Locally advanced thymoma; does neoadjuvant chemotherapy make a difference?
Abstract Background Regardless of its rare occurrence, Thymoma remains the most frequently encountered primary tumor of the anterior mediastinum comprising about 50% of all masses in the region. Surgical resection, via thymectomy, remains the mainstay treatment modality. In locally advanced and bord...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-023-02357-4 |
| _version_ | 1797556502673752064 |
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| author | Riad Abdel Jalil Farah A. Abdallah Zeinab Obeid Ahmad Khaled Harb Mohamad K. Abou Chaar Tariq Bassem Shannies Ahed El-Edwan Hussam Haddad Azza Ghraibeh Ahmad Abu-Shanab |
| author_facet | Riad Abdel Jalil Farah A. Abdallah Zeinab Obeid Ahmad Khaled Harb Mohamad K. Abou Chaar Tariq Bassem Shannies Ahed El-Edwan Hussam Haddad Azza Ghraibeh Ahmad Abu-Shanab |
| author_sort | Riad Abdel Jalil |
| collection | DOAJ |
| description | Abstract Background Regardless of its rare occurrence, Thymoma remains the most frequently encountered primary tumor of the anterior mediastinum comprising about 50% of all masses in the region. Surgical resection, via thymectomy, remains the mainstay treatment modality. In locally advanced and borderline resectable tumors, neoadjuvant chemotherapy (NACT) may be utilized to increase the chance of R0 resection, raising the question of its efficacy and safety. Methods Demographic and clinical data from patients who presented to a tertiary cancer center between January 2015–October 2021 with a diagnosis of thymoma and underwent curative surgical resection was collected. Computed tomography scan was used to delineate clinical staging, tumor size and to detect post-therapeutic variations in tumor burden. The response evaluation criteria in solid tumors (RECIST) was used to classify the effect of NACT on tumor burden. The pathological response was determined by measuring the percentage of necrotic tissue. Results A total of 23 patients were diagnosed with thymoma. Most patients were male with a mean age 46 (± 15) years at diagnosis. The most common clinical stage was stage II with 5 patients (22%). A total of 12 patients had NACT as compared to 11 patients who had upfront surgery. The mean change in tumor volume was 165 cm3 (p = 0.079) and the change in and maximum diameter was 1.53 ± 1.49 cm (p < 0.01). The effect of NACT on tumor burden based on RECIST criteria was minimal as 8 patients had stable disease. Based on pathological findings, the average necrotic portion of the tumor was 39.5% (p = 0.152). The overall survival rate is 95.65%, mean survival was 115 months (4–125). Recurrence occurred in 5 patients. The NACT group had a higher risk for recurrence (4; 33.3%) with a mean survival of 43.8 months compared to 59.6 months in those who did not receive induction therapy. Conclusions The exact role of induction chemotherapy in locally advanced thymoma patients remains controversial. NACT effect after utilizing radiological and pathological assessment tools was not found to significantly improve oncological outcomes compared to upfront surgery in locally advanced disease, with minimal radiologic and pathologic effect. To further demonstrate the impact of induction chemotherapy, we recommend multicentric collaborative studies. |
| first_indexed | 2024-03-10T17:03:49Z |
| format | Article |
| id | doaj.art-4dab28a83a4e460e9effe998524eacbd |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-03-10T17:03:49Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-4dab28a83a4e460e9effe998524eacbd2023-11-20T10:52:53ZengBMCJournal of Cardiothoracic Surgery1749-80902023-08-011811810.1186/s13019-023-02357-4Locally advanced thymoma; does neoadjuvant chemotherapy make a difference?Riad Abdel Jalil0Farah A. Abdallah1Zeinab Obeid2Ahmad Khaled Harb3Mohamad K. Abou Chaar4Tariq Bassem Shannies5Ahed El-Edwan6Hussam Haddad7Azza Ghraibeh8Ahmad Abu-Shanab9Department of Thoracic Oncology, King Hussein Cancer CenterDepartment of Research, King