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T. Routledge
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OA18 - New Insights in the Treatment of Thymic Malignancies (ID 408)
- Event: WCLC 2016
- Type: Oral Session
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:N. Girard, S.B. Watzka
- Coordinates: 12/07/2016, 11:00 - 12:30, Schubert 2
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OA18.06 - Treatment, Outcome and Prognostic Factors of Patients with Thymic Epithelial Tumors at First Recurrence (ID 5594)
11:55 - 12:05 | Author(s): T. Routledge
- Abstract
- Presentation
Background:
The treatment of patients with recurrent thymic tumors remains uncertain due to limited data because of the rare nature of this disease. This retrospective analysis was conducted to investigate clinical characteristics, outcomes and possible prognostic factors of patients presenting with a first recurrence of thymic tumors.
Methods:
107 patients with thymic neoplasms registered as C37 by ICD10 coding at Guy’s Hospital during the 2007-2016 period with first recurrence following primary treatment were selected and retrospectively reviewed via descriptive analysis. Differences in survival were assessed using Kaplan-Meier analysis and uni & multivariate Cox proportional hazards regression analyses.
Results:
25 patients (14 male & 11 female) with a median age of 51 years (range 36-80 years) experienced a first recurrence of thymoma (20 patients – 80%) or thymic carcinoma (5 patients – 20%) with a median time from diagnosis of 36 months (range, 7-270). At diagnosis, modified Masaoka disease stage was IIA/IIB/IIIA/IIIB/IVA/IVB in 4/0/8/2/6/5 patients; 18 patients’ (72%) primary resection was R0/R1/R2 in 11/3/4 patients; 9 patients (36%) received radiotherapy; 19 received chemotherapy (76%); CAP (n=10) and platinum-etoposide (n=6) regimens. At first relapse, 19 patients (76%) had thoracic recurrence and 6 patients (24%) extrathoracic recurrence. Nine patients (26%) underwent redo surgery, 3 of which recieved chemotherapy prior to resection. Overall resection status was 2/5/1 (1 patient’s data is not yet assessable) R0/R1/R2. Chemotherapy was administered in 17 patients (68%) with a median cycle of 4 (range, 1-6): 16 patients received combination chemotherapy consisting of platinum etoposide (n=10) or cisplatin-anthracycline based (CAP/CAV/AC n=5). Dose reduction and withdrawal were reported in 3 (18%) and 7 (41%) patients, respectively. In 4 out of these 7 patients withdrawal was due to PD; disease control rate (=CR+PR+SD) was 67% (in 10 out of 15 assessable patients). Three patients (12%) received radiotherapy of which one was treated exclusively with radiotherapy. Time to progression since the first recurrence was 12 months (range 2-52 months); in 16 patients extrathoracic recurrence was seen in 4 patients (25%) and thoracic in 12 patients (75%). Eight recurring patients (50%) received further chemotherapy. With a median follow-up of 32.5 months, 19 patients (75%) are alive and 2 (8%) disease-free; median OS has not been reached, median PFS was 29.5 months (range, 26.3-33.2). Analysis of possible prognostic factors will be presented.
Conclusion:
Patients with first recurrence of thymic tumors may benefit from combination chemotherapy and surgery when feasible.
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P3.03 - Poster Session with Presenters Present (ID 473)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.03-037 - Impact of Sarcomatoid Component in Patients with Biphasic Mesothelioma: Review of 118 Patients (ID 5104)
14:30 - 14:30 | Author(s): T. Routledge
- Abstract
Background:
Biphasic mesothelioma has a poor prognosis. There is no clear evidence on the role of multimodality treatment in patients with biphasic mesothelioma. The aim of this study was to analyse the impact of pathological features on survival, to determine which patients may benefit from multimodality treatment.
Methods:
Between January 2005 and December 2015, 214 patients with biopsy-proven biphasic mesothelioma were retrospectively identified to fulfil our inclusion criteria. The primary outcome was survival measured from time of diagnosis. Two slides were reviewed for each patient by a specialist thoracic pathologist. Slides were stained with Hematoxylin and Eosin (H+E) and the immunohistochemically-stained slides were digitally scanned and analysed using a Hamamatsu Nanozoomer scanner (Hamamatsu ‘NDP.View2’). The proportion of epithelioid and sarcomatoid components on each slide was mapped and its area in mm[2] recorded as a percentage of the total tumour area studied. Necrosis and lymphovascular invasion were analyzed. Patients with no slides available were excluded from the analysis (n=96). All eligible patients (n=118) were followed up until May 2016.
Results:
One hundred and eighteen patients were included in the analysis, 106 (89.9%) were male with a median age of 73 (range 53 - 91). Twenty-eight patients (23.7%) underwent Pleurectomy Decortication (PD) and 90 patients received medical treatment alone, either with chemotherapy or best supportive care. The median overall survival (OS) was 11.2 months (range 0.3 – 36.2). At 1 year and 2 years, 49.1% and 6.4% of patients were alive respectively. Univariable analysis revealed both age and PD to be associated with improved survival (p=0.004 and p=0.004). Patients treated with PD had OS of 12.8 months (range 5.6 - 36), compared to 9.2 months (range 0.3 – 31.8) in patients receiving medical treatment alone. No lymphovascular invasion was identified in any specimen. Necrosis was not correlated with survival (p=0.76). The proportion of epithelioid (p=0.45) or sarcomatoid (p=0.60) component within the specimen did not correlate significantly with overall survival. This remained true when patients undergoing surgical PD (epitheloid p=0.42 and sarcomatoid p=0.60) and medical treatment (epitheloid p=0.43 and sarcomatoid p=0.11) were analysed as separate subgroups.
Conclusion:
The prognosis for patients with biphasic mesothelioma remains poor, even after multimodality treatment including pleurectomy decortication (PD). However, necrosis and the proportion of sarcomatoid histology is not helpful in selecting patients with more favourable prognosis, who may benefit from a multimodality approach.
