Christopher B. Jackson, A. Rimner, C. Simone II, E. Lebow, James Huang, S. Lobaugh, Zhigang Zhang, Gregory Riely, M. Ginsberg, Andrew M. Pagano, Jason C. Chang, M. Mayoral, D. G. Gómez, A. Shepherd
Background Little is known about the effectiveness of hypofractionated radiation therapy (HFRT) or stereotactic body radiation therapy (SBRT) for the treatment of patients with oligometastatic (OM) or oligoprogressive (OP) thymic malignancies. Methods We retrospectively reviewed Stage IV patients with OM or OP thymic malignancies treated with HFRT or SBRT between 2009–2021. We defined OM as 5 or fewer sites of metastatic disease and OP as 5 or fewer sites of metastatic disease increasing in radiological size at the time of radiation. Analysis of local failure (LF, defined as failure within a treated lesion) and distant failure (DF, defined as failure outside the treated lesion) was done at the treatment course level using univariate analysis Fine-Gray regression adjusted for clustering. Analysis of overall survival (OS) and progression-free survival (PFS) was done at the patient level utilizing only the first course of treatment for each patient. Results Our analysis included 50 patients with 92 treatment courses. Patients had thymoma (50%), thymic carcinoma (TC, 40%), or atypical thymic carcinoid (ATC, 10%). The median biologic effective dose (BED) was 51 Gy (range, 38–106 Gy). With a median follow-up of 36 months, the median OS and PFS were 50 and 6.5 months, respectively. Patients with TC or ATC had significantly worse PFS than those with thymoma [hazard ratio (HR) 2.37; 95% confidence interval (CI): 1.18–4.76, P=0.013], but similar OS (P=0.55) and LF (P=0.729). Treated thymoma lesions had a lower hazard of DF than TC/ATC lesions, but this was not statistically significant (HR 0.59; 95% CI: 0.34–1.03, P=0.065). Lesions treated to a BED higher than 60 Gy had lower hazards of LF and DF, although this was not statistically significant (HR 0.29; 95% CI: 0.05–1.68, P=0.166 and HR 0.58; 95% CI: 0.3–1.1, P=0.096, respectively). Conclusions In our analysis, patients with TC or ATC had worse PFS than those with thymoma. Treated thymoma and TC/ATC lesions had similar hazards of LF, indicating similar radiation sensitivity in thymic lesions regardless of histology. There was a trend towards increased local control with higher BED regimens, but this did not reach statistical significance. Overall, our analysis points to the need for clinical trials on HFRT/SBRT for the treatment of these rare malignancies.
{"title":"AB013. Treatment of thymic oligometastastic or oligoprogressive lesions with hypofractionated radiation therapy or stereotactic body radiation therapy","authors":"Christopher B. Jackson, A. Rimner, C. Simone II, E. Lebow, James Huang, S. Lobaugh, Zhigang Zhang, Gregory Riely, M. Ginsberg, Andrew M. Pagano, Jason C. Chang, M. Mayoral, D. G. Gómez, A. Shepherd","doi":"10.21037/med-22-ab013","DOIUrl":"https://doi.org/10.21037/med-22-ab013","url":null,"abstract":"Background Little is known about the effectiveness of hypofractionated radiation therapy (HFRT) or stereotactic body radiation therapy (SBRT) for the treatment of patients with oligometastatic (OM) or oligoprogressive (OP) thymic malignancies. Methods We retrospectively reviewed Stage IV patients with OM or OP thymic malignancies treated with HFRT or SBRT between 2009–2021. We defined OM as 5 or fewer sites of metastatic disease and OP as 5 or fewer sites of metastatic disease increasing in radiological size at the time of radiation. Analysis of local failure (LF, defined as failure within a treated lesion) and distant failure (DF, defined as failure outside the treated lesion) was done at the treatment course level using univariate analysis Fine-Gray regression adjusted for clustering. Analysis of overall survival (OS) and progression-free survival (PFS) was done at the patient level utilizing only the first course of treatment for each patient. Results Our analysis included 50 patients with 92 treatment courses. Patients had thymoma (50%), thymic carcinoma (TC, 40%), or atypical thymic carcinoid (ATC, 10%). The median biologic effective dose (BED) was 51 Gy (range, 38–106 Gy). With a median follow-up of 36 months, the median OS and PFS were 50 and 6.5 months, respectively. Patients with TC or ATC had significantly worse PFS than those with thymoma [hazard ratio (HR) 2.37; 95% confidence interval (CI): 1.18–4.76, P=0.013], but similar OS (P=0.55) and LF (P=0.729). Treated thymoma lesions had a lower hazard of DF than TC/ATC lesions, but this was not statistically significant (HR 0.59; 95% CI: 0.34–1.03, P=0.065). Lesions treated to a BED higher than 60 Gy had lower hazards of LF and DF, although this was not statistically significant (HR 0.29; 95% CI: 0.05–1.68, P=0.166 and HR 0.58; 95% CI: 0.3–1.1, P=0.096, respectively). Conclusions In our analysis, patients with TC or ATC had worse PFS than those with thymoma. Treated thymoma and TC/ATC lesions had similar hazards of LF, indicating similar radiation sensitivity in thymic lesions regardless of histology. There was a trend towards increased local control with higher BED regimens, but this did not reach statistical significance. Overall, our analysis points to the need for clinical trials on HFRT/SBRT for the treatment of these rare malignancies.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43611391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vincent Yeung, Jacob P Zaemes, Justin Yeh, Cardoza Giancarlo, Jaeil Ahn, J. Reuss, B. Kallakury, Stephen V. Liu, A. Duttargi, G. Khan, Chul Kim
Background Trophoblastic antigen 2 (Trop2) is a cell surface glycoprotein expressed in multiple types of cancers, including breast cancer, non-small cell lung cancer, and gastrointestinal cancers1. Therapeutic intervention targeting Trop2-expressing tumors is an active area of investigation. Trop2 expression and the use of Trop2-directed therapy such as antibody-drug conjugate (ADC) have not yet been investigated in thymic epithelial tumors (TETs). Methods Patients with TETs treated at MedStar Georgetown University Hospital between 2011–2021 were retrospectively identified. Of the patients for whom tumor samples were available, immunohistochemistry (IHC) membranous staining for Trop2 was performed using SP295 rabbit IgG anti-human Trop2 (Abcam, Waltham, MA, USA). When available, IHC staining for Trop2 was performed on normal thymus tissue from the same patients. Positivity required at least 10% of the tumor cells to be stained, with an intensity scored of 1+ (weak), 2+ (moderate), and 3+ (strong).3 Medical records of the included patients were reviewed to identify clinical characteristics including age, sex, stage of disease, and WHO subtype. Results Thirty TET samples from 29 patients (17 patients with thymoma and 12 patients with thymic carcinoma) were identified. One patient with thymic carcinoma had two samples from different time points. From the same set of patients, 15 samples of normal thymus tissue were available. In the normal thymus tissue, 10 samples (67%) showed no positivity of Trop2, while the remaining 5 samples (33%) showed only 1+ IHC staining. In the thymoma samples, 4 (24%) showed 0 or 1+ IHC staining, while 13 (76%) showed 2+ or 3+ staining. Of the 12 thymic carcinoma samples, all exhibited Trop2 expression; three samples (23%) showed 1+ IHC staining while 8 (62%) showed 2+ staining and 2 (15%) showed 3+ staining. Conclusions Trop2 is readily expressed in both thymomas and thymic carcinomas with a higher degree of expression in thymic carcinoma. The expression of Trop-2 was lower in normal thymic tissue compared with TETs. The increased expression of Trop-2 in TETs suggests that Trop2 is an attractive therapeutic target for Trop-2 directed therapy.
