Neoadjuvant Chemotherapy for Stage III and IVA Thymomas: A Single-Institution Experience with a Long Follow-up Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Primary chemotherapy with adriamycin, cisplatin, vincristine and cyclophosphamide in locally advanced thymomas: a single institution experience Chemotherapy for invasive thymoma. A 13‐year experience Chemotherapy definitions and policies for thymic malignancies. A phase-II trial of dose-dense chemotherapy in patients with disseminated thymoma: report of a Japan Clinical Oncology Group trial (JCOG 9605) Randomized phase III study of cisplatin plus irinotecan versus carboplatin plus paclitaxel, cisplatin plus gemcitabine, and cisplatin plus vinorelbine for advanced non-small-cell lung cancer: Four-Arm Cooperative Study in Japan. Multicenter Phase II trial assessing effectiveness of imatinib mesylate on relapsed or refractory KIT-positive or PDGFR-positive sarcoma Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. A Prospective Phase II Trial of Induction Chemotherapy with Docetaxel/Cisplatin for Masaoka Stage III/IV thymic Epithelial Tumors Messenger RNA and protein expression of thymidylate synthase and DNA repair genes in thymic tumors. Combined Etoposide, Ifosfamide, and Cisplatin in the Treatment of Patients with Advanced Thymoma and Thymic Carcinoma. A French Experience Combined etoposide, ifosfamide, and cisplatin in the treatment of patients with advanced thymoma and thymic carcinoma Phase II study of carboplatin and paclitaxel in advanced thymoma and thymic carcinoma. Cisplatin, doxorubicin, and cyclophosphamide plus thoracic radiation therapy for limited-stage unresectable thymoma: an intergroup trial.
Background : Since 1989 we have enrolled patients with clinical -radiological stage III-IVA thymomas , independent of the surgeon 's judgment of resectability , into a prospect i ve study of neoadjuvant chemotherapy – surgery and postoperative radiotherapy . In this article , we review our long-term experience of neoadjuvant chemotherapy of advanced stage ( III-IVA ) thymomas . Methods : From 1989 to 2004 , 30 patients with Masaoka stage III and IVA thymomas underwent neoadjuvant chemotherapy , surgery , and postoperative radiotherapy . The neoadjuvant and adjuvant chemotherapy consisted of three courses of cisplatin , epidoxorubicin , and etoposide every 3 weeks . Adjuvant radiotherapy consisted of 45 Gy for complete resections or 60 Gy for incomplete resections . Results : The preoperative diagnosis of invasive thymomas was obtained for 16 patients : five by mediastinotomy , seven by video-assisted thoracic surgery , and four by fine needle aspiration . For 14 patients , no histological diagnosis was available , but a thymus-related syndrome was present in all . Twenty-seven patients are still alive ( 25 disease-free ) and three have died ( one disease-free ) . The 10-year survival rates were 85.7 % and 76.1 % for stage III and IVA thymomas , respectively ( difference not significant ) . Only the World Health Organization pathological diagnosis significantly affected the survival , with type B3 having a worse prognosis than type AB , B1 , and B2 thymomas ( p = 0.02 ) . Conclusion : The multimodality treatment of stage III and IVA thymomas by means of neoadjuvant chemotherapy provides good long-term outcomes in both stages of the disease PURPOSE To evaluate tumor resectability after induction chemotherapy and to determine disease-free and overall survival rates of patients with locally advanced unresectable thymoma that received a multimodal treatment regimen . PATIENTS AND METHODS Twenty-two patients ( 9 men , 13 women ) with histologically confirmed invasive thymoma were treated with a multidisciplinary regimen consisting of three courses of induction chemotherapy , surgical resection , and radiation therapy , followed by three courses of consolidation chemotherapy .  The median age was 47 years ( range , 25 - 70 ) . Eleven patients had stage III disease , 10 patients , stage IVA , and one patient , IVB . The most common histologic type was lymphocytic . Induction chemotherapy consisted of 500 mg/m(2 ) of cyclophosphamide on day 1 ; doxorubicin ( 20 mg/m(2 ) per day ) on days 1 - 3 via continuous infusion ( a total of 60 mg/m(2 ) ) ; cisplatin ( 30 mg/m(2 ) per day ) on days 1 - 3 ( a total of 90 mg/m(2 ) ) ; and prednisone ( 100 mg per day ) on days 1 - 5 . This cycle was repeated three times at 3 - 4-week intervals . Patients then underwent surgery for tumor resection and received radiotherapy . Consolidation chemotherapy given at 80 % of the induction chemotherapy