Robert J Korst1, Andrea Bezjak2, Shanda Blackmon3, Noah Choi4, Panos Fidias5, Geoffrey Liu6, Alexander Marx7, Cameron Wright8, Susan Mock9, John R Rutledge9, Shaf Keshavjee10. 1. Daniel and Gloria Blumenthal Cancer Center, Paramus, NJ; Division of Thoracic Surgery, Department of Surgery, The Valley Hospital, Valley Health System, Ridgewood, NJ; The International Thymic Malignancy Interest Group, Ardsley, NY. Electronic address: korsro@valleyhealth.com. 2. The International Thymic Malignancy Interest Group, Ardsley, NY; Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada. 3. Section of Thoracic Surgery, Department of Surgery, Methodist Hospital, Houston, Tex. 4. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Mass. 5. Department of Medicine, Massachusetts General Hospital, Boston, Mass. 6. The International Thymic Malignancy Interest Group, Ardsley, NY; Departments of Medicine and Medical Biophysics, Princess Margaret Cancer Center, Toronto, Ontario, Canada. 7. The International Thymic Malignancy Interest Group, Ardsley, NY; Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. 8. The International Thymic Malignancy Interest Group, Ardsley, NY; Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass. 9. Daniel and Gloria Blumenthal Cancer Center, Paramus, NJ. 10. The International Thymic Malignancy Interest Group, Ardsley, NY; Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: To determine the response rate, toxicity, and rate of complete resection after induction chemoradiotherapy for locally advanced thymic tumors, which were defined by specific radiographic criteria. METHODS: A single-arm, pilot trial was conducted at 4 institutions. Patients with thymoma or thymic carcinoma who met specific criteria on computed tomography were accrued. Induction therapy consisted of 2 cycles of cisplatin and etoposide combined with 45 Gy of thoracic radiotherapy. Patients underwent computed tomography and positron emission tomography before and after induction therapy and then resection was attempted. Postoperative chemoradiotherapy was administered in selected patients. The primary endpoint was the pathologic response to induction therapy. The secondary endpoints were toxicity, surgical complications, radiographic response, and the rate of R0 resection. RESULTS: A total of 22 patients were accrued during a 5-year period (1 patient withdrew before starting induction therapy). Of the 22 patients, 21 completed induction therapy, and 9 (41%) experienced grade 3 or 4 toxicity. A total of 10 patients had a partial radiographic response and 11 had stable disease. Of the 21 patients, 17 (77%) underwent an R0 resection, 3 (14%) an R1 resection, and 1 (5%) underwent debulking. Eight patients sustained surgical complications (36%), and two patients (9%) died postoperatively. Of the 21 patients, 13 (62%) had either thymic carcinoma or B3 thymoma and 15 (71%) had either Masaoka stage III or IV disease. No patient had a complete pathologic response, but 5 specimens (24%) had <10% viable tumor. CONCLUSIONS: The present induction chemoradiotherapy protocol, which used specific computed tomography inclusion criteria to successfully select locally advanced thymic tumors, appeared to be tolerable and resulted in a high rate of complete surgical resection.
OBJECTIVE: To determine the response rate, toxicity, and rate of complete resection after induction chemoradiotherapy for locally advanced thymic tumors, which were defined by specific radiographic criteria. METHODS: A single-arm, pilot trial was conducted at 4 institutions. Patients with thymoma or thymic carcinoma who met specific criteria on computed tomography were accrued. Induction therapy consisted of 2 cycles of cisplatin and etoposide combined with 45 Gy of thoracic radiotherapy. Patients underwent computed tomography and positron emission tomography before and after induction therapy and then resection was attempted. Postoperative chemoradiotherapy was administered in selected patients. The primary endpoint was the pathologic response to induction therapy. The secondary endpoints were toxicity, surgical complications, radiographic response, and the rate of R0 resection. RESULTS: A total of 22 patients were accrued during a 5-year period (1 patient withdrew before starting induction therapy). Of the 22 patients, 21 completed induction therapy, and 9 (41%) experienced grade 3 or 4 toxicity. A total of 10 patients had a partial radiographic response and 11 had stable disease. Of the 21 patients, 17 (77%) underwent an R0 resection, 3 (14%) an R1 resection, and 1 (5%) underwent debulking. Eight patients sustained surgical complications (36%), and two patients (9%) died postoperatively. Of the 21 patients, 13 (62%) had either thymic carcinoma or B3 thymoma and 15 (71%) had either Masaoka stage III or IV disease. No patient had a complete pathologic response, but 5 specimens (24%) had <10% viable tumor. CONCLUSIONS: The present induction chemoradiotherapy protocol, which used specific computed tomography inclusion criteria to successfully select locally advanced thymic tumors, appeared to be tolerable and resulted in a high rate of complete surgical resection.
Authors: Matthias Felix Häfner; Falk Roeder; Florian Sterzing; David Krug; Stefan A Koerber; Jutta Kappes; Hans Hoffmann; Alla Slynko; Jürgen Debus; Marc Bischof Journal: Strahlenther Onkol Date: 2014-08-26 Impact factor: 3.621
Authors: Robert J Korst; Sumudinie Fernando; Ann Christine Catlin; John R Rutledge; Nicolas Girard; James Huang; Frank Detterbeck Journal: Ann Thorac Surg Date: 2017-10-21 Impact factor: 4.330