Background: Thymic carcinoma is a rare disease with a poor prognosis. We retrospectively evaluated the feasibility and efficacy of induction therapy followed by surgery for advanced thymic carcinoma.
Methods: Six patients with thymic carcinoma who underwent surgery after preoperative induction therapy at Kanazawa University Hospital between 2016 and 2024 were reviewed. We diagnosed advanced thymic carcinoma (clinical Masaoka stage III or higher) by computed tomography (CT)-guided needle biopsy and positron emission tomography (PET)-CT.
Results: The study included six patients, consisting of four males and two females, with an average age of 60 years (range, 54–70 years). All patients were diagnosed with squamous cell carcinoma. The clinical Masaoka stages were stage IV for five patients and stage III for one patient. Among the stage IV cases, one patient had pleural dissemination, while the remaining four had lymph node metastases (three in the supraclavicular region, one in the cervical region, and one in the anterior mediastinum). Three patients received chemoradiotherapy, while the other three underwent chemotherapy. All patients received carboplatin (CBDCA) and paclitaxel (PTX) as the chemotherapy regimen. Treatment efficacy was categorized as a partial response (PR) in five patients and as stable disease (SD) in one patient. None of the patients experienced severe adverse effects from the induction therapy. Following preoperative treatment, all cases were deemed completely resectable. All patients underwent total thymectomy and supraclavicular to mediastinal lymph node dissection. Additional combined resections were performed, including resection of the pericardium (four patients), the superior vena cava to the right and left brachiocephalic veins (three patients), the left brachiocephalic vein alone (two patients), lung resections (three patients, including lobectomy), and the phrenic nerve (two patients). Artificial vessels were used for vascular replacement in five cases: four involved the replacement of the left brachiocephalic vein to the right auricle and the right brachiocephalic vein to the superior vena cava, while one involved the left brachiocephalic vein to the right auricle. No severe perioperative complications were reported. The pathological response to treatment was categorized as a partial response (PR) in four patients and a complete response (CR) in two patients. Postoperatively, four patients received adjuvant therapy; two underwent chemoradiotherapy and two received chemotherapy. The follow-up period ranged from 4 to 98 months. During the period, two patients died due to cancer recurrence: one after 38 months and the other after 30 months post-surgery. One patient developed multiple lung and lower mediastinal lymph node metastases and was treated with chemotherapy. The other developed multiple bone metastases and received chemotherapy, irradiation, and lenvatinib. The 3-year survival rate after surgery was 66.7%.
Conclusions: Induction therapy followed by surgery for advanced thymic carcinoma is feasible and may improve the resectability and long-term prognosis.