doses of cyclophosphamide , doxorubicin , and cisplatin and 100 % of the dose of prednisone was then repeated every 3 - 4 weeks for a total of three courses . RESULTS Induction chemotherapy produced major responses in 17 ( 77 % ) of the 22 patients including 3 ( 14 % ) complete responses ( CR ) and 14 ( 63 % ) partial responses ( PR ) . Twenty-one patients underwent surgical exploration : 16 ( 76 % ) had complete resection and 5 ( 24 % ) had incomplete resection ; one patient refused surgery . All 22 patients received radiation therapy . Nineteen of 22 patients completed the planned therapy , and all but one had completed consolidation chemotherapy at the time of analysis . With a median follow-up time of 50.3 months , 18 of the 19 patients who completed the multidisciplinary approach were disease-free . Of the 22 patients originally registered , 20 were alive at the time of analysis ( one patient died of endocarditis , and one died of recurrent disease ) . The overall survival rate was 95 % at 5 years ( 95 % confidence interval ( CI ) , 0.87 - 1.0 ) and 79 % at 7 years ( 95 % CI , 0.55 - 1.0 ) . The progression-free survival rates were 77 % at 5 years ( 95 % CI , 0.58 - 1.0 ) and 77 % at 7 years ( 95 % CI , 0.58 - 1.0 ) . The major side effect from induction and consolidation chemotherapy was myelosuppression . Nine patients experienced grade III/IV neutropenia , which included neutropenic fever in two patients , and grade III thrombocytopenia in two patients . The most common nonhematologic side effects were fatigue , nausea and vomiting , and decreased appetite . One patient experienced acute respiratory distress syndrome after surgical resection and required a prolonged hospitalization . No patients developed cardiac toxic effects , and no surgical mortality occurred . CONCLUSIONS The use of induction chemotherapy to optimize surgical resectability of thymoma followed by radiation therapy and consolidation chemotherapy lead to good control of residual disease and high overall survival rates . We believe that this combined multidisciplinary approach prolongs lives and may cure locally advanced unresectable malignant thymomas . Future prospect i ve multi-institutional studies are needed to further verify or define the best treatment for this patient population From 1990 to 1997 , 16 consecutive patients with stage III and IVa invasive thymoma were treated in a single institution with primary chemotherapy consisting in adriamycin ( 40 mg m–2 ) , cisplatin ( 50 mg m–2 ) administered intravenously on day 1 , vincristine ( 0.6 mg m–2 ) on day 2 and cyclophosphamide ( 700 mg m–2 ) on day 4 ( ADOC ) . The courses were repeated every 3 weeks . The aim was to evaluate the impact of this cytotoxic regimen with respect to response rate , per cent of patients radically resected , time to progression and overall survival . Two complete responses ( one clinical and one pathological ) and 11 partial responses were observed ( overall response rate 81.2 % ) ; two patients had stable disease and one progressed . Toxicity was mild as only two patients developed grade III/IV neutropenia and one patient grade III nausea/vomiting . Nine patients were radically resected ( five out of ten with stage III , and four out of six with stage IVa ) . Median time to progression and overall survival was 33.2 and 47.5 months respectively . Three patients were alive and disease free after more than 5 years . The ADOC scheme is highly active and manageable in the treatment of locally advanced thymoma . As a preoperative approach it should be offered to patients not amenable to surgery or to those surgically resectable but with a great deal of morbidity From 1977 to 1990 , 37 patients with Stage III or IV invasive thymoma ( 20 men and 17 women ; median age , 40 years of age ) were referred for chemotherapy to the Padova Medical Oncology Department . All patients initially received the same regimen ( 50 mg/m2 of cisplatin and 40 mg/m2 of doxorubicin intravenously ( IV ) on day 1 , 0.6 mg/m2 of vincristine IV on day 3 , and 700 mg/m2 of cyclophosphamide IV on day 4 [ ADOC ] ) , recycling at monthly intervals . No life‐threatening side effects were noted . The overall clinical response rate ( complete response plus partial response ) was 91.8 % , with 43 % complete remissions . Median duration of response and survival were 12 months ( range , 2 to 96 + months ) and 15 months ( range , 5 to 96 + months ) , respectively . Seven of the 16 complete remissions were pathologically confirmed at subsequent thoracotomy . Other chemotherapy combinations and radiation therapy have been