Background: To retrospectively evaluate the results of surgical resection, including extrapleural pneumonectomy (EPP) and local resection (LR) of pleural implants, in combination with adjuvant radiotherapy with or without induction therapy for the treatment of Masaoka stage IVa thymoma in our institution.
Methods: From October 2008 to October 2014, 15 consecutive patients with stage IVa thymoma underwent radical resection followed by adjuvant radiotherapy. Eight patients had neoadjuvant chemo or chemoradiotherapy and the rest had no induction. Extrapleural pneumonectomy (EPP) was performed on one patient in the induction group and two in the non-induction group. The other patients had extended thymectomy plus local resection (LR) of invaded organs and pleural/pericardial implants. Median follow-up duration was 23 months (interquartile range, 18–30 months). Perioperative results and recurrence free survival were analyzed.
Results: Overall mortality and in-hospital morbidity were 0% and 33.3% respectively. In the induction group, the response rate was 50% (three partial responses and one complete pathological response). In-hospital morbidity was insignificantly more favorable in the induction group (12.5% vs. 57.1%, P=0.10, Fisher’s test) especially in the responsive patients (0/4). EPP was associated with increased hemorrhagic events (100% vs. 8.3%, P<0.01, Fisher’s test) and prolonged length of ICU stay (median 7 vs. 3 days, P=0.02, Mann Whitney test). Overall 1- and 2-years recurrence rates were 6.7% and 26.7% respectively and patients after induction had lower recurrences at 2 years (12.5% vs. 42.9% in the non-induction group). Notably, none of the induction responsive patients but two of the EPP patients had their diseases relapsed during the follow-up time.
Conclusions: Neoadjuvant chemotherapy seems to be a beneficial addition to surgery and adjuvant radiotherapy for stage IVa thymoma. EPP is a more traumatic procedure and whether it may bring any survival advantage is still debatable.
