Abstract
AB009. Impact of neoadjuvant therapy followed by surgical intervention for thymic carcinoma patients
Shota Nakamura1, Osamu Noritake1, Heng Huang1, Yoshito Imamura1, Shoji Okado1, Yuji Nomata1, Hiroki Watanabe1, Yuta Kawasumi1, Yuka Kadomatsu1, Harushi Ueno1, Taketo Kato1, Tetsuya Mizuno1, Tetsunari Hase2, Toyofumi Fengshi Chen-Yoshikawa1
1Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;
2Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence to: Shota Nakamura, MD, PhD. Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Email: shota197065@med.nagoya-u.ac.jp.
Background: Thymic carcinoma has the potential to invade neighboring structures such as the cardiovascular system and lungs, making complete resection difficult with surgical treatment alone. This study aims to evaluate the outcomes of neoadjuvant therapy followed by surgical intervention in patients with thymic carcinoma involving invasion of neighboring structures.
Methods: We reviewed 17 cases of thymic carcinoma with neighboring structure invasion treated with neoadjuvant therapy followed by surgical resection from 2008 to 2023. We analyzed patient characteristics, treatment details, and postoperative courses.
Results: The median age was 54 years (range, 24–71 years), with 10 males. Histological types included 16 cases of squamous cell carcinoma and 1 case of large cell neuroendocrine carcinoma (LCNEC). Clinical stages were IIIa/IIIb/IVb in 14/3/1 cases according to the tumor-node-metastasis (TNM) classification. Neoadjuvant therapies included chemoradiotherapy (n=12), radiotherapy alone (n=4), and chemotherapy alone (n=2). RECIST showed stable disease (SD) or partial response (PR) in 10 and 8 cases, respectively. All patients underwent total thymectomy via median sternotomy, and all cases required resection of neighboring structures, except for one case which terminated at exploratory thoracotomy due to pleural dissemination. Resection completeness was R0/1/2 in 14/2/1 cases, with 4 cases achieving major pathological response (MPR). Postoperative complications, classified by Clavien-Dindo, were Grade III/IV in 1/2 cases, with no 90-day mortality. Four cases received postoperative adjuvant radiotherapy. With a median follow-up of 70 months (range, 8–86 months), the median overall survival and recurrence-free survival periods were 110 and 40 months, respectively. The 5-year survival and recurrence-free survival rates were 79% and 45%, respectively. Recurrences were observed in 10 cases, with 4 locoregional recurrences and 6 distant metastases.
Conclusions: A multidisciplinary treatment strategy combining neoadjuvant therapy followed by surgical intervention for thymic carcinoma patients with neighboring structure invasion was performed safely. The high rates of pathological complete resection and long-term recurrence-free survival in many cases indicate that this is an effective treatment strategy.
Keywords: Thymic carcinoma; multidisciplinary treatments; surgery
Acknowledgments
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-24-ab009/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. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the institutional review boards of Nagoya University Hospital (No. 2017-0034) and individual consent for this retrospective analysis was waived.
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-24-ab009
Cite this abstract as: Nakamura S, Noritake O, Huang H, Imamura Y, Okado S, Nomata Y, Watanabe H, Kawasumi Y, Kadomatsu Y, Ueno H, Kato T, Mizuno T, Hase T, Chen-Yoshikawa TF. AB009. Impact of neoadjuvant therapy followed by surgical intervention for thymic carcinoma patients. Mediastinum 2024;8:AB009.
