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. 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.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of childhood non-Hodgkin lymphoma. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
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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]
In another study, the ADOC regimen (doxorubicin, cisplatin, vincristine, cyclophosphamide) produced a 92% response rate (34 of 37 patients), including complete responses in 43% of patients.
One study of combined chemotherapy with cisplatin and etoposide produced responses in 9 of 16 patients treated, with a median response duration of 3.4 years and a median survival of 4.3 years.
Nine of 28 patients with invasive thymoma or thymic carcinoma who received four cycles of etoposide, ifosfamide, and cisplatin (VIP) at 3-week intervals had partial responses. The median duration of response was 11.9 months (range, <1–26 months), and the median overall survival (OS) rate was 31.6 months. The 1-year and 2-year survival rates were 89% and 70%, respectively.[Level of evidence: 3iiiDiv] Nine of 34 patients treated with VIP had partial responses (32%; 95% confidence interval, 16%–52%). The median follow-up was 43 months (range, 12.8–52.3 months), the median duration of response was 11.9 months (range, <1–26 months), and the median OS rate was 31.6 months. Based on Kaplan-Meier estimates, the 1-year and 2-year survival rates were 89% and 70%, respectively. These results appear to be inferior to other combinations.