Multimodality Treatment for Thymic Carcinoma: Review of 11 Cases at a Single Institute

Hisao Higo, Keiichi Fujiwara, Go Makimoto, Yuhei Tokimasa, Nobuhisa Kameyama, Mizuho Matsushita, Kammei Rai, Ken Sato, Takuo Shibayama, Toshiro Yonei, Akio Andou, Toshio Sato

Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Okayama, Japan.
Department of Respiratory Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan.

DOI: 10.4236/jct.2013.43091                

Abstract

Background: We reported our experience with thymic carcinomas and review their clinical features, treatment strategies, and prognoses. Methods: From April 1998 to November 2012, 11 patients pathologically diagnosed with thymic carcinoma and treated in our hospital were investigated. Results: There were 7 men and 4 women, with a median age of 62 years (range, 35 - 72). According to the Masaoka staging system, 3 patients had stage II, 1 stage III disease, 3 stage IVa disease and 4 stage IVb disease. Ten patients had squamous cell carcinoma, whereas 1 had large cell neuroendocrine carcinoma (LCNEC). We performed surgery or multimodality therapy including surgery as the initial therapy for 8 patients. Of the non-surgical cases, 1 patient received chemoradiotherapy and survived for over 6 years without recurrence, whereas 2 received palliative care. Three of 4 patients who underwent complete resection survived without disease recurrence, whereas only 1 patient with LCNEC survived in the incomplete resection group. Multimodality therapy with cisplatin and docetaxel was provided to 3 patients, and recurrence has not been observed in any of the cases. Conclusions: Favorable outcomes could be achieved in patients with thymic carcinoma who underwent intensive treatment. In particular, surgery combined with cisplatin and docetaxel plus thoracic irradiation may be an attractive approach for thymic carcinoma.

Keywords

Thymic Carcinoma; Multimodality Treatment; Cisplatin; Docetaxel

1. Introduction

Thymic carcinoma is a rare tumor arising from the thymic epithelium that accounts for approximately 14.1% of thymic epithelial neoplasms and differs from thymoma with respect to morphological and biological features. The most common histologic type in Japan is squamous cell carcinoma [1]. The prognosis of thymic carcinoma is worse than that of thymoma, with a 5-year survival rate of 33.3% to 50.5%, which correlates with the Masaoka staging system [1,2]. Unfortunately, 80% to 90% of cases are diagnosed at an advanced stage (stage III or IV) [1,3]. Treatment with surgery, radiotherapy, and chemotherapy has been described in some reports, but there is no consensus as to which modality or combined modality is the gold standard. We report our experience with 11 cases of thymic carcinoma and review their clinical features, treatment, and prognoses.

2. Patients and Methods

From April 1998 to November 2012, 11 patients were pathologically diagnosed with thymic carcinoma and treated in our hospital. We retrospectively reviewed their clinical features, treatment, and prognoses. The clinical or pathological stage of the disease was determined according to the staging system described by Masaoka et al. [4]. The pathological diagnosis of thymic carcinoma was established according to the histopathological criteria proposed by the World Health Organization (WHO) [5].

Overall survival time was calculated from the date of diagnosis until death or the last follow-up visit using the Kaplan-Meier method. Statistical analyses were performed using SPSS version 20 for Windows (IBM).

3. Results

3.1. Patient Characteristics

The study included 7 men and 4 women, with a median age of 62 years (range, 35 - 72). According to the Masaoka staging system, 3 patients had stage II disease, 1 stage III disease, 3 stage IVa disease and 4 stage IVb disease. Pathologically, 10 patients had squamous cell carcinoma, whereas 1 had large cell neuroendocrine carcinoma (LCNEC). We performed surgery or multimodality therapy including surgery as the initial therapy for 8 patients. Of the non-surgical cases, 1 patient received chemoradiotherapy, whereas 2 received palliative care.

3.2. Treatment Strategies and Clinical Outcomes

Table 1 summarizes all cases with respect to their initial treatment and respective outcomes. One patient (case 7) from the non-surgery group received pericardial drainage and died 21 months after the diagnosis. A second patient (case 8) was treated with radiotherapy to the site of bone metastasis followed by chemotherapy and eventually died 23 months later. Another patient (case 9) received chemotherapy consisting of cisplatin and docetaxel with concurrent thoracic irradiation in accordance with the OLCSG 0007 protocol [6]; this patient is still alive 6 years later without disease progression (Figure 1).

In the surgical intervention group, 1 patient received surgery alone, 2 patients received surgery and adjuvant radiotherapy, 3 patients received surgery with adjuvant chemotherapy and subsequent radiotherapy, and 2 patients received preoperative chemoradiotherapy, surgery, and adjuvant chemotherapy. Complete resection was performed in 4 of the 8 cases (Table 2). In the complete resection group, 3 of 4 patients were alive and disease free at the time of reporting, whereas the other patient (case 2) had recurrence of pleural dissemination. In the incomplete resection group, 1 patient with LCNEC was alive with no evidence of disease following postoperative radiotherapy and chemotherapy consisting of carboplatin and etoposide at the time of reporting.

However, the other 3 patients experienced disease recurrence. As shown in Table 2, better outcomes were achieved in patients at an early Masaoka stage and in those who underwent complete resection together with radiotherapy and chemotherapy.

Table 3 shows the site of disease recurrence in each patient who received surgery. Manifestations of disease recurrence were dissemination to the pleura, supraclavicular lymph nodes, and lungs. Seven of the 11 patients are still alive. The median survival time and 5-year survival rate were 63.7 months and 58.3%, respectively.

Conflicts of Interest

The authors declare no conflicts of interest.

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