The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

A Multidisciplinary Approach to Therapy for Unresectable Malignant Thymoma

Dong M. Shin, MD; Garrett L. Walsh, MD; Ritsuko Komaki, MD; Joe B. Putnam, MD; Jonathan Nesbitt, MD; Jae Y. Ro, MD, PhD; Hyung Ju C. Shin, MD; Keun H. Ki, MD; Amanda Wimberly, RN, BSN; Katherine M.W. Pisters, MD; David Schrump, MD; Mary Ann Gregurich, PhD; James D. Cox, MD; Jack A. Roth, MD; and Waun Ki Hong, MD
[+] Article, Author, and Disclosure Information

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(2):100-104. doi:10.7326/0003-4819-129-2-199807150-00006
Text Size: A A A

Background: The therapeutic outcome for unresectable, locally advanced, malignant thymoma has been poor.

Objective: To improve tumor resectability and patient survival rates by studying a multimodal approach to therapy for unresectable malignant thymoma.

Design: Prospective cohort study.

Setting: Tertiary care cancer center.

Participants: All eligible patients had newly diagnosed, histologically proven, unresectable malignant thymoma.

Intervention: The treatment regimen consisted of induction chemotherapy (three courses of cyclophosphamide, doxorubicin, cisplatin, and prednisone), surgical resection, postoperative radiation therapy, and consolidation chemotherapy (three courses of cyclophosphamide, doxorubicin, cisplatin, and prednisone). Tissue samples were taken at the time of surgical resection for assessment of tumor necrosis and Ki-67 expression.

Measurements: Tumor response and resectability (both overall and after induction chemotherapy) and disease-free survival rate in patients who received multimodal therapy.

Results: 13 patients were consecutively enrolled from February 1990 to December 1996, and 12 evaluable patients were assessed for response. Disease responded to induction chemotherapy completely in 3 patients (25%) and partially in 8 patients (67%); 1 patient had a minor response (8%). Eleven patients had surgical resection; 1 refused surgery. Tumors were removed completely in 9 (82%) and incompletely in 2 (18%) of 11 patients who had been receiving radiation therapy and consolidation chemotherapy. All 12 patients are alive (100% at 7 years), with a median follow-up of 43 months, and 10 patients are disease free (73% disease-free survival at 7 years). A high correlation was seen between tumor necrosis after induction chemotherapy and Ki-67 expression (r = −0.88).

Conclusions: Aggressive multimodal treatment is highly effective and may cure locally advanced, unresectable malignant thymoma.


Grahic Jump Location
Figure 1.
Treatment schema and outcome for patients with locally advanced unresectable thymoma (stage III or IVA).

Numbers in parentheses are numbers of patients.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.