{"title":"AB007. Expression of trophoblastic antigen 2 (Trop2) in thymic epithelial tumors","authors":"Vincent Yeung, Jacob P Zaemes, Justin Yeh, Cardoza Giancarlo, Jaeil Ahn, J. Reuss, B. Kallakury, Stephen V. Liu, A. Duttargi, G. Khan, Chul Kim","doi":"10.21037/med-22-ab007","DOIUrl":"https://doi.org/10.21037/med-22-ab007","url":null,"abstract":"Background Trophoblastic antigen 2 (Trop2) is a cell surface glycoprotein expressed in multiple types of cancers, including breast cancer, non-small cell lung cancer, and gastrointestinal cancers1. Therapeutic intervention targeting Trop2-expressing tumors is an active area of investigation. Trop2 expression and the use of Trop2-directed therapy such as antibody-drug conjugate (ADC) have not yet been investigated in thymic epithelial tumors (TETs). Methods Patients with TETs treated at MedStar Georgetown University Hospital between 2011–2021 were retrospectively identified. Of the patients for whom tumor samples were available, immunohistochemistry (IHC) membranous staining for Trop2 was performed using SP295 rabbit IgG anti-human Trop2 (Abcam, Waltham, MA, USA). When available, IHC staining for Trop2 was performed on normal thymus tissue from the same patients. Positivity required at least 10% of the tumor cells to be stained, with an intensity scored of 1+ (weak), 2+ (moderate), and 3+ (strong).3 Medical records of the included patients were reviewed to identify clinical characteristics including age, sex, stage of disease, and WHO subtype. Results Thirty TET samples from 29 patients (17 patients with thymoma and 12 patients with thymic carcinoma) were identified. One patient with thymic carcinoma had two samples from different time points. From the same set of patients, 15 samples of normal thymus tissue were available. In the normal thymus tissue, 10 samples (67%) showed no positivity of Trop2, while the remaining 5 samples (33%) showed only 1+ IHC staining. In the thymoma samples, 4 (24%) showed 0 or 1+ IHC staining, while 13 (76%) showed 2+ or 3+ staining. Of the 12 thymic carcinoma samples, all exhibited Trop2 expression; three samples (23%) showed 1+ IHC staining while 8 (62%) showed 2+ staining and 2 (15%) showed 3+ staining. Conclusions Trop2 is readily expressed in both thymomas and thymic carcinomas with a higher degree of expression in thymic carcinoma. The expression of Trop-2 was lower in normal thymic tissue compared with TETs. The increased expression of Trop-2 in TETs suggests that Trop2 is an attractive therapeutic target for Trop-2 directed therapy.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43439946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xuefei Zhang, Lan-ting Gao, Xiuxiu Hao, F. Yu, Z. Gu, W. Fang
Background Chemotherapy has been recommended to be the standard care for thymic epithelial tumors (TETs) patients with pleural dissemination. Efficacy of chemotherapy on pleural lesions is not yet assessed in large patient populations. This study aims to evaluate pleural response to chemotherapy and to analyze the related factors on patient survival to see if chemotherapy is a satisfying first-line treatment for these patients. Methods Consecutive TET patients with pleural dissemination treated at Shanghai Chest Hospital between 2007 and 2018 were enrolled in this study. Overall response rate (ORR) was used to assess the efficacy of chemotherapy, using modified RESIST 1.1. ORR, disease-control time (DCT), progression-free survival (PFS) and overall survival (OS) were analyzed in this study. The efficacy of different chemotherapy regimens was assessed by univariate and multivariate analysis. Results A total of 158 patients were enrolled in the study. Among them, 124 had thymomas and 34 thymic carcinomas; 109 cases received intentional radiotherapy and/or surgical resection for pleural lesions after chemotherapy, and 49 cases received chemotherapy alone. Overall, 14 patients experienced a partial response (ORR =8.9%) of pleural lesions after chemotherapy, with no complete response observed. Paclitaxel-containing regimen was associated with a higher ORR than other regimens (12.9% vs. 1.8%, P=0.018), even in thymomas. Thymic carcinoma seemed more sensitive to chemotherapy than thymoma (17.4% vs. 6.5%, P=0.08) but also there were more progressive diseases in thymic carcinoma. Multivariate analysis showed that an increased chemotherapy response for pleural lesions was independently associated with thymic carcinoma (P=0.049) and paclitaxel-containing chemotherapy (P=0.043). Thymoma and additional local therapy including surgery and radiotherapy, were associated with significantly prolonged PFS (P<0.05) and OS (P<0.05). For patients who received chemotherapy alone, the median disease control time (mDCT) was 10 months, while it was 24 months for those with additional local therapy. Conclusions For TETs with pleural dissemination, although paclitaxel-containing chemotherapy may be better than other regimens, chemotherapy as first-line treatment is not satisfying. Local therapies such as surgery and radiotherapy would help improve the therapeutic effect when applicable. Given the low response and survival rate of chemotherapy, novel treatment needs to be explored so as to improve management outcomes.
