Chemotherapy of invasive or metastatic thymoma: report of 11 cases

Eleven patients with invasive thymoma (seven males and four females) were seen from 1977 to 1983. All patients were adults with a median age of 46 years (range, 24-62), and presented after surgical exploration with nonremovable primary and with one or more of the following patterns of tumor extension: supraclavicular lymphadenopathy (four patients), superior vena cava syndrome (two), pleural effusion (nine), and pericardial effusion (three). The following distant metastases were also observed: lung (six patients), liver (one), skin (two), peritoneum (two), bone (one), and brain (one). The chemotherapy was administered in 4-day courses. All patients received the following: 50 mg/m2 of cisplatin iv and 40 mg/m2 of doxorubicin iv on Day 1, 0.6 mg/m2 of vincristine iv on Day 3, and 700 mg/m2 of cyclophosphamide iv on Day 4. The course was repeated every 3 weeks. Toxic effects were tolerable, as expected for the drug combination adopted. Four of 11 patients achieved objective complete regression of disease and six of 11 had partial remission, for an overall response rate of 91%; one patient had stable disease for 7 months. Six patients have died and the median survival has been 12.5 months, ranging from 5 to 23 months.