Title: Neoadjuvant chemotherapy, surgery, and postoperative radiation therapy for invasive thymoma
Abstract: CancerVolume 68, Issue 4 p. 706-713 Clinical TrialFree Access Neoadjuvant chemotherapy, surgery, and postoperative radiation therapy for invasive thymoma Paolo Macchiarini MD, Corresponding Author Paolo Macchiarini MD Service of Thoracic Surgery and the Institutes of, University of Pisa, Pisa, ItalyService of Thoracic Surgery, University of Pisa, Via Roma, 56, 1–56100 Pisa, Italy===Search for more papers by this authorAntonio Chella MD, Antonio Chella MD Service of Thoracic Surgery and the Institutes of, University of Pisa, Pisa, ItalySearch for more papers by this authorFrancesco Ducci MD, Francesco Ducci MD Service of Thoracic Surgery and the Institutes of, University of Pisa, Pisa, ItalySearch for more papers by this authorBruno Rossi MD, Bruno Rossi MD Radio-therapy, University of Pisa, Pisa, ItalySearch for more papers by this authorCesarina Testi MD, Cesarina Testi MD Neurology, University of Pisa, Pisa, ItalySearch for more papers by this authorGeneroso Bevilacqua MD, Generoso Bevilacqua MD Pathological Anatomy, University of Pisa, Pisa, ItalySearch for more papers by this authorC. Alberto Angeletti MD, C. Alberto Angeletti MD Pathological Anatomy, University of Pisa, Pisa, ItalySearch for more papers by this author Paolo Macchiarini MD, Corresponding Author Paolo Macchiarini MD Service of Thoracic Surgery and the Institutes of, University of Pisa, Pisa, ItalyService of Thoracic Surgery, University of Pisa, Via Roma, 56, 1–56100 Pisa, Italy===Search for more papers by this authorAntonio Chella MD, Antonio Chella MD Service of Thoracic Surgery and the Institutes of, University of Pisa, Pisa, ItalySearch for more papers by this authorFrancesco Ducci MD, Francesco Ducci MD Service of Thoracic Surgery and the Institutes of, University of Pisa, Pisa, ItalySearch for more papers by this authorBruno Rossi MD, Bruno Rossi MD Radio-therapy, University of Pisa, Pisa, ItalySearch for more papers by this authorCesarina Testi MD, Cesarina Testi MD Neurology, University of Pisa, Pisa, ItalySearch for more papers by this authorGeneroso Bevilacqua MD, Generoso Bevilacqua MD Pathological Anatomy, University of Pisa, Pisa, ItalySearch for more papers by this authorC. Alberto Angeletti MD, C. Alberto Angeletti MD Pathological Anatomy, University of Pisa, Pisa, ItalySearch for more papers by this author First published: 15 August 1991 https://doi.org/10.1002/1097-0142(19910815)68:4<706::AID-CNCR2820680407>3.0.CO;2-HCitations: 139AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Between January 1988 and June 1990, seven previously untreated patients with histologically confirmed and clinically staged IIIa invasive thymoma (IT) were enrolled in a prospective, single treatment arm study of neoadjuvant chemotherapy (NC) followed by surgery and postoperative radiation therapy (4600 to 6000 cGy). The NC included three cycles of cisplatin (75 mg/m2 on day 1), epirubicin (100 mg/ m2 on day 1), and etoposide (120 mg/m2 on days 1, 3, and 5), every 3 weeks. All patients showed a partial response (>50%) and underwent complete (n = 4) or incomplete (gross [n = 1] or microscopic [n = 2] residual tumor) surgical resection. Histologic examination was negative for two completely resected patients. Projected 2-year survival was 80%; all patients but one currently are alive and disease-free. This approach appeared to be feasible and may be a new therapeutic choice in the management of IT, but its use on a regular basis should be reserved until a larger number of patients and longer follow-up are available. References 1 Verley JM, Hollmann KH. Thymoma: A comparative study of clinical stages, histologic features and survival in 200 cases. Cancer 1985; 55: 1074–1086. 