{"title":"AB006. Effectiveness of chemotherapy as the first-line treatment for thymic tumors with pleural dissemination","authors":"Xuefei Zhang, Lan-ting Gao, Xiuxiu Hao, F. Yu, Z. Gu, W. Fang","doi":"10.21037/med-22-ab006","DOIUrl":"https://doi.org/10.21037/med-22-ab006","url":null,"abstract":"Background Chemotherapy has been recommended to be the standard care for thymic epithelial tumors (TETs) patients with pleural dissemination. Efficacy of chemotherapy on pleural lesions is not yet assessed in large patient populations. This study aims to evaluate pleural response to chemotherapy and to analyze the related factors on patient survival to see if chemotherapy is a satisfying first-line treatment for these patients. Methods Consecutive TET patients with pleural dissemination treated at Shanghai Chest Hospital between 2007 and 2018 were enrolled in this study. Overall response rate (ORR) was used to assess the efficacy of chemotherapy, using modified RESIST 1.1. ORR, disease-control time (DCT), progression-free survival (PFS) and overall survival (OS) were analyzed in this study. The efficacy of different chemotherapy regimens was assessed by univariate and multivariate analysis. Results A total of 158 patients were enrolled in the study. Among them, 124 had thymomas and 34 thymic carcinomas; 109 cases received intentional radiotherapy and/or surgical resection for pleural lesions after chemotherapy, and 49 cases received chemotherapy alone. Overall, 14 patients experienced a partial response (ORR =8.9%) of pleural lesions after chemotherapy, with no complete response observed. Paclitaxel-containing regimen was associated with a higher ORR than other regimens (12.9% vs. 1.8%, P=0.018), even in thymomas. Thymic carcinoma seemed more sensitive to chemotherapy than thymoma (17.4% vs. 6.5%, P=0.08) but also there were more progressive diseases in thymic carcinoma. Multivariate analysis showed that an increased chemotherapy response for pleural lesions was independently associated with thymic carcinoma (P=0.049) and paclitaxel-containing chemotherapy (P=0.043). Thymoma and additional local therapy including surgery and radiotherapy, were associated with significantly prolonged PFS (P<0.05) and OS (P<0.05). For patients who received chemotherapy alone, the median disease control time (mDCT) was 10 months, while it was 24 months for those with additional local therapy. Conclusions For TETs with pleural dissemination, although paclitaxel-containing chemotherapy may be better than other regimens, chemotherapy as first-line treatment is not satisfying. Local therapies such as surgery and radiotherapy would help improve the therapeutic effect when applicable. Given the low response and survival rate of chemotherapy, novel treatment needs to be explored so as to improve management outcomes.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48797303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Dolezal, Wenjie Guo, C. Bestvina, E. Vokes, J. Donington, A. Husain, M. Garassino
Background Rare tumors are diagnostic challenges for pathologists. Thymic epithelial tumors (TETs) are heterogenous and their treatment strategies vary according to histological subgroup. Previous work has shown that a second pathological opinion may result in a change in diagnosis for more than half of cases, with a potential treatment shift in 44%. The aim of this study is to assess the feasibility of using artificial intelligence and deep learning to classify TETs, which could be used to help improve pathologist diagnostic consistency for these challenging tumors. Methods Digital diagnostic hematoxylin and eosin (H&E) stained slides of tumors for 103 patients with thymoma type A, AB, B1, B2, and B3 were downloaded from The Cancer Genome Atlas (TCGA). An Xception-based deep convolutional neural network model was trained on slide images at 10× magnification to predict histologic subtype as an ordinal variable in three-fold cross-validation. Hyperparameters were taken from previously published experiments, and no additional hyperparameter tuning was performed to reduce the risk of overfitting. Validation predictions from each cross-fold were aggregated and compared between groups using analysis of variance (ANOVA) and one-sided t-tests with Bonferroni correction for multiple comparisons. Model activations at the post-convolutional layer for validation images in the first cross-fold were visualized with uniform manifold approximation and projection (UMAP) dimensionality reduction to better understand the spatial relationship between learned image features. Results Deep learning predictions among the TET subtypes were significantly different by ANOVA (P<0.0001) and correlated with the ordinal labels (R-squared =0.39). Thymoma A and AB subtypes were distinguished from both B1 and B2/B3 (P=0.023 and <0.001, respectively), and B1 tumors were distinguished from B2/B3 (P=0.011). Analysis of post-convolutional layer activations revealed an axis of transition through the ordinal variables, providing evidence that the deep learning model learned image features on a morphologic spectrum. Conclusions This is the first example in TETs that deep learning can discriminate between TET histologic subtypes using digital H&E slides. We aim to further validate the algorithm with a multi-institution dataset from centers of expertise to improve the ability to distinguish thymoma subtypes.
