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A.E. Fathalla
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P3.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 226)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.08-037 - Management of Thymic Neoplasm: Egyptian NCI Experience (ID 230)
09:30 - 09:30 | Author(s): A.E. Fathalla
- Abstract
Background:
Thymic tumors are rare entity with little information regarding outcomes after therapy with curative intent. We undertook a prospective analysis of all patients who underwent resection of thymic tumors at NCI hospitals. The optimal treatment includes surgical resection, chemotherapy, and radiotherapy.It is relatively uncommon(10%) but are highly aggressive.
Methods:
From 2008 to 2014, 13 patients (8 men, 5 women) underwent surgical resection of thymic tumor at a mean age of 47 years. Patient demographics, extent of surgical resection, and outcomes were compiled. Demographic variables, use of chemotherapy or radiotherapy, perioperative variables, recurrence rates, and long-term survival were analyzed retrospectively. The Masaoka stage and tumor diameter were recorded along with other variables that potentially influenced survival such tumor grade, site &number of metastatic disease.
Results:
The distribution of Masaoka stages at presentation was I in 6 (47%), II in 3 (23%), III in 1 (7%), and IV in 3 (23%). Neoadjuvant chemotherapy was administered to 3 patients (23%) whose tumors were deemed to be more locally invasive, two of them received neoadjuvant concomittant chemo-radiotherapy. Of the 13 patients in the surgical cohort, 8 (61.5%) were men. Mean age was 47 years (range: 21 to 58 years). No patient demonstrated an associated immunologic disorder such as myasthenia gravis. In all patients pathologic confirmation of thymic tumor was by CT giuded fine needle aspiration/biopsy as part of the diagnostic workup. Preoperatively, 3 of 13 patients (23%) received chemotherapy and 2 (15.5%) received radiotherapy. The decision to administer chemotherapy or radiotherapy preoperatively was individualized in each patient and based on the extent of tumor invasion. Complete tumor resection with pathologically confirmed negative resection margins (R0) was achieved in 12 patients (92.3%). The other 1 patient had microscopic residual disease (R1). Masaoka stage was I in 6 (47%), II in 3 (23%), III in 1(7%), and IV in 3 (23%). The most common approach to surgical resection was sternotomy, used in 11 patients (84.5%). Mean tumor size was 9.5 cm (range: 4.5 to 16 cm) for the 13 patients. Pulmonary wedge resection was done for only 2 cases,pleural resection 5 cases& lobectomy in only 1. No perioperative deaths occurred nor patients required tracheostomy for postoperative respiratory failure. The two patients who had unilateral phrenic nerve resection as part of their operation none of these patients underwent a diaphragmatic plication early in the postoperative course to improve respiratory insufficiency. Four patients received adjuvant chemotherapy or radiotherapy or both. Of those whose tumors were completely resected, 1 patient experienced a local recurrence. SurvivalMean length of survival in the entire group was 22.7 months (range: 14 to 36 months). At the last follow-up, 8 patients (61.5%) were alive without disease, 1 (7.5%) was alive with disease, and 4(31%) had died.
Conclusion:
Thymic tumor are amenable to surgical therapy, With increased use of computed tomography imaging, patients with early-stage disease are being identified more frequently, complete surgical resection appears to have favorable cure rates in these patients. Patients with locally advanced disease can experience long-term survival with a multimodality approach.
