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Thymoma and Thymic Carcinoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Recurrent Thymoma and Thymic Carcinoma

Patients with recurrent thymomas who undergo re-resection of recurrent disease may have prolonged survival when complete resection is attained.[1] 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.[2] 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.[3] 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.

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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.[4] Six of 13 patients treated with single-agent ifosfamide had objective responses.[5] 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).[6]

In a second study, 2 complete (5.3%) and 10 partial responses (25%) were observed among 42 patients.[7]

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%.[8][Level of evidence: 3iiiDiv]

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