Case Report
AB020. Salvage surgery following definitive chemoradiotherapy and immune checkpoint inhibitor therapy for locally advanced thymic carcinoma: a case report
Ryosuke Tokuda1, Satoshi Ikebe1, Taishi Harada2, Saki Nishimura1, Masayoshi Inoue3
1Department of General Thoracic Surgery, Fukuchiyama City-Hospital, Fukuchiyama, Japan;
2Department of Medical Oncology, Fukuchiyama City-Hospital, Fukuchiyama, Japan;
3Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
Correspondence to: Ryosuke Tokuda, MD. Department of General Thoracic Surgery, Fukuchiyama City-Hospital, Fukuchiyama, Kyoto, 620-8505, Japan. Email: toku@koto.kpu-m.ac.jp.
Background: Thymic carcinoma is a rare malignancy with a poor prognosis. Complete surgical resection is a favourable prognostic factor and is recommended whenever possible. Platinum-based chemotherapy or lenvatinib is the current standard treatment for unresectable thymic carcinomas; however, its efficacy remains limited. The efficacy of immune checkpoint inhibitors is currently under investigation. Here, we present a case of salvage surgery after immune checkpoint inhibitor therapy for an initially unresectable, locally advanced thymic carcinoma.
Case Description: The patient was a 67-year-old woman. Computed tomography showed a 4.7-cm anterior mediastinal mass compressing the aortic arch and left main pulmonary artery (Figure 1A), along with enlargement of the anterior mediastinal lymph nodes. It was diagnosed as an unresectable thymic epithelial tumour, cStage IVa (T4N0M0), because the tumour was suspected to have invaded the left main pulmonary artery. Thoracoscopic biopsy confirmed the diagnosis of squamous cell carcinoma with high programmed cell death-ligand 1 (PD-L1) expression (90–100%). After chemoradiotherapy (carboplatin, paclitaxel, and radiation at 60 Gy), the patient received eight courses of durvalumab. Without any significant immune-related adverse events, the primary tumour size reduced to 4.2 cm (Figure 1B), and the anterior mediastinal lymph nodes resolved after two and a half years of treatment. Salvage surgery was performed via a posterolateral incision without invasion of the great vessels. The operative time was 285 minutes, and blood loss was 95 mL. The final pathological stage was ypStage IIIA (T3N0M0) with an Ef1b–2. The patient was discharged uneventfully on postoperative day 9. The patient remained disease-free for 1 year and 8 months after salvage surgery.
Conclusions: Complete resection with salvage surgery was performed after definitive chemoradiotherapy, followed by treatment with immune checkpoint inhibitors. Salvage surgery following immune checkpoint inhibitor therapy may be an option for treating thymic carcinomas with high PD-L1 expression.
Keywords: Thymic carcinoma; thymic epithelial tumor; immune checkpoint inhibitors; salvage surgery; case report
Acknowledgments
None.
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-25-ab020/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committees and with the Helsinki Declaration and its subsequent amendments. Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/med-25-ab020
Cite this abstract as: Tokuda R, Ikebe S, Harada T, Nishimura S, Inoue M. AB020. Salvage surgery following definitive chemoradiotherapy and immune checkpoint inhibitor therapy for locally advanced thymic carcinoma: a case report. Mediastinum 2025;9:AB020.
