Imran H Mohiuddin1, Muhammad Furqan2, Gerald Clamon2, John Keech3, Carryn Anderson1, Mark C Smith1, John M Buatti1, Bryan G Allen1*
1Department of Radiation Oncology, University of Iowa, USA
2Department of Internal Medicine, Division of Hematology and Oncology, University of Iowa, USA
3Department of Surgery, Division of Thoracic Surgery, University of Iowa, USA
Purpose: Review our experience treating thymic carcinoma patients using a combination of surgery, chemotherapy and radiation therapy.
Methods: An institutional review of thymic carcinoma patients treated between 2007 and 2014 was performed analyzing clinical characteristics, treatment intent, surgical margin status, and radiation treatment dose. Survival curves were generated using the Kaplan-Meier method.
Results: Nine individuals were treated for newly diagnosed thymic carcinoma. Three patients had unresectable disease at presentation; two of these were treated with definitive chemo-radiation therapy while another received neoadjuvant chemotherapy. Seven subjects underwent surgical resection (one after neoadjuvant chemotherapy) with pathological staging ranging from IIa – IVb disease. Patients were planned for adjuvant radiotherapy followed by chemotherapy; however, one developed liver metastases prior to initiating radiotherapy and was therefore treated with palliative chemotherapy alone. A second patient was non-compliant with radiation treatments and was considered as treated with palliative chemotherapy alone. Of the seven patients who completed definitive treatment, median time to progression and overall survival has yet to be reached. Only one of these patients developed progressive disease 10 months after completing treatment and eventually succumbed to disease 41 months after completing definitive therapy. With a median follow up of 30 months, two year overall survival is 67% for all patients.
Conclusion: Resection with an emphasis on best possible oncologic margins, followed by radiation and chemotherapy remains an effective treatment strategy for advanced stage thymic carcinoma. In patients who present with unresectable tumors, neoadjuvant chemotherapy or definitive chemo-radiation therapy may also be considered as viable treatment strategies.
Thymic carcinoma; Radiation therapy; Thymectomy
Mohiuddin IH, Furqan M, Clamon G, Keech J, Anderson C, Smith MC, et al. A Single-Institution Analysis of Thymic Carcinoma Treated with Multi-Modality Therapy. Ann Radiat Ther Oncol. 2017; 1(2): 1011.