applied as second‐line treatment , achieving only minimal responses . In the opinion of the authors , such chemotherapy deserves evaluation for adjuvant and neo‐adjuvant treatment of invasive ( and /or inoperable ) thymoma due to the high complete response rate and overall response rate Thymic malignancies are rare epithelial tumors that may be aggressive and difficult to treat.1 Thymomas are usually localized to the anterior mediastinum and are frequently eligible for upfront surgical resection , which is the mainstay of the curative-intent treatment.1 However , approximately 30 % of patients present with an advanced tumor at the time of diagnosis , with invasion of neighboring organs , dissemination to the pleura , the pericardium , or less frequently extrathoracic organs . In such cases , chemotherapy has been used both to reduce the tumor burden — possibly allowing subsequent surgery or radiotherapy— and to achieve prolonged disease control . Recurrence after resection may be similarly treated with chemotherapy .  Thymic carcinomas , although rare , are usually already advanced at the time of presentation , and systemic therapy is important for almost all of these patients . Knowledge regarding chemotherapy for thymic tumors has mainly been based on retrospective series,2–9 although several prospect i ve trials have also been conducted.10–21 These studies have clearly demonstrated the chemosensitivity of thymoma , and to a lesser extent thymic carcinoma , to various cytotoxic agents and combinations . However , details of patient selection are often lacking ( either disease extent or general condition ) , and the intent of the treatment sequence is often vague . Adoption of a common language and definition of terms is crucial for the International Thymic Malignancies Interest Group ( ITMIG ) effort to develop a international prospect i ve data base of thymic tumors . The article by Huang et al.22 provides definitions for survival and endpoints for recurrences assessment and discusses how to measure response to treatment . Herein , we discuss additional points with regard to chemotherapy , including treatment sequence , general modalities , and impact of corticosteroids Background : To evaluate the safety and efficacy of dose-dense weekly chemotherapy in the treatment of advanced thymoma . Methods : Subjects comprised patients with histologically documented chemotherapy-naïve thymoma with stage-IVa or IVb disease . Thymic carcinoma , carcinoid or lymphoma cases were excluded . Patients received 9 weeks of chemotherapy : cisplatin ( 25 mg m−2 ) on weeks 1–9 ; vincristine ( 1 mg m−2 ) on weeks 1 , 2 , 4 , 6 and 8 ; and doxorubicin ( 40 mg m−2 ) and etoposide ( 80 mg m−2 ) on days 1–3 of weeks 1 , 3 , 5 , 7 and 9 . Chemotherapy courses were supported by granulocyte colony-stimulating factor . Post- protocol local therapy was allowed . Results : From July 1997 to March 2004 , 30 patients were entered . Three were ineligible due to different histology . Chemotherapy-associated toxicity was mainly haematological and was well tolerated , with no deaths due to toxicity , and 87 % of patients completed the planned 9-week regimen . Overall response rate was 59 % , with 16 of the 27 eligible patients achieving partial response . Median progression-fee survival ( PFS ) was 0.79 years ( 95 % confidence interval : 0.52–1.40 years ) , and PFS at 1 and 2 years was 37 and 15 % , respectively . Overall survival rates at 2 and 5 years were 89 and 65 % , respectively . Conclusion : In stage-IV thymoma patients , weekly dose-dense chemotherapy offers similar activity to conventional regimens BACKGROUND To compare the efficacy and toxicity of three platinum-based combination regimens against cisplatin plus irinotecan ( IP ) in patients with untreated advanced non-small-cell lung cancer ( NSCLC ) by a non-inferiority design . PATIENTS AND METHODS A total of 602 patients were r and omly assigned to one of four regimens : cisplatin 80 mg/m(2 ) on day 1 plus irinotecan 60 mg/m(2 ) on days 1 , 8 , 15 every 4 weeks ( IP ) carboplatin AUC 6.0 min x mg/mL ( area under the concentration-time curve ) on day 1 plus paclitaxel 200 mg/m(2 ) on day 1 every 3 weeks ( TC ) ; cisplatin 80 mg/m(2 ) on day 1 plus gemcitabine 1000 mg/m(2 ) on days 1 , 8 every 3 weeks ( GP ) ; and cisplatin 80 mg/m(2 ) on day 1 plus vinorelbine 25 mg/m(2 ) on days 1 , 8 every 3 weeks ( NP ) . RESULTS The response rate , median survival time , and 1-year survival rate were 31.0 % , 13.9 months , 59.2 % , respectively , in IP ; 32.4 % , 12.3 months , 51.0 % in TC ; 30.1 % , 14.0 months , 59.6 % in