Adaptive Radiation Therapy for Intact Thymoma: An Illustrative Report.

BACKGROUND/AIM: Adaptive radiation therapy (ART) is a technique capable of reducing radiation dose to normal tissue without compromising local control. For potentially resectable thymoma, induction therapy is standard of care. Because large disease volume is common in this context, ART has been suggested to reduce toxicity from induction chemoradiation. This has not been previously illustrated in the literature. CASE REPORT: A 38-year-old man with initially unresectable thymoma was treated with induction chemoradiation including cisplatin and etoposide. He received 45 Gy in 25 fractions and ART was utilized to shrink the radiotherapy field for the final 10 fractions. RESULTS: Thymectomy showed Masaoka stage III disease with negative margins. He experienced no treatment-related toxicity and has no evidence of disease 8 years after diagnosis. CONCLUSION: Induction chemoradiotherapy with ART appears to be feasible, safe, and efficacious for locally advanced intact thymoma.

Cystic and Encapsulated Atypical Thymoma (World Health Organization Type B3).

OBJECTIVES: Eight cases of encapsulated and cystic atypical thymomas (World Health Organization type B3) are presented. METHODS: Cases were identified after review of more than 500 thymomas. Histologic material from surgical resections was evaluated. RESULTS: The patients are seven men and one woman aged 43 to 71 years. Seven patients presented with nonspecific symptoms while one mass was found on autopsy. The tumors were 4 to 6 cm in greatest dimension and showed prominent cystic changes with an epithelial proliferation arranged in sheets and cords. Increased mitotic activity and nuclear pleomorphism were not identified. All tumors were encapsulated. Immunohistochemical studies showed the tumor cells positive for keratin cocktail, keratin 5/6, and p63. Clinical follow-up was available in five patients. All were alive without recurrence. CONCLUSIONS: These cases represent an unusual variant of atypical thymoma that can be misdiagnosed as thymic carcinoma or multilocular thymic cyst. Awareness of this histologic growth pattern is important for accurate diagnosis.

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma.

Thymoma remains the most common primary anterior mediastinal neoplasm. Surgical resection remains central to the treatment of thymoma, with thoracoscopic thymectomy (TT) being increasingly performed. This present review article aimed to summarize current studies comparing TT and open thymectomy (OT). Recently, most patients with Masaoka stage I-II thymoma have been receiving TT. This procedure is associated with a significantly shorter post-operative hospital stay, decreased intraoperative blood loss, and fewer complications compared with OT. Recurrence rates of thymoma after TT range from 0% to 6.7%, and the 5-year disease-free survival (DFS) ranges from 83.3% to 96%. The oncological outcomes of TT are comparable to that of OT. Masaoka stage and the World Health Organization (WHO) type classification are valuable predictors of the prognosis of thymoma; hence, the optimal treatment for thymoma should be performed according to these two. TT is less invasive, with equivalent oncological outcomes, when compared with the OT. Minimally invasive surgery including TT for stage I-II thymomas is becoming the mainstay of therapy.

Clinical outcomes for early-stage nasopharyngeal carcinoma with predominantly WHO II histology treated by intensity-modulated radiation therapy with or without chemotherapy in nonendemic region of China.

BACKGROUND: The clinical outcomes for early-stage nasopharyngeal carcinoma (NPC) in northwest China were evaluated. METHODS: A retrospective study was performed from 69 patients with NPC patients treated with intensity-modulated radiation therapy (IMRT) with or without chemotherapy. RESULTS: Median follow-up was 34 months. World Health Organization (WHO) type II was the predominant histology (71%). All treatment failures occurred in T2N1 NPCs (14.5%), with metastasis the major reason. The 3-year overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were 93.3%, 94.1%, and 94.8% respectively. The 3-year survival rate for T2N1 and IMRT alone group were both significantly poorer than the T1N0, T2N0, and T1N1 groups and the chemoradiation group, respectively (p < .05). N1 classification, T2N1 classification, and addition of chemoradiation were significant independent predictors (p < .05). No grade IV toxicities were observed. CONCLUSION: T2N1 classification is a unique subgroup with higher risk of distant metastasis. Improved outcomes of T2N1 NPC with predominantly WHO II histology after chemoradiation has not been reported.

Clinical significance of relationship between the myasthenia gravis and the WHO histological type & Masaoka clinical stages of thymoma / 国际外科学杂志

Objective To investigate the clinical significance of relationship between the myasthenia gravis and WHO histological types & Masaoka clinical stage of thymoma.Methods Retrospective analysis of resection specimen in thymoma and complete medical records in 81 cases from December 2004 to September 2009,using the analysis of statistical software between myasthenia gravis and both thymoma Masaoka clinical stages & the WHO histological types.Results The difference of merger with MG of thymoma Masaoka among different clinical stages was statistically significant (P ＜ 0.05).The difference of merger with MG Thymoma WHO among different histological types was statistically significant (P ＜ 0.05).The difference of thymoma Masaoka between the WHO histological type and Masaoka clinical stages was statistically significant (P ＜ 0.05,kappa =0.580,C =0.503).Conclusions There are some relationships between thymoma Masaoka clinical stages and MG,so had some relationships between thymoma WHO histological types and MG.At the same time,the thymoma WHO histological types reflects the Masaoka clinical stages in a certain extent.This relationship would be used as one of the important indicators to evaluate the prognosis of patients at some extent.