{"title":"AB012. Automated histologic subtyping of thymic epithelial tumors with deep learning","authors":"J. Dolezal, Wenjie Guo, C. Bestvina, E. Vokes, J. Donington, A. Husain, M. Garassino","doi":"10.21037/med-22-ab012","DOIUrl":"https://doi.org/10.21037/med-22-ab012","url":null,"abstract":"Background Rare tumors are diagnostic challenges for pathologists. Thymic epithelial tumors (TETs) are heterogenous and their treatment strategies vary according to histological subgroup. Previous work has shown that a second pathological opinion may result in a change in diagnosis for more than half of cases, with a potential treatment shift in 44%. The aim of this study is to assess the feasibility of using artificial intelligence and deep learning to classify TETs, which could be used to help improve pathologist diagnostic consistency for these challenging tumors. Methods Digital diagnostic hematoxylin and eosin (H&E) stained slides of tumors for 103 patients with thymoma type A, AB, B1, B2, and B3 were downloaded from The Cancer Genome Atlas (TCGA). An Xception-based deep convolutional neural network model was trained on slide images at 10× magnification to predict histologic subtype as an ordinal variable in three-fold cross-validation. Hyperparameters were taken from previously published experiments, and no additional hyperparameter tuning was performed to reduce the risk of overfitting. Validation predictions from each cross-fold were aggregated and compared between groups using analysis of variance (ANOVA) and one-sided t-tests with Bonferroni correction for multiple comparisons. Model activations at the post-convolutional layer for validation images in the first cross-fold were visualized with uniform manifold approximation and projection (UMAP) dimensionality reduction to better understand the spatial relationship between learned image features. Results Deep learning predictions among the TET subtypes were significantly different by ANOVA (P<0.0001) and correlated with the ordinal labels (R-squared =0.39). Thymoma A and AB subtypes were distinguished from both B1 and B2/B3 (P=0.023 and <0.001, respectively), and B1 tumors were distinguished from B2/B3 (P=0.011). Analysis of post-convolutional layer activations revealed an axis of transition through the ordinal variables, providing evidence that the deep learning model learned image features on a morphologic spectrum. Conclusions This is the first example in TETs that deep learning can discriminate between TET histologic subtypes using digital H&E slides. We aim to further validate the algorithm with a multi-institution dataset from centers of expertise to improve the ability to distinguish thymoma subtypes.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48842903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Chua, Emma Cole, B. Dunne, P. Antippa, J. Lai, M. McCusker
Background To review the incidence of non-therapeutic thymectomies at our institution, and to identify preoperative imaging features to assist in reducing the incidence. Methods Retrospective review of consecutive patients undergoing thymectomy for an anterior mediastinal lesion at a single institution over a 13-year period. Preoperative clinical features were reviewed. Preoperative computed tomography (CT) scans were reviewed for features of the anterior mediastinal lesion, including mean attenuation, presence of calcification, lesion margins, and location. In some cases, fluorodeoxyglucose positron emission tomography (FDG-PET) was performed and SUV measured. Final histopathological diagnosis was reviewed. Non-therapeutic thymectomy was defined as a thymectomy for lymphoma or benign disease, in the absence of clinical features of myasthenia gravis. Results One hundred and five thymectomies were performed. Sixty-three thymectomies (60%) were performed for thymic neoplasm [thymoma (n=60) or thymic carcinoma (n=3)]. The rate of non-therapeutic thymectomy was 13% (n=14). Of the non-therapeutic thymectomy specimens, most were cystic lesions (n=6) and thymic hyperplasia (n=3). Mean CT attenuation of the lesions was higher overall in the therapeutic group versus the non-therapeutic group (52 vs. 23 HU, P<0.005). For resected thymomas, attenuation (HU 57) was higher compared to lesions in the non-therapeutic group: hyperplasia (18 HU, P<0.005), cysts (22 HU, P<0.005), benign thymic tissue (30 HU, P<0.005) and lymphoma (HU 41, P=0.009). Mean age of patients with thymoma was significantly higher than for age of patients with non-therapeutic resection of thymic hyperplasia (62 vs. 49 years, P=0.003). Twenty patients underwent FDG-PET scan (therapeutic group 15, non-therapeutic 5). There was no significant difference in FDG uptake between thymoma, and lesions in the non-therapeutic group. Of the non-therapeutic thymectomy group, none underwent preoperative magnetic resonance imaging (MRI). Conclusions The non-therapeutic thymectomy rate was 13%. Higher CT attenuation and higher age were significant differentiators of thymic neoplasm from benign pathology. Of the patients who underwent non-therapeutic thymectomy, none were investigated with preoperative MRI. FDG-PET did not differentiate thymoma from benign pathology. Attention to the above imaging and demographic features, and inclusion of MRI in the preoperative work up, may help reduce the rate of non-therapeutic thymectomy.
{"title":"AB009. Lessons learned from non-therapeutic thymectomies","authors":"M. Chua, Emma Cole, B. Dunne, P. Antippa, J. Lai, M. McCusker","doi":"10.21037/med-22-ab009","DOIUrl":"https://doi.org/10.21037/med-22-ab009","url":null,"abstract":"Background To review the incidence of non-therapeutic thymectomies at our institution, and to identify preoperative imaging features to assist in reducing the incidence. Methods Retrospective review of consecutive patients undergoing thymectomy for an anterior mediastinal lesion at a single institution over a 13-year period. Preoperative clinical features were reviewed. Preoperative computed tomography (CT) scans were reviewed for features of the anterior mediastinal lesion, including mean attenuation, presence of calcification, lesion margins, and location. In some cases, fluorodeoxyglucose positron emission tomography (FDG-PET) was performed and SUV measured. Final histopathological diagnosis was reviewed. Non-therapeutic thymectomy was defined as a thymectomy for lymphoma or benign disease, in the absence of clinical features of myasthenia gravis. Results One hundred and five thymectomies were performed. Sixty-three thymectomies (60%) were performed for thymic neoplasm [thymoma (n=60) or thymic carcinoma (n=3)]. The rate of non-therapeutic thymectomy was 13% (n=14). Of the non-therapeutic thymectomy specimens, most were cystic lesions (n=6) and thymic hyperplasia (n=3). Mean CT attenuation of the lesions was higher overall in the therapeutic group versus the non-therapeutic group (52 vs. 23 HU, P<0.005). For resected thymomas, attenuation (HU 57) was higher compared to lesions in the non-therapeutic group: hyperplasia (18 HU, P<0.005), cysts (22 HU, P<0.005), benign thymic tissue (30 HU, P<0.005) and lymphoma (HU 41, P=0.009). Mean age of patients with thymoma was significantly higher than for age of patients with non-therapeutic resection of thymic hyperplasia (62 vs. 49 years, P=0.003). Twenty patients underwent FDG-PET scan (therapeutic group 15, non-therapeutic 5). There was no significant difference in FDG uptake between thymoma, and lesions in the non-therapeutic group. Of the non-therapeutic thymectomy group, none underwent preoperative magnetic resonance imaging (MRI). Conclusions The non-therapeutic thymectomy rate was 13%. Higher CT attenuation and higher age were significant differentiators of thymic neoplasm from benign pathology. Of the patients who underwent non-therapeutic thymectomy, none were investigated with preoperative MRI. FDG-PET did not differentiate thymoma from benign pathology. Attention to the above imaging and demographic features, and inclusion of MRI in the preoperative work up, may help reduce the rate of non-therapeutic thymectomy.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46425336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Yu, Ning Xu, Xuefei Zhang, Xiuxiu Hao, Z. Gu, Wen-xu Fang
Background Multilocular thymic cysts are sometimes associated with thymic epithelial tumors (TETs) and may be misdiagnosed as benign lesions. Cystic TETs generally progress during the course of follow-up. Case Description A 55-year-old woman was referred to our hospital in 2017. Her symptoms and physical exams were unremarkable. No abnormal lab results were detected other than elevated ESR (76 mm/lh). Contrast chest computed tomography (CT) showed an anterior mediastinal mass of 3×2×5 cm3 with heterogenous attenuation. The cystic feature was confirmed on contrast magnetic resonance imaging (MRI). Positron emission tomography (PET)-CT was also performed and there was no uptake in the lesion. Benign thymic cyst with infection was among the differential diagnoses. Therefore, intravenous antibiotics were administered for a week. A follow-up CT performed a month later showed a radical change: no visible lesion was present in the anterior mediastinum. Patient was cautioned that malignancy was still possible and that regular follow-up was necessary. The patient did not have another chest CT until the end of 2020. Follow-up chest CT showed lobulated anterior mediastinal mass with multiple pleural implants, highly suggestive of malignancy. Thymectomy plus pleurectomy was performed. Patient was discharged on post-operative day 10. Diagnosis: the pathology was thymic squamous cell carcinoma. The tumor invaded right pleura and pericardium, and pleural implants were confirmed metastasis (T2N0M1a, Stage IVa). Resection status was R0. Adjuvant radiation and chemotherapy were administered. Patient experienced recurrence after 10 months. Conclusions Multilocular thymic cysts can lead to misdiagnosis. Regular follow-up is needed if upfront surgery lacks evidence of malignancy and is deemed inappropriate at first. In cystic lesions or small lesions, it is sometimes difficult to make a clinical decision between surgery and follow-up based on imaging alone. Rash decision might result in unnecessary surgery or disease progression. Novel diagnostic tools might provide insights into the decision- making of these patients.
