Patients with recurrent thymomas who undergo re-resection of recurrent disease may have prolonged survival when complete resection is attained. However, only a minority of patients may be candidates for resection.
In a review of 395 patients who underwent resections for thymic epithelial tumors, 67 had tumor recurrence and 22 underwent a re-resection procedure. The 10-year survival rate was 70%. In a second series, 30 of 266 patients initially treated by total resection of the tumor had a recurrence, and in all 30 patients surgical resection had been attempted. Complete resection of the recurrent tumor was obtained in ten cases. Overall 5-year and 10-year survival rates for the 30 patients with recurrent thymomas were 48% and 24%, respectively.
The age-adjusted incidence of carcinoid tumors worldwide is approximately 2 per 100,000 persons.[1,2] The average age at diagnosis is 61.4 years. Carcinoid tumors represent about 0.5% of all newly diagnosed malignancies.[2,3]
Carcinoid tumors are rare, slow-growing tumors that originate in cells of the diffuse neuroendocrine system. They occur most frequently in tissues derived from the embryonic gut. Foregut tumors, which account for up to 25% of cases, arise...
Of note, patients in these series may have received chemotherapy and/or radiation therapy in addition to surgery.
A number of studies have demonstrated that certain chemotherapy drugs can induce tumor responses as single agents or in combination. In general, higher response rates have been reported with combinations; however, no randomized trials have been conducted to date.
A phase II trial of cisplatin (50 mg/m2) reported an objective response rate of 10% among 21 patients. Six of 13 patients treated with single-agent ifosfamide had objective responses. Octreotide with or without prednisone may induce responses in patients with octreotide scan-positive thymoma. Six of 16 patients achieved objective responses to octreotide (1.5 mg/day subcutaneously) associated with prednisone (0.6 mg/kg/day orally for 3 months, 0.2 mg/kg/day orally during follow-up).
In a second study, 2 complete (5.3%) and 10 partial responses (25%) were observed among 42 patients.
In general, combination chemotherapy produces complete and partial remissions; some of the complete remissions have been pathologically confirmed at subsequent surgery.
In a series of 30 patients with stage IV or locally progressive recurrent tumor following radiation therapy, the PAC regimen (cisplatin, doxorubicin, cyclophosphamide) achieved a 50% response rate, including three complete responses. The median duration of response was 12 months, and the 5-year survival rate was 32%.[Level of evidence: 3iiiDiv]