Hussein Cancer CenterDepartment of Research, King Hussein Cancer CenterDepartment of Research, King Hussein Cancer CenterDepartment of Surgery, King Hussein Cancer CenterDepartment of Research, King Hussein Cancer CenterDepartment of Anesthesia, King Hussein Cancer CenterDepartment of Pathology, King Hussein Cancer CenterDepartment of Radiology, King Hussein Cancer CenterDepartment of Thoracic Oncology, King Hussein Cancer CenterAbstract Background Regardless of its rare occurrence, Thymoma remains the most frequently encountered primary tumor of the anterior mediastinum comprising about 50% of all masses in the region. Surgical resection, via thymectomy, remains the mainstay treatment modality. In locally advanced and borderline resectable tumors, neoadjuvant chemotherapy (NACT) may be utilized to increase the chance of R0 resection, raising the question of its efficacy and safety. Methods Demographic and clinical data from patients who presented to a tertiary cancer center between January 2015–October 2021 with a diagnosis of thymoma and underwent curative surgical resection was collected. Computed tomography scan was used to delineate clinical staging, tumor size and to detect post-therapeutic variations in tumor burden. The response evaluation criteria in solid tumors (RECIST) was used to classify the effect of NACT on tumor burden. The pathological response was determined by measuring the percentage of necrotic tissue. Results A total of 23 patients were diagnosed with thymoma. Most patients were male with a mean age 46 (± 15) years at diagnosis. The most common clinical stage was stage II with 5 patients (22%). A total of 12 patients had NACT as compared to 11 patients who had upfront surgery. The mean change in tumor volume was 165 cm3 (p = 0.079) and the change in and maximum diameter was 1.53 ± 1.49 cm (p < 0.01). The effect of NACT on tumor burden based on RECIST criteria was minimal as 8 patients had stable disease. Based on pathological findings, the average necrotic portion of the tumor was 39.5% (p = 0.152). The overall survival rate is 95.65%, mean survival was 115 months (4–125). Recurrence occurred in 5 patients. The NACT group had a higher risk for recurrence (4; 33.3%) with a mean survival of 43.8 months compared to 59.6 months in those who did not receive induction therapy. Conclusions The exact role of induction chemotherapy in locally advanced thymoma patients remains controversial. NACT effect after utilizing radiological and pathological assessment tools was not found to significantly improve oncological outcomes compared to upfront surgery in locally advanced disease, with minimal radiologic and pathologic effect. To further demonstrate the impact of induction chemotherapy, we recommend multicentric collaborative studies.https://doi.org/10.1186/s13019-023-02357-4ThymomaNeoadjuvant chemotherapyRadiographic effectHistopathological effect |
| spellingShingle | Riad Abdel Jalil Farah A. Abdallah Zeinab Obeid Ahmad Khaled Harb Mohamad K. Abou Chaar Tariq Bassem Shannies Ahed El-Edwan Hussam Haddad Azza Ghraibeh Ahmad Abu-Shanab Locally advanced thymoma; does neoadjuvant chemotherapy make a difference? Journal of Cardiothoracic Surgery Thymoma Neoadjuvant chemotherapy Radiographic effect Histopathological effect |
| title | Locally advanced thymoma; does neoadjuvant chemotherapy make a difference? |
| title_full | Locally advanced thymoma; does neoadjuvant chemotherapy make a difference? |
| title_fullStr | Locally advanced thymoma; does neoadjuvant chemotherapy make a difference? |
| title_full_unstemmed | Locally advanced thymoma; does neoadjuvant chemotherapy make a difference? |
| title_short | Locally advanced thymoma; does neoadjuvant chemotherapy make a difference? |
| title_sort | locally advanced thymoma does neoadjuvant chemotherapy make a difference |
| topic | Thymoma Neoadjuvant chemotherapy Radiographic effect Histopathological effect |
| url | https://doi.org/10.1186/s13019-023-02357-4 |
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