{"title":"AB005. Thymic carcinoma arising in a multilocular thymic cyst that previously went through complete remission after antibiotics treatment","authors":"F. Yu, Ning Xu, Xuefei Zhang, Xiuxiu Hao, Z. Gu, Wen-xu Fang","doi":"10.21037/med-22-ab005","DOIUrl":"https://doi.org/10.21037/med-22-ab005","url":null,"abstract":"Background Multilocular thymic cysts are sometimes associated with thymic epithelial tumors (TETs) and may be misdiagnosed as benign lesions. Cystic TETs generally progress during the course of follow-up. Case Description A 55-year-old woman was referred to our hospital in 2017. Her symptoms and physical exams were unremarkable. No abnormal lab results were detected other than elevated ESR (76 mm/lh). Contrast chest computed tomography (CT) showed an anterior mediastinal mass of 3×2×5 cm3 with heterogenous attenuation. The cystic feature was confirmed on contrast magnetic resonance imaging (MRI). Positron emission tomography (PET)-CT was also performed and there was no uptake in the lesion. Benign thymic cyst with infection was among the differential diagnoses. Therefore, intravenous antibiotics were administered for a week. A follow-up CT performed a month later showed a radical change: no visible lesion was present in the anterior mediastinum. Patient was cautioned that malignancy was still possible and that regular follow-up was necessary. The patient did not have another chest CT until the end of 2020. Follow-up chest CT showed lobulated anterior mediastinal mass with multiple pleural implants, highly suggestive of malignancy. Thymectomy plus pleurectomy was performed. Patient was discharged on post-operative day 10. Diagnosis: the pathology was thymic squamous cell carcinoma. The tumor invaded right pleura and pericardium, and pleural implants were confirmed metastasis (T2N0M1a, Stage IVa). Resection status was R0. Adjuvant radiation and chemotherapy were administered. Patient experienced recurrence after 10 months. Conclusions Multilocular thymic cysts can lead to misdiagnosis. Regular follow-up is needed if upfront surgery lacks evidence of malignancy and is deemed inappropriate at first. In cystic lesions or small lesions, it is sometimes difficult to make a clinical decision between surgery and follow-up based on imaging alone. Rash decision might result in unnecessary surgery or disease progression. Novel diagnostic tools might provide insights into the decision- making of these patients.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48323378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Cattaneo, L. Rosso, I. Righi, G. Croci, P. Mendogni
Background Herein we report a case of thymectomy performed by bilateral hybrid RATS/VATS technique with the Versius Robotic System (CMR Surgical, Cambridge, UK) in a patient affected by thymoma with cystic-necrotic regression and chronic myeloid leukemia (CML) treated with Imatinib. Case Description A 74-year-old woman was referred to our Centre in November 2021 for an occasional finding of anterior mediastinal masses detected by magnetic resonance imaging (MRI)-scan during regular follow-up for benign pancreatic cysts. The patient was asymptomatic, without any neurological signs of myasthenia gravis. She referred a previous history of thyroidectomy for multinodular goiter and CML, for which she assumed Levotiroxin and Imatinib. Computed tomography (CT)-scan confirmed the presence of a 5.5 cm left-sided dishomogeneous mediastinal mass and a 3 cm right paracardiac partially cystic lesion. Both masses had an increased fluorodeoxyglucose (FDG) uptake at the CT/positron emission tomography (PET)-scan with SUVmax 9.8 for the left lesion and SUVmax 3.6 for the right one. Therefore, the patient underwent surgical radical thymectomy with hybrid bilateral technique: we used the Versius Robotic System (three-port technique) for exeresis of the left masses and we performed a standard three-port thoracoscopy to complete the dissection of the second lesion on the right side. The procedure was uneventful. Only one left chest tube was positioned and then removed on the 3rd post-operative day. The patient was discharged on 4th post-operative day without any complications. Diagnosis: anatomopathological examination described the left mass as a 5.5×5.4 cm type B2 thymoma (cytokeratin AE1/AE3+, p40+, CD5−, CD117−, CD20−) with aspects (<10%) of B3 thymoma and coagulative necrosis with microcalcification, crystal of cholesterol and lympho-histiocytic phlogosis; macroscopic infiltration into the fatty tissue was highlighted. The right lesion was described as thymic residual with cystic aspect and B2 thymoma outbreak. Conclusions We validated our mini-invasive hybrid robot-assisted thoracoscopic surgery/video-assisted thoracoscopic surgery (RATS/VATS) technique as a feasible and safe surgical approach for complex anterior mediastinal lesions. Moreover, in this case, anatomopathological examination suggests an important role of Imatinib in the cystic-necrotic regression of thymoma; this finding could support further studies involving tyrosine kinase inhibitors (TKI) in the treatment of thymic neoplasms.
