Evaluation of Surgical Therapy in Advanced Thymic Tumors

Markowiak, Till; Ansari, Mohammed Khalid Afeen; Neu, Reiner; Schalke, Berthold; Marx, Alexander; Hofmann, Hans‐Stefan; Ried, Michael

doi:10.3390/cancers13184516

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…Furthermore, the resection status of the tumor may affect the patient's prognosis and a macroscopic complete (R0/R1) was more beneficial to the survival of advanced patients. Markowiak et al found that the median survival time after R2 resection was 25 months, which was significantly shorter than that after R0 or R1 resection (115 months) (28). Also in the current study, we got a similar result that total resection of the primary site was better than partial resection or debulking surgery concerning survival time.…”

Section: B Asupporting

confidence: 82%

“…Markowiak et al. found that the median survival time after R2 resection was 25 months, which was significantly shorter than that after R0 or R1 resection (115 months) ( 28 ). Also in the current study, we got a similar result that total resection of the primary site was better than partial resection or debulking surgery concerning survival time.…”

Section: Discussionmentioning

confidence: 99%

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The role of surgery in advanced thymic tumors: A retrospective cohort study

Tian

2023

Front. Oncol.

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BackgroundThere is no definitive and detailed treatment guideline for advanced thymic tumors, thus when lymph node and other organ metastasis are present, clinical guidelines recommend chemotherapy-based multidisciplinary treatment. A consensus has been reached that surgery has beneficial effects on partial patients with stage IVA whose metastatic lesions were isolated and resectable, but because of few cases of advanced thymic tumor s and the scarcity of reports, the role of surgery in stage IVB is still unknown. The current study aimed to systematically analyze the role of surgery in advanced thymic tumors based on the Surveillance, Epidemiology, and End Results (SEER) database, with a sufficient number of cases. A secondary aim was to clarify the prognostic value of surgery in advanced thymic tumors.MethodData derived from a total of 979 patients with advanced thymoma or advanced thymic carcinoma were collected from the SEER database. Propensity score matching was performed to eliminate confounding factors, and Cox regression analyses were conducted to assess prognoses.ResultsPatients were assigned to four groups based on pathology and whether surgery was performed; thymoma (surgery), thymoma (no surgery), thymic carcinom a (surgery), and thymic carcinoma (no surgery). Disease-specific survival differed significantly in the thymoma (surgery) and thymoma (no surgery) groups, both before and after propensity score matching (both p < 0.001). Similarly, disease-specific survival differed significantly in the thymic carcinoma (surgery) and the thymic carcinoma (no surgery) groups (p < 0.001 before and p = 0.003 after). No total resection, distant metastasis, and thymic carcinoma were all unfavorable prognostic factors.ConclusionsIn the present study surgery had positive effects on advanced thymoma and advanced thymic carcinoma patients who could undergo surgical resection, significantly improving survival times. Total resection of the primary site was the most advantageous form of surgery. The study provides a reference for the clinical treatment of advanced thymic tumors.

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Section: B Asupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

The role of surgery in advanced thymic tumors: A retrospective cohort study

Tian

2023

Front. Oncol.

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“…lungs, vessels) in stage III, en bloc resection of these structures should also be performed, and depending on the extent of tumor infiltration, surgical resection should be performed primarily or after induction therapy. 96,97 Randomized-controlled data regarding neoadjuvant or adjuvant therapy do not exist to date. A consensus decision should be reached by an interprofessional team of thoracic surgeons, oncologists, and radiation therapists.…”

