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Thymoma with dissemination: efficacy of macroscopic total resection of disseminated nodules
World Journal of Surgery, 05/13/09

Yano M et al. - In a study to assess the efficacy of macroscopic total resection of disseminated nodules in thymoma with dissemination, it was concluded that pursuing total resection for thymoma and disseminated nodules may be beneficial for stage IV thymoma. The combination of preoperative steroid pulse therapy, macroscopic total resection, and postoperative hemithoracic irradiation (HTR) may prolong the interval to relapse, but it did not lead to cure.

Methods

28 thymoma pts with pleural and/or pericardial disseminated nodules were treated.
Among them, 21 pts underwent resection of thymoma and pleural disseminated nodules.

Results

Preoperative steroid pulse therapy was performed in 14 pts.
Macroscopic total resection of all tumors was achieved in 15 pts.
Postoperative adjuvant radiotherapy was performed for mediastinum in 20 pts and HTR in 11 pts.
Overall survival rate of operated 21 pts was 73.1% at 5 yrs.
Pts who underwent resection showed a better prognosis than pts without resection.
Relapse was diagnosed in 14 of 21 pts who underwent resection.
Disease-free survival (DFS) was 67.5% at 1 yr, 39.8% at 3 yrs, and 13.3% at 5 yrs.
HTR alone did not improve the DFS.
Among the pts who underwent total resection, relapse-free survival (RFS) was better than in pts with subtotal resection.
Achievement of a trimodality therapy with preoperative steroid pulse, total resection, and postoperative HTR was associated with prolonged RFS in operated pts.

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