在此，我们报告了一例胸腺瘤合并囊性坏死消退和慢性髓性白血病(CML)经伊马替尼治疗的患者，采用双侧杂交RATS/VATS技术和Versius机器人系统(CMR Surgical, Cambridge, UK)进行胸腺切除术。病例描述一名74岁的女性于2021年11月被转介到我们的中心，因为在良性胰腺囊肿的定期随访中，磁共振成像(MRI)扫描偶尔发现前纵隔肿块。患者无症状，无任何重症肌无力的神经学症状。她曾因多结节性甲状腺肿和慢性粒细胞白血病而行甲状腺切除术，她认为是左替罗欣和伊马替尼。计算机断层扫描(CT)证实存在5.5厘米的左侧不均匀纵隔肿块和3厘米的右侧心旁部分囊性病变。两个肿块在CT/正电子发射断层扫描(PET)扫描时均有氟脱氧葡萄糖(FDG)摄取增加，左侧病变SUVmax为9.8，右侧病变SUVmax为3.6。因此，患者采用双侧混合技术行胸腺根治术:我们使用Versius机器人系统(三孔技术)运动左侧肿物，我们使用标准三孔胸腔镜完成右侧第二个病变的解剖。整个过程很顺利。仅放置一根左胸管，并于术后第3天拔除。术后第4天出院，无并发症。诊断:左侧肿块为5.5×5.4 cm B2型胸腺瘤(细胞角蛋白为AE1/AE3+、p40+、CD5−、CD117−、CD20−)，伴B3型胸腺瘤(<10%)，凝固性坏死伴微钙化、胆固醇结晶、淋巴组织细胞炎;肉眼可见脂肪组织浸润。右侧病变为胸腺残余伴囊性面及B2型胸腺瘤爆发。结论:微创机器人辅助胸腔镜/视频辅助胸腔镜混合手术(RATS/VATS)技术是治疗复杂前纵隔病变可行且安全的手术方法。此外，在这种情况下，解剖病理学检查表明伊马替尼在胸腺瘤的囊性坏死消退中起重要作用;这一发现可以支持酪氨酸激酶抑制剂(TKI)治疗胸腺肿瘤的进一步研究。
{"title":"AB011. Thymoma in patient receiving tyrosine kinase inhibitor (TKI) treatment: morphological aspects and surgical approach","authors":"M. Cattaneo, L. Rosso, I. Righi, G. Croci, P. Mendogni","doi":"10.21037/med-22-ab011","DOIUrl":"https://doi.org/10.21037/med-22-ab011","url":null,"abstract":"Background Herein we report a case of thymectomy performed by bilateral hybrid RATS/VATS technique with the Versius Robotic System (CMR Surgical, Cambridge, UK) in a patient affected by thymoma with cystic-necrotic regression and chronic myeloid leukemia (CML) treated with Imatinib. Case Description A 74-year-old woman was referred to our Centre in November 2021 for an occasional finding of anterior mediastinal masses detected by magnetic resonance imaging (MRI)-scan during regular follow-up for benign pancreatic cysts. The patient was asymptomatic, without any neurological signs of myasthenia gravis. She referred a previous history of thyroidectomy for multinodular goiter and CML, for which she assumed Levotiroxin and Imatinib. Computed tomography (CT)-scan confirmed the presence of a 5.5 cm left-sided dishomogeneous mediastinal mass and a 3 cm right paracardiac partially cystic lesion. Both masses had an increased fluorodeoxyglucose (FDG) uptake at the CT/positron emission tomography (PET)-scan with SUVmax 9.8 for the left lesion and SUVmax 3.6 for the right one. Therefore, the patient underwent surgical radical thymectomy with hybrid bilateral technique: we used the Versius Robotic System (three-port technique) for exeresis of the left masses and we performed a standard three-port thoracoscopy to complete the dissection of the second lesion on the right side. The procedure was uneventful. Only one left chest tube was positioned and then removed on the 3rd post-operative day. The patient was discharged on 4th post-operative day without any complications. Diagnosis: anatomopathological examination described the left mass as a 5.5×5.4 cm type B2 thymoma (cytokeratin AE1/AE3+, p40+, CD5−, CD117−, CD20−) with aspects (<10%) of B3 thymoma and coagulative necrosis with microcalcification, crystal of cholesterol and lympho-histiocytic phlogosis; macroscopic infiltration into the fatty tissue was highlighted. The right lesion was described as thymic residual with cystic aspect and B2 thymoma outbreak. Conclusions We validated our mini-invasive hybrid robot-assisted thoracoscopic surgery/video-assisted thoracoscopic surgery (RATS/VATS) technique as a feasible and safe surgical approach for complex anterior mediastinal lesions. Moreover, in this case, anatomopathological examination suggests an important role of Imatinib in the cystic-necrotic regression of thymoma; this finding could support further studies involving tyrosine kinase inhibitors (TKI) in the treatment of thymic neoplasms.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42695188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Peeters, E. Kneepkens, F. Marcuse, Xin Zhang, M. Hochstenbag, J. Maessen, D. Ruysscher
Background Radiotherapy (RT) for thymic epithelial tumors (TET) is indicated postoperatively for advanced/aggressive disease or incomplete resection, or as primary treatment in inoperable patients. In selected patients, proton therapy spares better normal tissues compared to standard photon treatment, and therefore has a high potential to reduce toxicity. The aim of this study is to compare photon and proton plans regarding doses and normal tissue complication probability (NTCP), as a validated surrogate for toxicity. Methods Patients with TET referred for radiotherapy from 08.2019–03.2022 were included. Intensity-modulated proton therapy (IMPT) and volumetric-arc photon therapy (VMAT) plans were compared for mean doses to the lungs (MLD), heart (MHD) and esophagus (MED) (using Wilcoxon signed ranks test), and normal tissue complication probability (NTCP) with endpoints radiation pneumonitis (grade ≥2), cardiac toxicity (major coronary events), acute dysphagia (grade ≥2) and since 03.2022 secondary breast cancer. VMAT plans consisted typically of 2–3 partial 6 MV arcs in the anterior region, and the dose was prescribed to the PTV. IMPT plans were typically administered with 3 or 4 anterior and anterior-oblique beams, using robust optimization. Results Twenty-four TET-patients had a VMAT-IMPT comparison (17 thymoma/4 thymic carcinoma) with Masaoka-Koga stages IIA–IVB. Mean age was 61 years. Average MLD, MHD and MED decreased significantly with IMPT (from 9.4 to 5.4 Gy, from 9.0 tot 6.6 Gy and from 7.4 to 2.0 Gy, respectively). Average NTCP-values for radiation pneumonitis, cardiac toxicity and dysphagia all decreased with IMPT compared to VMAT from 11.6% to 7.1%, from 16.3% to 14.6% and from 15.5% to 3.4%, respectively. Average NTCP-difference favoring proton therapy was 4.5% (range, 0.6% to 15.9%) for radiation pneumonitis, 1.7% (−0.1% to 4.9%) for cardiac toxicity and 12.1% (−0.3% to 43.4%) for dysphagia. Seventeen patients (71%) had a significantly lower NTCP with IMPT for at least one of the endpoints and qualified for reimbursement; 13 of these were treated with protons at our centre. Conclusions IMPT significantly reduced mean doses to lungs, heart and esophagus in all patients compared with VMAT, resulting in a significant reduction of NTCP for at least one endpoint in 71% of patients.
