive and well (62-136 months from the diagn osis), two are alive with relapse at 16 and 85 months, one patient died at 86 months from another cause, and one patient died at 18 months from local relapse and lung metastases. Conclusions: A pre-operative shrinkage of the thymic carcinoma by means of neoadjuvant multi-drug chemotherapy may improv e the resectability, and therefore, the survival rate. Our experience, alth ough preliminary, is encouraging and merits additional study in a multicent er trial with a sufficient number of patients to draw definitive conclusion s. (C) 2001 Elsevier Science B.V. All rights reserved.