Induction Therapy versus Initial Surgery in Advanced Thymic Tumors: Perioperative and Oncological Outcome

Giovanni Leuzzi, Gabriele Alessandrini, Isabella Sperduti, Daniele Forcella, Mirella Marino, Anna Ceribelli, Francesco Facciolo

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose Despite the intense debate concerning management of advanced thymic tumors, no specific oncological strategies have been yet recommended. We report our 13 years' experience to investigate this issue. Methods From 01/2001 to 12/2013, the clinical data of 28 patients treated for Masaoka stages III–IV thymic tumors were retrospectively reviewed. Eleven potentially nonresectable patients (Group A) underwent induction chemotherapy plus surgery, while immediate surgery was performed in 17 patients (Group B). The endpoint was to compare the two groups on (1) surgical resectability; (2) postoperative course; (3) disease-free survival; and (4) overall survival. Results Both groups were comparable in terms of age, gender, clinical stage, clinical tumor size, histology, and adjuvant therapy. Length of surgery was statistically longer in Group A (p = 0.015). Combined surgery and R0 resection was similarly performed in both groups (p = 0.14 and p = 0.99, respectively). The 3-year overall survival was 71.4% for Group A and 93.3% for Group B (p = 0.84). On the other hand, 3-year disease-free survival was 40.5 and 53.7% for Group A and B, respectively (p = 0.67). At multivariate analysis, gender was the strongest predictor for recurrence (hazard ratio = 5.71 [1.22; 26.67], p = 0.03). Conclusion Our results suggest that induction therapy allows obtaining acceptable clinical responses as well as resectability, survival, and recurrence rates. In selected patients with “clinically resectable” stage III–IV cancers, surgery (as first step of a multimodality therapy) could be a feasible treatment option.

Original languageEnglish
JournalThoracic and Cardiovascular Surgeon
DOIs
Publication statusAccepted/In press - Aug 24 2015

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Thymus Neoplasms
Disease-Free Survival
Therapeutics
Recurrence
Induction Chemotherapy
Survival
Neoplasms
Histology
Multivariate Analysis
Survival Rate

Keywords

  • advanced thymoma
  • induction therapy
  • multimodality therapy
  • thymic tumors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Induction Therapy versus Initial Surgery in Advanced Thymic Tumors : Perioperative and Oncological Outcome. / Leuzzi, Giovanni; Alessandrini, Gabriele; Sperduti, Isabella; Forcella, Daniele; Marino, Mirella; Ceribelli, Anna; Facciolo, Francesco.

In: Thoracic and Cardiovascular Surgeon, 24.08.2015.

Research output: Contribution to journalArticle

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abstract = "Purpose Despite the intense debate concerning management of advanced thymic tumors, no specific oncological strategies have been yet recommended. We report our 13 years' experience to investigate this issue. Methods From 01/2001 to 12/2013, the clinical data of 28 patients treated for Masaoka stages III–IV thymic tumors were retrospectively reviewed. Eleven potentially nonresectable patients (Group A) underwent induction chemotherapy plus surgery, while immediate surgery was performed in 17 patients (Group B). The endpoint was to compare the two groups on (1) surgical resectability; (2) postoperative course; (3) disease-free survival; and (4) overall survival. Results Both groups were comparable in terms of age, gender, clinical stage, clinical tumor size, histology, and adjuvant therapy. Length of surgery was statistically longer in Group A (p = 0.015). Combined surgery and R0 resection was similarly performed in both groups (p = 0.14 and p = 0.99, respectively). The 3-year overall survival was 71.4{\%} for Group A and 93.3{\%} for Group B (p = 0.84). On the other hand, 3-year disease-free survival was 40.5 and 53.7{\%} for Group A and B, respectively (p = 0.67). At multivariate analysis, gender was the strongest predictor for recurrence (hazard ratio = 5.71 [1.22; 26.67], p = 0.03). Conclusion Our results suggest that induction therapy allows obtaining acceptable clinical responses as well as resectability, survival, and recurrence rates. In selected patients with “clinically resectable” stage III–IV cancers, surgery (as first step of a multimodality therapy) could be a feasible treatment option.",
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AB - Purpose Despite the intense debate concerning management of advanced thymic tumors, no specific oncological strategies have been yet recommended. We report our 13 years' experience to investigate this issue. Methods From 01/2001 to 12/2013, the clinical data of 28 patients treated for Masaoka stages III–IV thymic tumors were retrospectively reviewed. Eleven potentially nonresectable patients (Group A) underwent induction chemotherapy plus surgery, while immediate surgery was performed in 17 patients (Group B). The endpoint was to compare the two groups on (1) surgical resectability; (2) postoperative course; (3) disease-free survival; and (4) overall survival. Results Both groups were comparable in terms of age, gender, clinical stage, clinical tumor size, histology, and adjuvant therapy. Length of surgery was statistically longer in Group A (p = 0.015). Combined surgery and R0 resection was similarly performed in both groups (p = 0.14 and p = 0.99, respectively). The 3-year overall survival was 71.4% for Group A and 93.3% for Group B (p = 0.84). On the other hand, 3-year disease-free survival was 40.5 and 53.7% for Group A and B, respectively (p = 0.67). At multivariate analysis, gender was the strongest predictor for recurrence (hazard ratio = 5.71 [1.22; 26.67], p = 0.03). Conclusion Our results suggest that induction therapy allows obtaining acceptable clinical responses as well as resectability, survival, and recurrence rates. In selected patients with “clinically resectable” stage III–IV cancers, surgery (as first step of a multimodality therapy) could be a feasible treatment option.

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