{"title":"AB003. Benefits of proton radiotherapy in thymic epithelial tumors using the model-based approach","authors":"S. Peeters, E. Kneepkens, F. Marcuse, Xin Zhang, M. Hochstenbag, J. Maessen, D. Ruysscher","doi":"10.21037/med-22-ab003","DOIUrl":"https://doi.org/10.21037/med-22-ab003","url":null,"abstract":"Background Radiotherapy (RT) for thymic epithelial tumors (TET) is indicated postoperatively for advanced/aggressive disease or incomplete resection, or as primary treatment in inoperable patients. In selected patients, proton therapy spares better normal tissues compared to standard photon treatment, and therefore has a high potential to reduce toxicity. The aim of this study is to compare photon and proton plans regarding doses and normal tissue complication probability (NTCP), as a validated surrogate for toxicity. Methods Patients with TET referred for radiotherapy from 08.2019–03.2022 were included. Intensity-modulated proton therapy (IMPT) and volumetric-arc photon therapy (VMAT) plans were compared for mean doses to the lungs (MLD), heart (MHD) and esophagus (MED) (using Wilcoxon signed ranks test), and normal tissue complication probability (NTCP) with endpoints radiation pneumonitis (grade ≥2), cardiac toxicity (major coronary events), acute dysphagia (grade ≥2) and since 03.2022 secondary breast cancer. VMAT plans consisted typically of 2–3 partial 6 MV arcs in the anterior region, and the dose was prescribed to the PTV. IMPT plans were typically administered with 3 or 4 anterior and anterior-oblique beams, using robust optimization. Results Twenty-four TET-patients had a VMAT-IMPT comparison (17 thymoma/4 thymic carcinoma) with Masaoka-Koga stages IIA–IVB. Mean age was 61 years. Average MLD, MHD and MED decreased significantly with IMPT (from 9.4 to 5.4 Gy, from 9.0 tot 6.6 Gy and from 7.4 to 2.0 Gy, respectively). Average NTCP-values for radiation pneumonitis, cardiac toxicity and dysphagia all decreased with IMPT compared to VMAT from 11.6% to 7.1%, from 16.3% to 14.6% and from 15.5% to 3.4%, respectively. Average NTCP-difference favoring proton therapy was 4.5% (range, 0.6% to 15.9%) for radiation pneumonitis, 1.7% (−0.1% to 4.9%) for cardiac toxicity and 12.1% (−0.3% to 43.4%) for dysphagia. Seventeen patients (71%) had a significantly lower NTCP with IMPT for at least one of the endpoints and qualified for reimbursement; 13 of these were treated with protons at our centre. Conclusions IMPT significantly reduced mean doses to lungs, heart and esophagus in all patients compared with VMAT, resulting in a significant reduction of NTCP for at least one endpoint in 71% of patients.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46698266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Changlu Wang, Ying Zhao, Qin Zhang, W. Zeng, Tian-Ying Jia, Lei Zhu, Wenqing Fang, X. Fu
Background Optimal pharmaceutical regimen for advanced thymic epithelial tumors (TETs) remains controversial when first-line chemotherapy fails. This retrospective study aims to evaluate the efficacy and safety of anlotinib treatment for patients with relapsed and refractory TETs. Methods Patients with progression disease after failure of platinum-based chemotherapy were enrolled in this study. Anlotinib was orally taken once a day at an initial dose of 12 mg (10 mg when body weight <60 kg). The cycle was repeated every 3 weeks (2 weeks of treatment followed by 1 week rest). There are 3 dose levels (12, 10 and 8 mg), and dose may be reduced to a lower level when grade 3 toxicity occurred. Objective response rate (ORR) and progression-free survival (PFS) were recorded as primary end points, and they were analyzed separately in thymoma (THY) and thymic carcinoma (TC) cohorts. Meanwhile, toxicities were assessed according to CTCAE (version 5.0). Results There were 50 patients enrolled in this study from October 2018 to June 2021 at a median age of 50 (range, 23–79) years old. Patients with THY and TC were 33 (66%) and 17 (34%) respectively. The ORR in THY and TC patients were 33% (11/33) and 41% (7/17), respectively. The median PFS (mPFS) were 7 (95% CI: 5.9–10.2) months in THY patients and 6 (95% CI: 4.6–9.3) months in TC group. Eleven patients experienced dose reduction due to toxicities, among whom, 8 patients discontinued treatment even after dose reduction. Six patients with THY showed myasthenia gravis (MG) deterioration during treatment, and 2 of them died of MG crisis. Conclusions Anlotinib is active in patients with advanced TETs refractory to routine chemotherapy. Prescription of Anlotinib to patients with MG should be made cautiously.