10.1002/1097-0142(19850301)55:5<1074::AID-CNCR2820550524>3.0.CO;2-T CASPubMedWeb of Science®Google Scholar 2 Batata MA, Martini N, Huvos AG, Aguilar RI, Beattie EJ Jr. Thy- momas: Clinicopathologic features, therapy, prognosis. Cancer 1974; 34: 389–396. 10.1002/1097-0142(197408)34:2<389::AID-CNCR2820340224>3.0.CO;2-Z CASPubMedWeb of Science®Google Scholar 3 Salyer WR, Eggleston JC. Thymoma: A clinical and pathological study of 65 cases. Cancer 1976; 37: 229–249. 10.1002/1097-0142(197601)37:1<229::AID-CNCR2820370133>3.0.CO;2-2 CASPubMedWeb of Science®Google Scholar 4 Maggi G, Giaccone G, Donadio M et al. Thymomas: A review of 169 cases with particular reference to results of surgical treatment. Cancer 1986; 58: 765–776. 10.1002/1097-0142(19860801)58:3<765::AID-CNCR2820580326>3.0.CO;2-S CASPubMedWeb of Science®Google Scholar 5 Trastek VF, Payne WS. Surgery of the thymus gland. In: TW Shields, ed. General Thoracic Surgery, ed. 3. Philadelphia: Lea and Febiger, 1989; 1124–1136. Google Scholar 6 Arriatnam LS, Kalnicki S, Mincer F, Botstein C. The management of malignant thymoma with radiation therapy. Int J Radiat Oncol Biol Phys 1979; 5: 77–80. 10.1016/0360-3016(79)90042-7 PubMedWeb of Science®Google Scholar 7 Arriagada R, Marchant-Gerard R, Tubiana M, Amiel JL, Haj L. Radiation therapy in the management of malignant thymic tumors. Acta Radiol Oncol 1981; 20: 167–172. 10.3109/02841868109130192 CASPubMedWeb of Science®Google Scholar 8 Uematsu M, Kondo M. A proposal for treatment of invasive thy-moma. Cancer 1986; 58: 1979–1984. 10.1002/1097-0142(19861101)58:9<1979::AID-CNCR2820580904>3.0.CO;2-0 CASPubMedWeb of Science®Google Scholar 9 Hu E, Levine J. Chemotherapy of malignant thymoma. Cancer 1986; 57: 1101–1104. 10.1002/1097-0142(19860315)57:6<1101::AID-CNCR2820570606>3.0.CO;2-A CASPubMedWeb of Science®Google Scholar 10 Fornasiero A, Daniele O, Ghiotto C, et al. Chemotherapy of invasive thymoma. J Clin Oncol 1990; 8: 1419–1423. 10.1200/JCO.1990.8.8.1419 CASPubMedWeb of Science®Google Scholar 11 Giaccone G, Musella R, Bertetto O, Donadio M, Calciati A. Cisplatin-containing chemotherapy in the treatment of invasive thymoma: Report of five cases. Cancer Treat Rep 1985: 69: 695–697. CASPubMedWeb of Science®Google Scholar 12 Dy C, Calvo FA, Mindan JP et al. Undifferentiated epithelial-rich invasive thymoma: Complete response to cisplatin, vinblastine, and bleomycin therapy. J Clin Oncol 1988; 6: 536–542. 10.1200/JCO.1988.6.3.536 CASPubMedWeb of Science®Google Scholar 13 Fisher B, Gunduz N, Saffer EA. Influence of the interval between primary tumor removal and chemotherapy on kinetics and growth of metastases. Cancer Res 1983; 43: 1488–1492. CASPubMedWeb of Science®Google Scholar 14 Frei E III. What's in a name: Neoadjuvant. J Natl Cancer Inst 1988; 80: 1088–1089. 10.1093/jnci/80.14.1088 PubMedWeb of Science®Google Scholar 15 Miller AB, Hoogstraten B, Staquet M et al. Reporting results of cancer treatment. Cancer 1981; 47: 207–214. 10.1002/1097-0142(19810101)47:1<207::AID-CNCR2820470134>3.0.CO;2-6 CASPubMedWeb of Science®Google Scholar 16 Osserman KE, Genkings G. Studies in myasthenia gravis: Review of a twenty year experience in over 1200 patients. Mt Sinai J Med 1971; 38: 497–537. CASPubMedWeb of Science®Google Scholar 17 Bariety M, Coury C. Etude physio-pathologique et clinique des syndromes mediastinaux. In: M Masson Bariety, Couriee, eds. Le Me- diastin et sa Pathologie. Paris: Masson, 1958; 55–85. Google Scholar 18 Rosai J, Levine GD. Tumors of the thymus. In: Atlas of Tumor Pathology, Fascicle 13. Washington, DC: Armed Forces Institute of Pathology, 1976. Google Scholar 19 Levine GD, Rosai J. Thymic hyperplasia and neoplasia: A review of recent concepts. Hum Pathol 1978; 9: 495–515. 