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.
A classification system has been developed by the National Cancer Institute's PDQ Adult Treatment Editorial Board to allow the ranking of human cancer treatment studies according to statistical strength of the study design and scientific strength of the treatment outcomes (i.e., endpoints) measured. This classification system has been adapted to allow the ranking of human studies of complementary and alternative medicine treatments for cancer. The purpose of classifying studies in this way is to...
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]