GP ; and 33.1 % , 11.4 months , 48.3 % in NP . No statistically significant differences were found in response rate or overall survival , but the non-inferiority of none of the experimental regimens could be confirmed . All the four regimens were well tolerated . CONCLUSION The four regimens have similar efficacy and different toxicity profiles , and they can be used to treat advanced NSCLC patients Background Imatinib myselate is a molecularly targeted drug that inhibits Abl tyrosine kinase , as well as type III tyrosine kinase receptors such as platelet-derived growth factor receptor ( PDGFR ) , KIT , colony-stimulating factor 1 receptor ( CSF-1R ) , and discoidin domain receptor ( DDR ) . Ph1 chromosome-positive chronic myeloid leukemias ( CMLs ) , KIT-positive gastrointestinal stromal tumors ( GISTs ) , and PDGFR-positive dermatofibrosarcoma protuberans ( DFSP ) have been reported to be responsive to imatinib treatment . We conducted a multicenter Phase II trial of imatinib in patients with relapsed or refractory KIT-positive ( excluding GISTs ) or PDGFR-positive sarcomas . Methods Patient ages ranged from 12 and 75 years . Eligibility criteria included ( 1 ) metastatic sarcomas with a definitive diagnosis based on histopathology or that were completely unresectable and locally advanced ; ( 2 ) relapsed or refractory cases that had completed st and ard treatment ; and ( 3 ) a tumor confirmed by immunohistochemical staining to be KIT- or PDGFR-positive . A 600-mg dose of imatinib was administered to patients once a day , with each patient receiving six courses of the drug and each course lasting 4 weeks . In cases categorized as stable or progressive , the imatinib dose was increased to 800 mg/day administered twice daily . Results A total of 25 patients who met the eligibility criteria were enrolled in the trial ; 22 were evaluated for response . The response rate with a 600 mg/day dose of imatinib was 4.5 % ( 0 complete response , 1 partial response ) . There were no other objective responses after increasing imatinib to 800 mg/day ( 0/10 ) . We estimated 50 % progression-free survival to be 61.0 days for an imatinib dose of 600 mg/day based on the Kaplan-Meier method . Side effects of imatinib were generally similar to those observed in previous clinical trials . Conclusions Our results did not indicate effectiveness of imatinib monotherapy at a dose of 600 or 800 mg/day in patients with relapsed or refractory KIT-positive ( excluding GISTs ) or PDGFR-positive sarcomas . Our findings suggest the need to evaluate the synergistic effect of combination therapy with other anticancer drugs BACKGROUND Irinotecan hydrochloride , a topoisomerase I inhibitor , is effective against small-cell lung cancer . In a phase 2 study of irinotecan plus cisplatin in patients with extensive small-cell lung cancer , there was a high response rate and a promising median survival time . METHODS We conducted a multicenter , r and omized , phase 3 study in which we compared irinotecan plus cisplatin with etoposide plus cisplatin in patients with extensive ( metastatic ) small-cell lung cancer . RESULTS The planned size of the study population was 230 patients , but enrollment was terminated early because an interim analysis found a statistically significant difference in survival between the patients assigned to receive irinotecan and cisplatin and those assigned to receive etoposide and cisplatin ; as a result , only 154 patients were enrolled . The median survival was 12.8 months in the irinotecan-plus-cisplatin group and 9.4 months in the etoposide-plus-cisplatin group ( P=0.002 by the unadjusted log-rank test ) . At two years , the proportion of patients surviving was 19.5 percent in the irinotecan-plus-cisplatin group and 5.2 percent in the etoposide-plus-cisplatin group . Severe or life-threatening myelosuppression was more frequent in the etoposide-plus-cisplatin group than in the irinotecan-plus-cisplatin group , and severe or life-threatening diarrhea was more frequent in the irinotecan-plus-cisplatin group than in the etoposide-plus-cisplatin group . CONCLUSIONS Irinotecan plus cisplatin is an effective treatment for metastatic small-cell lung cancer Background : Initial complete resection is a powerful prognostic indicator of survival in thymic epithelial tumors ( TETs ) , but is obviously related to tumor stage . Here , we report the results of a prospect i ve study of neoadjuvant docetaxel/cisplatin in locally advanced TETs . Methods : Patients with histologically proven , Masaoka stage III/IV TETs at presentation were enrolled in this open-label , phase II , nonr and omized study . Patients received docetaxel 75 mg/m2 I.V , followed by cisplatin 75 mg/m2 I.V on day 1 of every 3-week cycle . After three cycles , surgical resection was performed if the tumor was considered resectable . Results : From March 2007 to July 2011 , 27 patients were enrolled in the trial . Masaoka stage at presentation was III ( n = 8 ; 29.6 % ) , IVA ( n = 17 ; 63.0 % ) , and IVB ( n = 2 ; 7.4 % ) . Histologic types were nine thymomas ( 33.3 % ) and 18 thymic carcinomas ( 66.7 % ) . After completion of neoadjuvant chemotherapy , 17 patients ( 63.0 % ) achieved partial response and 10 ( 37.0 % ) had stable disease . Nineteen patients ( 70.4 % ) underwent surgery and eight did not because of surgeons ’ decision ( n = 5 ) , patient refusal ( n = 2 ) , or decision to undergo radiation therapy instead ( n = 1 ) . Fifteen among the 19 patients achieved complete resection ( 78.9 % ) , which yields 55.6 % of complete resection rate with intent-to-treat analysis . The most common side effects of severity greater than grade 3 were neutropenia and diarrhea . With a median follow-up of 42.6 months , 4-year overall survival , and progression-free survival in all patients was 79.4 and 40.6 % , respectively . Conclusion : Neoadjuvant docetaxel/cisplatin is both feasible and well tolerated , and potentially improves surgical resectability in patients with advanced TETs BACKGROUND Thymic epithelial tumors include several entities with different biologic behavior . Chemotherapy is indicated in advanced disease , but limited data exist on gene expression correlation with the response to chemotherapeutic agents . PATIENTS AND METHODS A series of 69 thymic neoplasms ( 7 A- , 6 AB- , 6 B1- , 10 B2- , 14 B3-thymomas , 22 carcinomas and 4 combined tumors ) was collected to assess gene expression of thymidylate synthase ( TS ) , excision repair cross complementing-1 ( ERCC1 ) , ribonucleotide reductase subunit 1 ( RRM1 ) , topoisomerase 2α ( TOP2A ) and mTOR . RESULTS A strong linear correlation between TS gene and protein expression was observed ( P<0.0001 , R=0.40 ) . TS expression was significantly lower in pure A-thymomas and thymic carcinomas ( P<0.0001 ) and progressively decreasing from B1-type to thymic carcinomas ( B1>B2>B3>C ; P<0.0001 ) . RRM1 and TOP2A mRNA expression levels were significantly correlated with TS levels ( both P=0.03 ) with a similar trend of expression among histotypes . RRM1 and TOP2A high levels were significantly correlated with high TS ( P=0.03 ) and low tumor stages ( I-II ) ( P<0.0001 and P<0.01 , respectively ) . No relevant changes of ERCC1 and mTOR were detected . CONCLUSIONS Low TS and , to a minor extent , RRM1 and TOP2A expression were detected in aggressive thymic tumors . These findings should be prospect ively considered in selecting the most appropriate chemotherapy Introduction : The value of a nonanthracyclin regimen in thymic carcinoma and malignant thymoma is not well defined . These regimens may be useful in some patients , particularly with cardiac diseases . The objective of this study is to evaluate the response rate , progression free survival , overall survival and toxicity of combined etoposide , ifosfamide , and cisplatin in patients with advanced thymoma and thymic carcinoma . Methods : From October 1995 to April 2001 , 18 patients with advanced thymoma or thymic carcinoma were entered on trial , and receive etoposide ( 100 mg/m2 on days 1–3 ) , ifosfamide ( 1500 mg/m2 on days 1–3 ) , s and cisplatin ( 30 mg/m2 on days 1–3 ) . Cycles were repeated every 3 weeks for a total of six cycles . Results : Among 16 evaluable patients , there were no complete responses and four partial responses ( complete and partial responses rate , 25 % ; confidence interval [ CI ] 95 , 7–48 % ) . The median follow-up was 32.6 months ( range , < 9–84 months ) , and the median overall survival has not yet been reached because more than 50 % of patients are still alive . Based on Kaplan-Meier estimates , the 1-year and 2-year survival rates were 93.8 and 78.1 % , respectively . The toxicity was predominantly myelosuppresion and alopecia . Conclusions : The combined etoposide , ifosfamide , and cisplatin regimen has moderate activity in patients with advanced thymic tumors . Our results confirm the Eastern Cooperative Oncology Group trial published in 2001 . Response rates appear to be lower to many phase II trials , but survival seems similar Patients  with thymic tumors ( thymoma and thymic carcinoma ) are known to respond to a variety of chemotherapeutic agents , including single‐agent ifosfamide