Background: Invasive thymoma is a rare mediastinal tumor. Clinicopathological characteristics that influence survival of patients with this tumor are under debate. Treatment is based on tumor resection. The benefice of therapies, such as radiation therapy (RT) and/or chemotherapy (CT) as adjuvant treatments to surgery, or palliative therapy to unresectable or recurrent thymoma are discussed. Objectives: The aim of this study was to assess patients with invasive thymoma, with specific emphasis on factors predicting survival. Methods: We studied retrospectively 23 patients with invasive thymoma. Parameters assessed were age, presenting symptoms, histological features, stage at diagnosis, treatment modalities and survival. All patients received primary therapy: 11 patients (48%) had tumor resection associated with CT and/or RT, while 12 patients had palliative therapy including RT and/or CT. Regimens for CT were based on cisplatin. Results: Patients’ mean age was 58 years. Three patients had stage II disease at diagnosis (13%), 8 patients had stage III (35%) and 12 patients had stage IV (52%). Median overall survival was 20 months (range: 4–160) and five-year survival rate was 43.5% (10 patients). Surgical resection had a significant impact on survival (p < 0.0001). Survival was also related to stage of the disease at diagnosis (p = 0.006), but not to histology of the tumor (p = 0.12). Salvage treatment was of clinical importance: 5 out of 15 patients (33.3%) who relapsed during a 5-year follow-up responded to a multimodality therapeutic approach that affected survival (p = 0.019). Conclusion: Factors determining the outcome of these tumors are the stage of the disease at diagnosis, and the adequacy of surgical removal. Salvage treatment of recurrent thymoma may give a moderate response rate and improve survival.

Gray GF, Gutowski WT: Thymoma: A clinicopathologic study of 54 cases. Am J Surg Pathol 1979:3:235–249.
Masaoka A, Monden Y, Nakahara K, Tanioka T: Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981;48:2485–2492.
Cohen DJ, Ronnigen LD, Graeber GM, Deshong JL, Jaffin J, Burge JR, Zajtchuk R: Management of patients with malignant thymoma. J Thorac Cardiovasc Surg 1984;87:301–307.
Gamondès JP, Balawi A, Greenland T, Adleine P, Mornex JF, Zhang J, Maret G: Seventeen years of surgical treatment of thymoma: Factors influencing survival. Eur J Cardiothorac Surg 1991;5:124–131.
Maggi G, Giaccone G, Donadio M, Ciuffreda L, Dalesio O, Leria G, Trifiletti G, Casadio C, Palestro G, Mancuso M, Calciati A: Thymoma: A review of 169 cases, with particular reference to results of surgical treatment. Cancer 1986;58:765–776.
Curran WJJ, Kornstein MJ, Brooks JJ, Turrisi AT: Invasive thymoma: The role of mediastinal irradiation following complete or incomplete surgical resection. J Clin Oncol 1988;6:1722–1727.
Fornasiero A, Daniele O, Ghiotto C, Piazza M, Fiore-Donati L, Calabro F, Rea F, Fiorentino MV: Chemotherapy for invasive thymoma. A 13 years’ experience. Cancer 1991;68:30–33.
Giaccone G, Ardizzoni A, Kirkpatrick A, Clerico M, Sahmoud T, van Zanddwijk N: Cisplatin and etoposide combination chemotherapy for locally advanced or metastatic thymoma: A phase 2 study of the European Organisation for Research and Treatment of Cancer, Lung Cancer Cooperative Group. J Clin Oncol 1996;14:814–820.
Cowen D, Richaud P, Mornex F, Bachelot T, Jung GM, Mirabel X, Marchal C, Lagrange JL, Rambert P, Chaplain G, N’Guyen TD, Resbeut M: Thymoma: Results of a multicentric retrospective series of 149 non-metastatic irradiated patients and review of the literature. Radiother Oncol 1995;34:9–16.
Ciernik IF, Cierni K, Meier U, Lütolf UM: Prognostic factors and outcome of incompletely resected invasive thymoma following radiation therapy. J Clin Oncol 1994;12:1484–1490.
Froudarakis ME, Fournel P, Tiffet O, Croisier P, Bocquel V, Court-Fortune I, Vergnon JM, Cuilleret J, Emonot A: Should physicians insist in treating invasive malignant thymoma? Eur Respir J 1998;12(suppl 28):414s.
Bernatz PE, Harrison EG, Clagett OT: Thymoma: A clinicopathologic study. J Thorac Cardiovasc Surg 1961;42:424–433.
Lewis JE, Wick MR, Scheithauer BW, Bernatz PE, Taylor WF: Thymoma: A clinicopathological review. Cancer 1987;60:2727–2743.
