Multimodality therapy for thymoma patients with pleural dissemination

  • Shota NakamuraEmail author
  • Koji Kawaguchi
  • Takayuki Fukui
  • Shuhei Hakiri
  • Naoki Ozeki
  • Shunsuke Mori
  • Masaki Goto
  • Kumiko Hashimoto
  • Toshinari Ito
  • Kohei Yokoi
Original Article



Although multidisciplinary treatment is recommended for patients with advanced stage and recurrent thymoma, a detailed treatment strategy remains controversial. We have performed a multimodality therapy of induction chemotherapy (CAMP therapy: cisplatin, doxorubicin, and methylprednisolone) combined with surgery for those patients. We now conducted a retrospective study for investigating the results of this multimodality therapy for thymoma patients with pleural dissemination.

Patients and methods

Between 2003 and 2017, 201 patients underwent surgical resection for thymomas. Twenty-six of them received induction CAMP therapy followed by surgery, and 19 of them with pleural dissemination were enrolled in this study. Those cohort were divided into 2 groups by employing surgical procedures: extrapleural pneumonectomy (EPP) group (n = 10) and resection of plural dissemination (RPD) group (n = 9).


The median age of all patients was 49 years. Based on the WHO classification, the histological diagnoses of those thymomas were as follows: Type B1 (n = 1), Type B2 (n = 13), and Type B3 (n = 5). Seven patients were complicated with myasthenia gravis (MG). Clinical stage of the 13 primary cases based on the Masaoka classification were stage IV, and the remaining six cases had recurrent pleural dissemination after surgery. Partial response in induction CAMP therapy was obtained in 78.9% (n = 15) of the patients. Adverse events (Grade 4) occurred in 2 patients (10.5%). Postoperative complications (Grade 4) were observed in 2 patients (10.5%). In all of the enrolled patients, the five-year overall survival rate (5Y-OS) and 5-year progression-free survival rate (5Y-PFS) were 76.7% and 55.1%, respectively. In the EPP group, 5Y-OS and 5Y-PFS were 83.3% and 83.3%, respectively, and in the RPD group, 70.0% and 29.6%, respectively.


Multidisciplinary treatment using induction CAMP therapy and surgical resection for thymoma patients with pleural dissemination was effective and feasible. Because of the low recurrent rate of disease, young patients with good cardiopulmonary function and well-controlled MG might be good candidates for EPP.


Thymic malignancy Thymoma Multidisciplinary treatment Pleural dissemination Induction chemotherapy 


Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.


  1. 1.
    Block MI. Thymoma. In: Pearson F, Cooper J, Deslauriers J et al. Thoracic surgery. 2nd ed, vol 63. Philadelphia: Churchill Livingstone; 2002. pp. 1688–96.Google Scholar
  2. 2.
    Yokoi K, Kondo K, Fujimoto K, Hara M, Kadota Y, Kawaguchi K, et al. JLCS medical practice guidelines for thymic tumors: summary of recommendations. Jpn J Clin Oncol. 2017;47:1119–22.CrossRefGoogle Scholar
  3. 3.
    Rubin M, Straus B, Allen L. Clinical disorders associated with thymic tumors. Arc Intern Med. 1964;114:389–98.CrossRefGoogle Scholar
  4. 4.
    Ishikawa Y, Matsuguma H, Nakahara R, Suzuki H, Ui A, Kondo T, et al. Multimodality therapy for patients with invasive thymoma disseminated into the pleural cavity: the potential role of extrapleural pneumonectomy. Ann Thorac Surg. 2009;88:952–7.CrossRefGoogle Scholar
  5. 5.
    Yokoi K, Matsuguma H, Nakahara R, Kondo T, Kamiyama Y, Mori K, et al. Multidisciplinary treatment for advanced invasive thymoma with cisplatin, doxorubicin, and methylprednisolone. J Thorac Oncol. 2007;2:73–8.CrossRefGoogle Scholar
  6. 6.
    Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48:2485–92.CrossRefGoogle Scholar
  7. 7.
    Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. Introduction to the 2015 World Health Organization classification of tumors of the lung, pleura, thymus, and heart. J Thorac Oncol. 2015;10:1240–2.CrossRefGoogle Scholar
  8. 8.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 2009;45:228–47.CrossRefGoogle Scholar
  9. 9.
    Kim ES, Putnam JB, Komaki R, Walsh GL, Ro JY, Shin HJ, et al. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas. Lung cancer. 2004;44:369–79.CrossRefGoogle Scholar
  10. 10.
    Loehrer Sr PJ, Kim K, Aisner SC, Livingston R, Einhorn LH, Johnson D, et al. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. The Eastern Cooperative Oncology Group, Southwest Oncology Group, and Southeastern Cancer Study Group. J Clin Oncol. 1994;12:1164–8.CrossRefGoogle Scholar
  11. 11.
    Fornasiero A, Daniele O, Ghiotto C, Piazza M, Fiore-Donati L, Calabro F, et al. Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991;68:30–3.CrossRefGoogle Scholar
  12. 12.
    Kunitoh H, Tamura T, Shibata T, Nakagawa K, Takeda K, Nishiwaki Y, et al. JCOG Lung Cancer Study Group. A phase-II trial of dose-dense chemotherapy in patients with disseminated thymoma: report of a Japan Clinical Oncology Group trial (JCOG 9605). Br J Cancer. 2009;101:1549–54.CrossRefGoogle Scholar
  13. 13.
    Wright CD. Pleuropneumonectomy for the treatment of Masaoka stage IVA thymoma. Ann Thorac Surg. 2006;82:1234–9.CrossRefGoogle Scholar
  14. 14.
    Yang HC, Yoon YS, Kim HK, Choi YS, Kim K, Shim YM, et al. En bloc extended total thymectomy and extrapleural pneumonectomy in Masaoka stage IVA thymomas. J Cardiothorac Surg. 2011;6:28.CrossRefGoogle Scholar
  15. 15.
    Okuda K, Yano M, Yoshino I, Okumura M, Higashiyama M, Suzuki K, et al. Thymoma patients with pleural dissemination: nationwide retrospective study of 136 cases in Japan. Ann Thorac Surg. 2014;97:1743–8.CrossRefGoogle Scholar
  16. 16.
    Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;76:878–84.CrossRefGoogle Scholar
  17. 17.
    Ruffini E, Detterbeck F, Van Raemdonck D, Rocco G, Thomas P, Weder W, et al. Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database. Eur J Cardio-Thorac Surg. 2014;46:361–8.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryNagoya University Graduate School of MedicineNagoyaJapan

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