Multimodality treatment program in invasive thymic epithelial tumor

Little is known regarding malignant thymoma and thymic carcinoma optimal therapy, and a multimodality approach could therefore be proposed in an attempt to improve the survival of patients. We report our experience with 8 cases of malignant thymoma or thymic carcinoma. These patients took part in a multimodality treatment program including neoadjuvant chemotherapy, surgery, and postoperative radiotherapy in our center between December 1995 and June 2001. The induction chemotherapy consisted of 4 courses of the CAP regimen (cyclophosphamide 600 mg/m2 day 1, doxorubicin 50 mg/m2 day 1, and cisplatin 80 mg/m2 day 2), every 3 weeks. Patients underwent surgical resection after complete hematological recovery pending sufficient tumor response with a postchemotherapy resectable status. Adjuvant radiotherapy up to 60 Gy in 30 fractions was attempted postsurgically or after best chemotherapeutic response in nonsurgical patients. Among the 8 patients, 3 had a thymic carcinoma and 5 a malignant thymoma; 5 had a stage IV and 3 a stage III disease (Masaoka). Six patients partially responded to the chemotherapy regimen. Three patients were operated upon, and complete resection was performed in 2 cases. Finally, 4 patients achieved the planned radiotherapy. Four patients are still alive without evidence of tumor activity (23-77 months from the diagnosis) and 1 patient is alive with relapse at 56 months. The low compliance with the program led us to an early discontinuation. The high proportion of thymic carcinoma and advanced disease in our limited series might be an explanation for this unsatisfactory result. Optimal multimodality treatment of epithelial thymic tumor remains to be defined in multicenter trials.