Treatment of invasive or metastatic thymoma: report of eleven cases

The clinical presentation and therapeutic modalities of 11 patients with invasive or metastatic thymoma are presented. Two patients had myasthenia gravis, and five had extrathoracic metastases. Survival exceeded five years in five patients, and four patients remain free of recurrence between 2.1 and 9.0 years after diagnosis. Surgery, with an attempt at complete resection, is the first step of therapy. A second thoracotomy for local relapse or attempt at curative resection was carried out in four patients. Radiotherapy to the mediastinum and/or metastatic sites was given to ten patients with doses ranging from 3600-6000 rads (median = 4500 rads) in the nine nonmyasthenic patients. Inclusion of supraclavicular fossae in the radiotherapy field is recommended because it was a site of relapse in two patients. Systemic therapies were given to eight patients. Objective responses were seen with two of various chemotherapeutic regimens. A combination of bleomycin, Adriamycin, cisplatin, and prednisone ("BAPP") produced a partial remission in two of five patients, during 12 and 4 months, respectively. Two of three patients responded to maytansine as a single agent after failure of other agents. Immunotherapy with intravenous Corynebacterium parvum or intradermal Methanol-Extraction Residue of bacillus Calmette-Guérin (MER-BCG) was ineffective in one patient each. The importance of combined modalities in the management of the disease is emphasized.