Morgenthaler TI, Brown LR, Colby TV, Harper CMJ, Coles DT: Thymoma. Mayo Clin Proc 1993;68:1110–1123.
Park HS, Shin DM, Lee JS, Komaki R, Pollack A, Putnam JB, Cox JD, Hong WK: Thymoma: A retrospective study of 87 cases. Cancer 1994;73:2491–2498.
Salyer WR, Eggleston JC: Thymoma: A clinical and pathological study of 65 cases. Cancer 1976;37:229–249.
Marino M, Müller-Hermelink HK: Thymoma and thymic carcinoma: Relation of thymoma epithelial cells to the cortical and medullar differentiation of thymus. Virchows Arch 1985;407:119–149.
Pescarmona E, Rendina EA, Venuta F, Ricci C, Ruco LP, Baroni CD: The prognostic implication of thymoma in histologic subtyping: A study of 80 consecutive cases. Am J Clin Pathol 1990;93:190–195.
Quantanilla-Martinez L, Wilkins Jr EW, Choi N, Efird J, Hug E, Harris NL: Thymoma: Histologic subclassification is an independent prognostic factor. Cancer 1994;74:606–617.
Suster S, Moran CA: Thymoma, atypical thymoma, and thymic carcinoma. A novel conceptual approach to the classification of thymic epithelial neoplasms. Am J Clin Pathol 1999;111:826–833.
Suster S, Moran CA: Primary thymic epithelial neoplasms: Spectrum of differentiation and histological features. Semin Diagn Pathol 1999;16:2–17.
Yamakawa Y, Masaoka A, Hashimoto T, Niwa H, Mizuno T, Fujii Y: A tentative tumor-node-metastasis classification of thymoma. Cancer 1991;68:1984–1987.
Sugiura H, Morikawa T, Ito K, Ono K, Okushiba S, Satoshi K, Katoh H: Long-term results of surgical treatment for invasive thymoma. Anticancer Res 1999;19:1433–1437.
Nakahara K, Ohno K, Hashimoto J, Maeda H, Miyoshi S, Sakurai M, Monden Y, Kawashima Y: Thymoma: Results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients. J Thorac Cardiovasc Surg 1988;95:1041–1047.
Mornex F, Resbeut M, Richaud P, Jung GM, Mirabel X, Marchal C, Lagrange JL, Rambert P, Chaplain G, Nguyen TD: Radiotherapy and chemotherapy for invasive thymomas: A multicentric retrospective review of 90 cases. Int J Radiat Oncol Biol Phys 1995;32:651–659.
Maggi G, Casadio C, Cavallo A, Cianci R, Mollinatti M, Ruffini E: Thymoma: Results of 241 operated cases. Ann Thorac Surg 1991;51:152–156.
Fornasiero A, Daniele O, Ghiotto C, Sartori F, Rea F, Piazza M, Fiore-Donati L, Morandi P, Aversa SML, Paccagnella A, Pappagallo GL, Fiorentino MV: Chemotherapy of invasive thymoma. J Clin Oncol 1990;8:1419–1423.
Thomas CR, Wright CD, Loehrer PJ: Thymoma: State of the art. J Clin Oncol 1999;17:2280–2290.
Hejna M, Haberl I, Raderer M: Nonsurgical management of malignant thymoma. Cancer 1999;85:1871–1884.
Loehrer PJ, Kim KM, Aisner SC, Livingston R, Einhorn LH, Johnson D, Blum R: Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: Final results of an intergroup trial. J Clin Oncol 1994;12:1164–1168.
Loehrer PJ, Chen M, Kim KM, Aisner SC, Einhorn LH, Livingston R, Johnson D: Cisplatin, doxorubicin and cyclophosphamide plus thoracic radiation therapy for limited-stage unresectable thymoma: An intergroup trial. J Clin Oncol 1997;15:3093–3099.
Monden Y, Nakahara K, Iioka S, Nanjo S, Ohno K, Fujii Y, Hashimoto J, Kitagawa Y, Masaoka A, Kawashima Y: Recurrence of thymoma: Clinicopathological features, therapy and prognosis. Ann Thorac Surg 1985;39:165–169.
Kirchner PA: Reoperation for thymoma: Report of 23 cases. Ann Thorac Surg 1990;49:550–555.
Loehrer PJ: Current approaches to the treatment of thymoma. Ann Med 1999;31(suppl 2):73–79.
Langenfeld J, Graeber GM: Current management of thymoma. Surg Oncol Clin N Am 1999;8:327–339.
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