10.1016/S0046-8177(78)80131-2 CASPubMedWeb of Science®Google Scholar 20 Macchiarini P, Danesi R, Mariotti R et al. Phase II study of high-dose epirubicin in untreated patients with small cell lung cancer. Am J Clin Oncol 1990; 13: 302–307. 10.1097/00000421-199008000-00007 CASPubMedWeb of Science®Google Scholar 21 Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481. 10.1002/cncr.21979 CASWeb of Science®Google Scholar 22 Monden Y, Nakahara K, Lioka S et al. Recurrence of thymoma: Clinicopathological features, therapy and prognosis. Ann Thorac Surg 1985; 39: 165–169. 10.1016/S0003-4975(10)62558-1 CASPubMedWeb of Science®Google Scholar 23 Vokes EE, Schilsky RL, Weichselbaum RR, Kozloff MK, Panje WR. Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for locally advanced head and neck cancer: A clinical and pharmacological analysis. J Clin Oncol 1990; 8: 241–247. 10.1200/JCO.1990.8.2.241 CASPubMedWeb of Science®Google Scholar 24 Loeher PJ, Perez C, Roth IM et al. Cisplatin plus Adriamycin plus cyclophosphamide in limited and extensive thymoma: Preliminary results of an intergroup trial (Abstr). Proc Am Soc Clin Oncol 1988; 7: 199. Google Scholar 25 Shabel FM, Tradel MW, Laster WR et al. Cis-dichlorodiammine- platinum (II): Combination chemotherapy and cross resistance studies in tumors of mice. Cancer Treat Rep 1979; 63: 1459–1473. PubMedWeb of Science®Google Scholar 26 Evans WK, Osaba ED, Feld R, Shepherd FA, Bazos MJ, DeBoer G. Etoposide (VP-16) and cisplatin: An effective treatment for relapse in small-cell lung cancer. J Clin Oncol 1985; 3: 65–71. 10.1200/JCO.1985.3.1.65 CASPubMedWeb of Science®Google Scholar 27 Macchiarini P, Chella A, Riva A et al. Feasibility phase II study of high-dose epirubicin-based regimens for untreated patients with small cell lung cancer. Am J Clin Oncol 1990; 13: 495–500. 10.1097/00000421-199012000-00009 CASPubMedWeb of Science®Google Scholar 28 Jaretzki A III, Wolff M. Maximal thymectomy for myasthenia gravis. J Thorac Cardiovasc Surg 1988; 96: 711–716. PubMedWeb of Science®Google Scholar 29 Loehrer PJ, Bonomi P, Goldman S et al. Remission of invasive thymoma due to chemotherapy. Chest 1985; 87: 377–380. 10.1378/chest.87.3.377 CASPubMedWeb of Science®Google Scholar 30 Skarin A, Jochelson M, Sheldon T et al. Neoadjuvant chemo-therapy in marginally resectable stage III MO non-small-cell lung cancer: Long-term follow-up in 41 patients. J Surg Oncol 1989; 40: 266–274. 10.1002/jso.2930400413 CASPubMedWeb of Science®Google Scholar 31 Geller NL, Bosl GJ, Chan EY. Prognostic factors for relapse after complete resection in patients with metastatic germ cell tumors. Cancer 1989; 63: 440–445. 10.1002/1097-0142(19890201)63:3<440::AID-CNCR2820630308>3.0.CO;2-7 CASPubMedWeb of Science®Google Scholar 32 Curran WJ, Kornstein MJ, Brooks JJ, Turrisi AT. Invasive thy-moma: The role of mediastinal irradiation following complete or incomplete surgical resection. J Clin Oncol 1988; 6: 1722–1727. 10.1200/JCO.1988.6.11.1722 PubMedWeb of Science®Google Scholar 33 Dartvelle P, Chapelier A, Navajas M et al. Replacement of the superior vena cava with polytetrafluoroethylene grafts combined with resection of mediastinal-pulmonary malignant tumors. J Thorac Car-diovasc Surg 1987; 94: 361–366. PubMedWeb of Science®Google Scholar 34 Piccione W, Faber LP, Warren WH. Superior vena cava recon-struction using autologous pericardium. Ann Thorac Surg 1990; 50: 417–419. 10.1016/0003-4975(90)90486-P PubMedWeb of Science®Google Scholar 35 Pendergast WJ, Drake WP, Mardinay MR. A proper sequence for the treatment of B16 melanoma: Chemotherapy, surgery and im-munotherapy. J Natl Cancer Inst 1976; 57: 539–544. PubMedWeb of Science®Google Scholar Citing Literature Volume68, Issue415 August 1991Pages 706-713 ReferencesRelatedInformation