Clinical Outcomes and Prognosis of Recurrent Thymoma Management

Abstract

World Health Organization histologic types AB or B1 and complete re-resection are favorable prognostic factors of recurrent thymoma. In particular, complete re-resection of recurrent thymoma contributes to better survival than other management. Therefore, we suggest that long-term surveillance extended at least 20 years may be essential for early detection of recurrence to increase the chance of complete re-resection of recurrent thymoma.

Long-Term Outcomes of Recurrent Thymoma

“…Thus, reoperation may be recommended for recurrent thymoma whenever complete resection is possible. However, the rate of complete resection was low in previous studies (50% to 90%) [4,[6][7][8]16,17,24], which is consistent with our data. And we found that single recurrence had higher complete resection rate than multiple recurrence.…”

“…Whereas, unlike the previous studies [3,4,[6][7][8]12,[16][17][18][19][20][21], we observed that much high percent (71.4%) of patients who underwent reoperation received adjuvant chemotherapy, radiotherapy, or chemoradiotherapy, which may improve the treatment outcomes of recurrent thymoma and confound the benefit of reoperation. Based on that adjuvant treatment can improve the outcomes of patients who have median survival interval after recurrence of the chemotherapy group was higher compared with the group of patients without retreatment, but no statistical significance (P=0.062).…”

“…And current evidence in the literature on the survival after debulking surgery for thymoma was contradictory, and most of the studies did not show any survival benefit after debulking for thymoma [23]. Furthermore, complete resection may have good survival even after the second recurrence [16]. Thus, reoperation may be recommended for recurrent thymoma whenever complete resection is possible.…”

“…The answer probably is no. It was reported that the 5-year OS rates after initial treatment of complete resection were much better than incomplete resection for patients with recurrent thymoma (64% to 91.7% vs. 16% to 81.6%) [6,7,16,17], and complete resection even resulted in comparative survival with patients without recurrence [16], however, incomplete resection had no survival benefit and the prognosis was poor [6,12,16,17]. In addition, lung recurrences may be operated if they appear to be completely operable, which may achieve long-term survival [22].…”

Thymic epithelial tumours: from basic principles to individualised treatment strategies

“…The risk of cardiac toxicity is even more increased because of previous use of mediastinal radiotherapy and the potential development of paraneoplastic myocarditis [101]; the use of less toxic agents, including paclitaxel [97] or pemetrexed [92]. In case of recurrence, the strategy may actually primarily consist of a similar multimodal management to that conducted at time of first diagnosis, with surgery and radiotherapy in eligible cases [102][103][104][105]. Complete resection remains a major prognostic factor in this setting.…”