and cisplatin with etoposide . The purpose of this trial was to evaluate the response rate , progression free survival , overall survival , and toxicity of combined etoposide , ifosfamide , and cisplatin ( VIP ) in patients with advanced thymoma and thymic carcinoma PURPOSE The purpose of this study was to evaluate the impact of carboplatin and paclitaxel in patients with advanced previously untreated thymoma and thymic carcinoma . PATIENTS AND METHODS We conducted a prospect i ve multicenter study in patients with unresectable thymoma ( n = 21 ) or thymic carcinoma ( n = 23 ) . Patients were treated with carboplatin ( area under the curve , 6 ) plus paclitaxel ( 225 mg/m(2 ) ) every 3 weeks for a maximum of six cycles . The primary end point of this trial was to evaluate the objective response rate . RESULTS From February 2001 through January 2008 , 46 patients were enrolled . Thirteen patients had grade 4 or greater toxicity , mostly neutropenia .  Using RECIST ( Response Evaluation Criteria in Solid Tumors ) 1.0 criteria , three complete responses ( CRs ) and six partial responses ( PRs ; objective response rate [ ORR ] , 42.9 % ; 90 % CI , 24.5 % to 62.8 % ) were observed in the thymoma cohort ; 10 patients had stable disease . For patients with thymic carcinoma , no CRs and five PRs ( ORR , 21.7 % ; 90 % CI , 9.0 % to 40.4 % ) were observed ; 12 patients had stable disease . Progression-free survival ( PFS ) was 16.7 ( 95 % CI , 7.2 to 19.8 ) and 5.0 ( 95 % CI , 3.0 to 8.3 ) months for thymoma and thymic carcinoma cohorts , respectively . To date , only seven patients ( 33.3 % ) with thymoma have died , compared with 16 patients ( 69.6 % ) with thymic carcinoma . Median survival time was 20.0 months ( 95 % CI , 5.0 to 43.6 months ) for patients with thymic carcinoma , but it has not been reached for patients with thymoma . CONCLUSION Carboplatin plus paclitaxel has moderate clinical activity for patients with thymic malignancies , but this seems less than expected with anthracycline-based therapy . Patients with thymic carcinoma have poorer PFS and overall survival than patients with thymoma PURPOSE To determine the response rate of cisplatin plus doxorubicin plus cyclophosphamide ( PAC ) in patients with limited-stage unresectable thymoma . In addition , this study was undertaken to determine the toxicity , progression-free survival , and overall survival of combined-modality therapy with PAC plus radiation therapy . PATIENTS AND METHODS Patients with a histologic diagnosis of limited-stage unresectable thymoma or thymic carcinoma were eligible . Further requirements included a Karnofsky Performance Score of > 60 , no prior radiation to the chest , and adequate bone marrow , hepatic , and renal function . No patient had undergone chemotherapy previously . Patients received two to four cycles ( repeated every 3 weeks ) of cisplatin ( 50 mg/m2 ) , doxorubicin ( 50 mg/m2 ) , and cyclophosphamide ( 500 mg/m2 ) followed by a total dosage of 54 Gy to the primary tumor and regional lymph nodes for patients with a stable , partial , or complete response to chemotherapy . RESULTS From November 1983 through January 1995 , 26 patients were entered onto the trial . Three patients were ineligible on the basis of pathologic review ( lung cancer , germ cell cancer , lymphoma ) . Toxicity , primarily hematologic , was mild , with only one early death due to a perforated abdominal viscus . Among the 23 assessable patients , there were five complete and 11 partial responses to chemotherapy ( overall response rate , 69.6 % ) . The median time to treatment failure was 93.2 months ( range , 3 to 99.2 + months ) , and the median survival time was 93 months ( range , 1 to 110 months ) . The 5-year survival rate is 52.5 % . CONCLUSIONS PAC combination chemotherapy produces response rates in the management of patients with limited thymoma . Combined-modality therapy is feasible and associated with prolonged progressive-free survival . The benefit of combined-modality therapy over radiation therapy alone is suggested for patients with unresectable thymoma
Abstract Purpose Thymic malignancies , comprising thymoma and thymic carcinoma , are rare .
Consequently , optimal chemotherapy for advanced thymic malignancies remains controversial .
Platinum-based chemotherapy is currently the consensus treatment based on the results of single-arm phase II trials and retrospective investigations .
However , comparison of cisplatin-based and carboplatin-based chemotherapy has yet to be undertaken ; the effectiveness of the addition of anthracycline also remains uncertain .