Mediastinum (Hong Kong, China)最新文献

{"title":"AB004. Radiotherapy for thymic epithelial tumors: what is the optimal dose?—a systematic review","authors":"A. Angrisani, R. Houben, F. Marcuse, M. Hochstenbag, J. Maessen, D. de Ruysscher, S. Peeters","doi":"10.21037/med-22-ab004","DOIUrl":"https://doi.org/10.21037/med-22-ab004","url":null,"abstract":"Background Thymic epithelial tumors (TETs) are rare thoracic tumors, often requiring multimodal approaches. Surgery represents the first step of the treatment, possibly followed by adjuvant radiotherapy (RT) and, less frequently, chemotherapy. For unresectable tumors, a combination of chemotherapy and RT is often used. Currently, the optimal dose for patients undergoing radiation is not clearly defined. The available guidelines’ recommendations on RT are based on studies with a low level of evidence, where two-dimensional (2D)-RT was widely used. Methods A systematic review of the recent literature regarding the optimal radiation dose for patients with TETs undergoing RT was carried out. It included reports using modern RT techniques such as 3D-CRT, intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT), or proton therapy. A comprehensive literature search of four databases was conducted following the PRISMA guidelines. Two investigators independently screened and reviewed the retrieved references. Reports with <20 patients, 2D-RT use only, median follow-up time 3 years, three additional studies could be evaluated. A total of 193 patients were analyzed, stratified for prognostic factors (histology, stage, and completeness of resection), and synthesized according to the SWIM method. The paucity and heterogeneity of eligible studies led to controversial results. Overall, a dose escalation for post-operative RT beyond 50 Gy is not recommended for totally resected tumors, platinum-based chemo plus concurrent RT >54 Gy is recommended for unresectable TETs, while a dose below 52 Gy has been defined as \"palliative\" for recurrent TETs. Conclusions The optimal RT dose for postoperative or primary RT in the era of modern RT did not univocally emerge. Current recommendations remain valid. Doses of 54 Gy or higher can be recommended for definitive RT only. Conversely, this overview can spark new evidence to define the optimal RT dose for each TETs category.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43862237","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}

{"title":"AB001. Surgical resection followed by entire hemithorax irradiation in patients with stage IVa thymoma: preliminary result of a prospective phase II study","authors":"Changlu Wang, Qin Zhang, Xiao-long Fu, Z. Gu, T. Mao, W. Fang","doi":"10.21037/med-22-ab001","DOIUrl":"https://doi.org/10.21037/med-22-ab001","url":null,"abstract":"Background The aim of this study is to evaluate the safety and tumor-control effect of macroscopically surgical resection plus low-dose hemithorax irradiation in this group of patients. Methods This clinical trial was registered in April 2020 (ChiCTR2000035540). Patients enrolled in this study meet the following criteria: (I) pathologically confirmed thymoma, (II) with pleural dissemination (de-novo or recurrence), (III) removal of all visible lesions by surgical resection, (IV) age between 18 and 75 years. Radiotherapy was carried out 4–6 weeks after surgery via intensity modulated radiotherapy (IMRT) technique. The clinical target volume (CTV) covered the entire ipsilateral pleura and lung structure. A 4–6 mm margin was added beyond CTV to form the planning target volume (PTV). The radiation dose was 14 Gy in 14 fractions. A boost radiation (30 Gy/15 fraction) will be delivered to mediastinal tumor bed if the T stage is beyond T2. Progression-free survival (PFS) and toxicity were recorded as main end-points. Results From April 2020 to July 2021, a total of 65 patients have been enrolled in this trial. There were 29 male and 36 female patients with the age ranging between 27 and 75 years. The pathological subtypes were A (n=2), AB (n=2), B1 (n=11), B2 (n=23) and B3 (n=27), respectively. Thirty-five patients received previous surgery and developed pleural recurrence before this study, and 27 of them also underwent mediastinal tumor bed radiotherapy (≤50 Gy). The other 30 patients were diagnosed as primary thymoma with pleural dissemination. After surgery, 61 patients completed the hemithorax radiotherapy without severe side effects. The most common adverse events were fatigue, appetite loss and vomiting, and most of them were mild. Two patients suspended treatment at 6 Gy due to fatigue and resumed the therapy after 1–2 weeks of rest. One patient discontinued treatment due to grade 3 thrombocytopenia at 6 Gy, another patient discontinued treatment due to weakness at 8 Gy. After a median follow-up of 18 (10–25) months, 5 (7.7%) patients developed pleural recurrence. By the cut-off time, the disease control rate is 92.3%. Conclusions Prophylactic entire hemithorax radiotherapy after surgical resection is a safe and effective treatment modality for patients with stage IVa thymoma.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43423868","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}

{"title":"AB010. Clinical significance of serum Cyfra 21-1 as a marker in thymic epithelial tumors","authors":"Xiuxiu Hao, Xuefei Zhang, Wen-xu Fang","doi":"10.21037/med-22-ab010","DOIUrl":"https://doi.org/10.21037/med-22-ab010","url":null,"abstract":"Background There have been no specific serum biomarkers for thymic epithelial tumors (TETs) yet. The study aimed to explore the diagnostic and prognostic value of potentially relevant serum tumor markers in TETs. Methods We retrospectively analyzed the database of our own with the aim of reviewing the clinical records of 301 patients who have a thymic epithelial tumor after radical thymectomy, in the period between November 2012 and December 2017. Logistic regression analysis was used to evaluate relationships between tumor markers and tumor characteristics. Cox regression analysis and Kaplan Meier analysis were used to evaluate free-from-recurrence (FFR) in complete resected (R0) patients. Results There were 231 (76.7%) thymoma patients, 70 (23.3%) thymic carcinomas (TCs) and neuroendocrine thymic tumors (NETTs) patients in the study. The carcinoembryonic antigen (CEA), Cyfra 21-1, squamous cell carcinoma (SCC) antigen, neuron-specific enolase (NSE), and cancer antigen 125 (CA125) levels were evaluated. Elevated Cyfra 21-1, older age, higher T stage, and N stage were associated with TCs and NETTs in multivariable logistic regression analysis. In 222 patients who received R0 resection without neoadjuvant therapy, elevated Cyfra 21-1, higher T stage, and TCs and NETTs were associated with a poorer 5-year FFR in Cox regression analysis. There were significant differences in 5-year FFR between an elevated Cyfra 21-1 level and a normal Cyfra 21-1 level (42.9% vs. 92.4%, P<0.001). As for histological subtypes, TCs and NETTs were associated with a poorer 5-year FFR than thymomas (59.8% vs. 95.0%, P<0.001). Conclusions Serum Cyfra 21-1 level could be a potential tumor marker in the diagnosis of thymic carcinomas and NETTs, and the prognosis of recurrence.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48825568","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}

{"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":" ","pages":""},"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}

{"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":" ","pages":""},"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}

{"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":" ","pages":""},"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}

{"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":"6 1","pages":""},"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}

{"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":" ","pages":""},"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}

{"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":" ","pages":""},"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}

{"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":" ","pages":""},"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}