Section: Therapeutic Advances In Neurological Disordersmentioning

confidence: 99%

Guideline for the management of myasthenic syndromes

Wiendl,

Abicht,

Chan

et al. 2023

Ther Adv Neurol Disord

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Myasthenia gravis (MG), Lambert-Eaton myasthenic syndrome (LEMS), and congenital myasthenic syndromes (CMS) represent an etiologically heterogeneous group of (very) rare chronic diseases. MG and LEMS have an autoimmune-mediated etiology, while CMS are genetic disorders. A (strain dependent) muscle weakness due to neuromuscular transmission disorder is a common feature. Generalized MG requires increasingly differentiated therapeutic strategies that consider the enormous therapeutic developments of recent years. To include the newest therapy recommendations, a comprehensive update of the available German-language guideline ‘Diagnostics and therapy of myasthenic syndromes’ has been published by the German Neurological society with the aid of an interdisciplinary expert panel. This paper is an adapted translation of the updated and partly newly developed treatment guideline. It defines the rapid achievement of complete disease control in myasthenic patients as a central treatment goal. The use of standard therapies, as well as modern immunotherapeutics, is subject to a staged regimen that takes into account autoantibody status and disease activity. With the advent of modern, fast-acting immunomodulators, disease activity assessment has become pivotal and requires evaluation of the clinical course, including severity and required therapies. Applying MG-specific scores and classifications such as Myasthenia Gravis Activities of Daily Living, Quantitative Myasthenia Gravis, and Myasthenia Gravis Foundation of America allows differentiation between mild/moderate and (highly) active (including refractory) disease. Therapy decisions must consider age, thymic pathology, antibody status, and disease activity. Glucocorticosteroids and the classical immunosuppressants (primarily azathioprine) are the basic immunotherapeutics to treat mild/moderate to (highly) active generalized MG/young MG and ocular MG. Thymectomy is indicated as a treatment for thymoma-associated MG and generalized MG with acetylcholine receptor antibody (AChR-Ab)-positive status. In (highly) active generalized MG, complement inhibitors (currently eculizumab and ravulizumab) or neonatal Fc receptor modulators (currently efgartigimod) are recommended for AChR-Ab-positive status and rituximab for muscle-specific receptor tyrosine kinase (MuSK)-Ab-positive status. Specific treatment for myasthenic crises requires plasmapheresis, immunoadsorption, or IVIG. Specific aspects of ocular, juvenile, and congenital myasthenia are highlighted. The guideline will be further developed based on new study results for other immunomodulators and biomarkers that aid the accurate measurement of disease activity.

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“…Hyperthermic intrapleural chemotherapy, as well as EPP, may be discussed in case of TET in stage IVa [ 6 ]. Further recommendations in international guidelines regarding surgical resection or the application of HITOC are still lacking [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical cytoreduction and hyperthermic intrathoracic chemotherapy for thymic tumours with pleural spread is effective on survival: results from the multicentre German hyperthermic intrathoracic chemotherapy study

Ried

Hassan

Passlick

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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Objectives Cytoreductive surgery and hyperthermic intrathoracic chemotherapy (HITOC) is effective on survival for patients with pleural metastatic thymic tumours. Methods Multicentre, retrospective analysis of patients with stage IVa thymic tumours treated with surgical resection and HITOC. Primary end-point was overall survival, secondary end-points were recurrence-/progression-free survival and morbidity/mortality. Results A total of n = 58 patients (thymoma n = 42, thymic carcinoma n = 15, atypical carcinoid of the thymus n = 1) were included, who had primary pleural metastases (n = 50; 86%) or pleural recurrence (n = 8; 14%). Lung-preserving resection (n = 56; 97%) was the preferred approach. Macroscopically complete tumour resection was achieved in n = 49 patients (85%). HITOC was performed with cisplatin alone (n = 38; 66%) or in combination with doxorubicin (n = 20; 34%). Almost half of the patients (n = 28; 48%) received high-dose cisplatin > 125 mg/m2 body surface area. Surgical revision was required in eight (14%) patients. In-hospital mortality rate was 2%. During follow-up tumour recurrence/progression was evident in n = 31 (53%) patients. Median follow-up time was 59 months. The 1-, 3-, and 5-year survival rates were 95%, 83%, and 77%, respectively. Recurrence/progression free survival rates were 89%, 54%, and 44%, respectively. Patients with thymoma had significantly better survival compared to patients with thymic carcinoma (p-value ≤0.001). Conclusions Promising survival rates in patients with pleural metastatic stage IVa in thymoma (94%) and even in thymic carcinoma (41%) were achieved. Surgical resection and HITOC is safe and effective for treatment of patients with pleural metastatic thymic tumours stage IVa. Clinical registration number DRKS-ID DRKS00015012

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Evaluation of Surgical Therapy in Advanced Thymic Tumors

Cited by 5 publications

References 32 publications

The role of surgery in advanced thymic tumors: A retrospective cohort study

The role of surgery in advanced thymic tumors: A retrospective cohort study

Guideline for the management of myasthenic syndromes

Surgical cytoreduction and hyperthermic intrathoracic chemotherapy for thymic tumours with pleural spread is effective on survival: results from the multicentre German hyperthermic intrathoracic chemotherapy study

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