Clinical outcomes of adjuvant treatments for invasive thymoma: Dose chemotherapy influence prognosis?

Abstract

7715 Background: The aim of this study was to evaluate therapeutic outcomes and to validate prognostic factors, including adjuvant chemotherapy, in resected thymoma patients who received adjuvant treatment. Methods: One hundred thymoma patients who received post-surgical adjuvant therapy from 1995 to 2005 were retrospectively reviewed. 55 patients received only radiotherapy for the adjuvant therapy, while 45 patients received both radiotherapy and chemotherapy. The total radiation dose was 45–63 Gy, with a median dose of 50.4 Gy. The chemotherapy consisted of 6 cycles of doxorubicin, cisplatin, vincristine, and cyclophosphamide. Treatments were applied every 3–4 weeks. The median follow-up duration was 65 months (range, 5–200 months). Results: The 5-year overall survival (OS) and disease- free survival (DFS) rates were 75.7% (89.2% in stage II, 67.9% in stage III, and 52.1% in stage IVA) and 70.3% (83% in stage II, 62.4% in stage III, and 33.6% in stage IVA) respectively. According to multivariate analysis, the prognostic factors for OS were age, WHO histology, Masaoka stage, and recurrence, while pleural involvement and WHO histology had statistically significant impacts on DFS. Higher radiation dosage, positive resection margins, and adjuvant chemotherapy did not influence survival outcomes. The most common relapse site was the pleura (15 patients, 53.6%). The toxicity from chemotherapy and radiotherapy was manageable, with no deaths due to toxicity. Conclusion: The prognosis of invasive thymoma was poor despite adjuvant treatments with radiotherapy and chemotherapy. In addition to WHO histology, pleural involvement was the most important prognostic factor for recurrence. The pleura was the most common relapse site. Therefore, new modalities to reduce pleural recurrence are warranted. No significant financial relationships to disclose.