Thymic Carcinoma treatment options updated:2002.01.05

START here thymoma.de

Thanks to the research from a fellow thymoma patient, I'm able to provide these valuable new information about treatment options for patients who have to deal with thymic carcinoma or with locally advanced unresectable invasive thymoma.

Sue, here is an abstract to share with everyone. It doesn't seem to be published as a journal article yet and was released in abstract form in 1997 and is viewable on ASCO online. Dr. Shin is an oncologist and is now at he University of Pittsburg, so patients can get this kind of aggressive and very successful treatment at both MD Anderson and Pittsburg from clinicians with experience.

A Thymic Carcinoma behaves a little bit more aggressively than a standard Thymoma; however, even in the grouping of Thymomas of all types, there is a continuum of histologic subtypes that seem to have a bearing on prognosis. Thymic Carcinoma is at one end of this spectrum and the Medullary Subtype (or WHO Histologic Classification A) is at the most favorable end - often associated with localized Thymomas.

Anyway, I think the successful outcome of this approach is worth mentioning to people.

Induction chemotherapy (IC) followed by surgical resection (SR), radiotherapy (RT), and consolidative chemotherapy (CC) may cure
the advanced stages of unresectable invasive thymoma. D. M. Shin, R. Komaki, J. B. Putnam, G. Walsh, J. Nesbitt, J. Y. Ro, R. A. Schea,
K.M.W. Pisters, D. Shrump, J. D. Cox, J. Roth, and W. K. Hong. The University of Texas M.D. Anderson Cancer Center, Houston, TX
77030.

To improve resectability and prolong the survival of patients (pts) with locally advanced unresectable invasive thymoma (Masaoka stages III and
IVA), we conducted a prospective study using IC for 3 cycles, followed by SR and RT (50 Gy for no residual tumor at SR; 60 Gy for residual
tumor or incomplete resection at SR), and CC for 3 cycles. IC and CC included Cyclophosphamide 500 mg/m2 I.V. day 1; Doxorubicin 20
mg/m2/day continuous infusion days 1 -3 (total 60 mg/m 2); Cisplatin 30 mg/m2/day I.V. days 1 - 3 (total 90 mg/m2 ); Prednisone 100 mg P.O.
days 1 - 5, repeated every 3 - 4 weeks. From 2/1990 to 10/1996, 13 pts were entered, and 12 pts (1 patient not evaluable due to wrong
histology) were evaluable for response, toxicity, and survival. Characteristics of these 12 pts included 5 males and 7 females; median age 42 (range
23 - 66); stage III in 5 pts/stage IVA in 7 pts; 11 untreated pts and 1 recurrent disease; mean KPS 80% (70-100%). With IC, 11 (92%) of 12 pts
had major responses (3 CRs, 8 PRs, and 1 MR). Ten pts (1 refused SR, 1 still on IC) underwent SR (8 pts had complete resection and 2 had
incomplete resection) with no mortality and low morbidity. Of 10 resected cases, no viable tumors were identified in 2 cases and more than 90% of
tumor necrosis was observed in 2 cases. All 10 pts completed RT without morbidity. Median follow-up time was 38 months (range, 2 - 81
months). All 12 pts are alive: 2 pts who had incomplete resection developed recurrence and the remaining 10 pts are alive without evidence of
recurrence to date (83% disease-free survival at 6 yrs). The toxicity of chemotherapy was modest and all pts were well tolerated. This study
suggests that aggressive multidisciplinary approach may cure the advanced stages of invasive thymoma. Large scale of study with longer follow-up is
necessary.