Zusammenfassung
Introduction: Patients with pleural thymoma spread (Masaoka stage IVa) should be treated within a multimodal treatment regime. However, the extent of local surgical resection to achieve optimal tumour control remains controversial. Patients and Methods: Prospective analysis between September 2008 and April 2013 of all patients with a Masaoka stage IVa thymoma, who underwent radical ...
Zusammenfassung
Introduction: Patients with pleural thymoma spread (Masaoka stage IVa) should be treated within a multimodal treatment regime. However, the extent of local surgical resection to achieve optimal tumour control remains controversial. Patients and Methods: Prospective analysis between September 2008 and April 2013 of all patients with a Masaoka stage IVa thymoma, who underwent radical pleurectomy/decortication (P/D) followed by hyperthermic intrathoracic chemotherapy (HITHOC). Results: A total of 11 patients (male n = 7; mean age 46.5 +/- 11.4 years) with a primary stage IVa thymoma (n = 3) or thymoma with pleural relapse (n = 8) were included after successful transsternal thymoma resection. WHO histological classification was: B1 n = 1, B2 n = 6, B3 n = 3 and C n = 1. A radical P/D (5/11; 45%) was extended with resection of the pericardium and diaphragm in 6/11 (55%) patients. After surgical resection (91% complete macroscopic R0/R1-resection) the HITHOC with cisplatin (100 mg/m(2) body surface area (BSA) n = 7; 150 mg/m(2) BSA n = 4) was performed for one hour at 42 degrees C. Operative revision was necessary in two patients (chylo- and hematothorax) with one patient also requiring temporary renal replacement therapy due acute renal failure (cisplatin 150 mg/m(2) BSA). 30-day mortality was 0%. Local recurrence (pulmonary n = 1, paravertebral n = 2) was documented in 3/10 (30%) patients after R0/R1 resection. After a mean follow-up of 23 months the overall median survival was 27 months and 82% (9/11) patients are still alive at the end of the study period. Conclusions: Masaoka stage IVa thymoma could be safely treated with lung-sparing radical P/D and HITHOC with cisplatin in a multimodality treatment regime. Early results with respect to recurrence and survival are encouraging, but further studies are warranted and we have to await long-term results.
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