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

Abstract

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

Outcome after cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy in patients with secondary pleural metastases

“…The main finding of our study was a prolonged survival in selected patients with secondary pleural metastases after CRS+HITOC as a part of multimodal treatment approach with median overall survival of 39 months and median RFS/PFS of 14 months. Retrospective studies showed an encouraging survival of patients with pleural mesothelioma or thymus tumours with pleural involvement, who underwent a multimodal treatment approach including local interventions with CRS+HITOC ( 5 , 11 , 20 ). However, there is paucity of studies investigating the outcome of CRS+HITOC in patients with secondary pleural metastases as a part of multimodal concept.…”

“…Four high-volume departments of thoracic surgery in Germany collected data in the “German HITOC-Study” funded by the Deutsche Forschungsgemeinschaft – DFG, German Research Association (DFG, RI2905/3-1). The study group has already published first results about HITOC after CRS for pleural malignancies in general and for thymic tumours with pleural spread ( 5 , 13 , 14 ). Now, the focus will be on secondary pleural metastases and its surgical treatment combined with HITOC.…”

Optimism with caution for patients with advanced thymoma and thymic carcinoma

“…Evidently, the data presented by the multicentre German group are significant, but confirmation by others authors is demanded. To reinforce the data obtained by Ried et al [ 2 ], Chappuy et al [ 10 ] reported an important experience with 40 patients with T IVa pleural involvement treated with partial pleurectomy and HITHOC showing a median length of survival of 118 months and a median DFI of 70 months [ 10 ]. The group of Pisa in Italy had also similar results [ 11 ].…”

“…The answer to this question could be found in the good results reported from the multicentre German HITOC study entitled ‘Surgical cytoreduction and hyperthermic intrathoracic chemotherapy for thymic tumours with pleural spread is effective on survival: results from the multicentre German HITOC-study’ [ 2 ]. The study includes 42 patients with T and 15 patients with TC with pleural metastases or recurrences.…”

“…It seems evident that clinical data reported worldwide, although are mostly retrospective, confirm that HITHOC is useful. Furthermore, we are witnessing another clinical success of the use of HITHOC combined with cytoreductive surgery for advanced thoracic cancers [ 2 ]. It appears clear that HITHOC is contributing to adding years of survival after surgery for advanced thoracic cancers such as mesotheliomas, stage IV–M1a pleural effusion lung cancer, and pseudomyxoma [ 6–9 ].…”