1. Susman, Ed

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PHOENIX-Repeat surgeries for recurrent thymic cancer-sometimes even multiple surgeries-can still achieve a complete RO resection, researchers reported at the 52nd annual meeting of the Society of Thoracic Surgeons in Phoenix.

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"Surgery and iterative surgery achieve better survival rates compared with chemotherapy and radiation therapy alone in patients with recurrence and re-recurrences after complete resection," said Antonio D'Andrilli, MD, an Oncology Thoracic Surgery Specialist at University of Rome's La Sapienza Sant'Andrea Hospital.


"Surgery should always be performed when technically feasible," he urged in his poster presentation.


Study Results

In the retrospective, multicenter study, D'Andrilli examined outcomes among 53 patients who experienced recurrence and/or re-recurrences after complete resection of thymic tumors. Data, including demographics, stage, type of treatment, pathology, and survival were statistically analyzed.


The study revealed 32 of the 53 patients with re-recurrences underwent surgery with curative intent. Among this group, 22 had a second recurrence and an R0 re-resection was achieved in 10 of these cases. Radical resection was also obtained in 6 of 8 patients with a third recurrence; and complete resection was achieved in 3 of 5 patients who had a fourth recurrence.


Surgically treated patients had a significantly better survival than non-surgically treated patients (P<0.0001), D'Andrilli reported. Survival rates were significantly higher after complete resection than after incomplete resection (P<0.0001). Patients undergoing surgery for a single recurrence had a better survival rate than those operated for multiple recurrences (P = 0.02).


The 21 patients undergoing chemo/radiotherapy alone or debulking showed worse survival rates than those receiving surgery for single (P<0.0001) and for multiple recurrences (P=0.02). Patients having more than one recurrence had a median survival of 176 months and showed a significantly better prognosis if radically resected (P=0.01) compared with debulking or no surgery.


According to Stephen D. Cassivi, MD, a Thoracic Surgeon and Professor of Surgery at the Mayo Clinic, Rochester, Minn., "This is not a surprising finding. This retrospective study illustrates good judgment on the surgeon's part in selecting patients who are likely to survive if they get a good surgery; they have chosen people who have resectable disease and favorable prognosis and have followed through on providing them with the surgery they needed. This is a good study; it provides further basis for what we already do with these patients."


Cassivi explained that the thymus gland sits behind the sternum and preforms immune functions during gestation and in the first few years of life, but then the responsibilities of the gland are transferred to other parts of the body such as the bone marrow or the spleen. "As we get older, not only does the thymus gland function diminish, but its relative size diminishes and may even regress in size. In some cases, for reasons unknown at this time, people develop tumors of the thymus gland," he explained.


Some of these tumors are squamous cell carcinomas and "can be invasive and problematic", Cassivi noted. "If they are early stage tumors, surgery is the right treatment and a very effective treatment."


Recurrence, is cancer stage-related. "The earlier they are treated the less likely they are to recur; the later the stage, the more likely they will recur," Cassivi said.


"These cancers can become locally invasive and metastatic," he concluded. "In general, in appropriately selected patients, recurrence should be resected when these events occur, taking into account the particulars of the patients and the particulars of where the recurrences occurs."


Ed Susman is a contributing writer.