{"title":"AB002. Anlotinib as salvage treatment for patients with relapsed and refractory thymic epithelial tumors","authors":"Changlu Wang, Ying Zhao, Qin Zhang, W. Zeng, Tian-Ying Jia, Lei Zhu, Wenqing Fang, X. Fu","doi":"10.21037/med-22-ab002","DOIUrl":"https://doi.org/10.21037/med-22-ab002","url":null,"abstract":"Background Optimal pharmaceutical regimen for advanced thymic epithelial tumors (TETs) remains controversial when first-line chemotherapy fails. This retrospective study aims to evaluate the efficacy and safety of anlotinib treatment for patients with relapsed and refractory TETs. Methods Patients with progression disease after failure of platinum-based chemotherapy were enrolled in this study. Anlotinib was orally taken once a day at an initial dose of 12 mg (10 mg when body weight <60 kg). The cycle was repeated every 3 weeks (2 weeks of treatment followed by 1 week rest). There are 3 dose levels (12, 10 and 8 mg), and dose may be reduced to a lower level when grade 3 toxicity occurred. Objective response rate (ORR) and progression-free survival (PFS) were recorded as primary end points, and they were analyzed separately in thymoma (THY) and thymic carcinoma (TC) cohorts. Meanwhile, toxicities were assessed according to CTCAE (version 5.0). Results There were 50 patients enrolled in this study from October 2018 to June 2021 at a median age of 50 (range, 23–79) years old. Patients with THY and TC were 33 (66%) and 17 (34%) respectively. The ORR in THY and TC patients were 33% (11/33) and 41% (7/17), respectively. The median PFS (mPFS) were 7 (95% CI: 5.9–10.2) months in THY patients and 6 (95% CI: 4.6–9.3) months in TC group. Eleven patients experienced dose reduction due to toxicities, among whom, 8 patients discontinued treatment even after dose reduction. Six patients with THY showed myasthenia gravis (MG) deterioration during treatment, and 2 of them died of MG crisis. Conclusions Anlotinib is active in patients with advanced TETs refractory to routine chemotherapy. Prescription of Anlotinib to patients with MG should be made cautiously.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47227872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
X. Mielgo-Rubio, S. Hernando Polo, Elisabeth Jiménez Aguilar, C. Olier Garate, Alicia Hurtado Nuño, D. Moreno Muñoz, Maria Virginia Sánchez Becerra, A. G. González López, Mónica Esteban García, Teresa Robles Bermejo, M. Barón, F. Hernando Trancho, Jose Ramón Jarabo, Juan Carlos Cámara Vicario
Background Management of advanced malignant thymoma is very challenging due to the lack of evidence from randomized trials. Despite advanced and non-curable status, most patients achieve long survival and they usually receive several treatment lines along their disease. There is no standard second line, and toxicity of chemotherapy (CT) should be considered for these long survivors. Treatment with somatostatin analogs showed efficacy in patients with refractory recurrent and/or metastatic thymomas. Case Description In January 2010, a 31-year-old woman was diagnosed of a mass in the anterior mediastinum with a biopsy compatible with thymoma B3 and myasthenia gravis. Thymoma was resected after 2 cycles of neoadjuvant CT with acronym: cisplatin, doxorrubicin, vincristine and cyclophosphamide (ADOC) schedule, then she received additional adjuvant ADOC. Disease progressed on November 2012 with pleural implants and lung nodule in upper right lobe. After 6 cycles of systemic CT with carboplatin and etoposide and major partial response, she was operated on twice on November 2013 and March 2014 with resection of residual disease in lung and pleura. After new pleural disease progression 14 months later (May 2015), new surgical resection was dismissed and received several rounds of retreatment with carboplatin and etoposide with rest periods between them. After each course of this CT, the patient presented a tumor response, but in the last cycles she began to present significant bone marrow toxicity. After the last significant progression in November 2021, it was decided to assess a low-toxic treatment alternative to CT, and despite no uptake in the octreotide scan, octreotide 30 mg IM every 28 days was started achieving stable disease according to RECISTv1 criteria (progression-free interval of 9 months to date) and good tolerance. Diagnosis: long survivor patient with advanced thymoma with pleural relapsing disease treated with several rounds of chemotherapy and response to octreotide instead of no uptake in the octreotide scan. Conclusions Somatostatin analogs can be a low-toxic treatment option in pretreated advanced thymoma patients regardless the octreotide scan uptake. This treatment should be studied in prospective clinical trials.
{"title":"AB014. Effective somatostatin analogs in a case of advanced thymoma with no uptake in the octreotide scan","authors":"X. Mielgo-Rubio, S. Hernando Polo, Elisabeth Jiménez Aguilar, C. Olier Garate, Alicia Hurtado Nuño, D. Moreno Muñoz, Maria Virginia Sánchez Becerra, A. G. González López, Mónica Esteban García, Teresa Robles Bermejo, M. Barón, F. Hernando Trancho, Jose Ramón Jarabo, Juan Carlos Cámara Vicario","doi":"10.21037/med-22-ab014","DOIUrl":"https://doi.org/10.21037/med-22-ab014","url":null,"abstract":"Background Management of advanced malignant thymoma is very challenging due to the lack of evidence from randomized trials. Despite advanced and non-curable status, most patients achieve long survival and they usually receive several treatment lines along their disease. There is no standard second line, and toxicity of chemotherapy (CT) should be considered for these long survivors. Treatment with somatostatin analogs showed efficacy in patients with refractory recurrent and/or metastatic thymomas. Case Description In January 2010, a 31-year-old woman was diagnosed of a mass in the anterior mediastinum with a biopsy compatible with thymoma B3 and myasthenia gravis. Thymoma was resected after 2 cycles of neoadjuvant CT with acronym: cisplatin, doxorrubicin, vincristine and cyclophosphamide (ADOC) schedule, then she received additional adjuvant ADOC. Disease progressed on November 2012 with pleural implants and lung nodule in upper right lobe. After 6 cycles of systemic CT with carboplatin and etoposide and major partial response, she was operated on twice on November 2013 and March 2014 with resection of residual disease in lung and pleura. After new pleural disease progression 14 months later (May 2015), new surgical resection was dismissed and received several rounds of retreatment with carboplatin and etoposide with rest periods between them. After each course of this CT, the patient presented a tumor response, but in the last cycles she began to present significant bone marrow toxicity. After the last significant progression in November 2021, it was decided to assess a low-toxic treatment alternative to CT, and despite no uptake in the octreotide scan, octreotide 30 mg IM every 28 days was started achieving stable disease according to RECISTv1 criteria (progression-free interval of 9 months to date) and good tolerance. Diagnosis: long survivor patient with advanced thymoma with pleural relapsing disease treated with several rounds of chemotherapy and response to octreotide instead of no uptake in the octreotide scan. Conclusions Somatostatin analogs can be a low-toxic treatment option in pretreated advanced thymoma patients regardless the octreotide scan uptake. This treatment should be studied in prospective clinical trials.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49309368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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