Hyperthermic intraoperative chemotherapy (HIOC) for Stage IVa thymic malignancy may improve 5‐year disease‐free survival

• Published in: Journal of surgical oncology Vol. 127; no. 4; pp. 734 - 740
• Main Authors: Dolan, Daniel P., Polhemus, Emily, Lee, Daniel N., Mazzola, Emanuele, Jaklitsch, Michael T., Wee, Jon O., Bueno, Raphael, Swanson, Scott J., White, Abby
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-03-2023
• Subjects: Chemotherapy; Disease-Free Survival; Humans; hyperthermic intraoperative chemotherapy; Neoplasm Staging; Retrospective Studies; Surgery; Thymectomy; thymic malignancy; Thymoma - pathology; Thymoma - surgery; Thymus Neoplasms - pathology; Thymus Neoplasms - surgery; Treatment Outcome; thymic malignancy; thymectomy; hyperthermic intraoperative chemotherapy
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.27150

Background and Objectives
Stage IVa thymic malignancy has limited treatments. This study evaluated whether hyperthermic intraoperative chemotherapy (HIOC) after radical resection of Stage IVa thymic malignancy improves survival.
Methods
All patients who underwent resection, with or without HIOC, for Stage IVa thymic malignancy at a single center from 1990 to 2021 were reviewed.
Results
Thirty‐four patients were identified; 22 surgery‐only versus 12 surgery and HIOC (60 min cisplatin regimen 175 mg/m2). Demographics and comorbidities were similar between groups. Three patients in each group were carcinomas; remainder were thymomas. Thirty‐two patients underwent attempted macroscopic complete resection; 22 operations succeeded, 68.8%. Significant complications were similar between groups, 18.2% surgery‐only versus 25.0% HIOC, p = 0.68. Median time to recurrence trended longer for HIOC patients (42.9 vs. 32.9 months in surgery‐only, p = 0.77). Overall survival, 5‐year, was similar (75.8% HIOC vs. 76.2% surgery‐only, p = 0.91). On stratified analysis, thymoma patients with macroscopic complete resection and HIOC experienced similar 5‐year Overall (80.0% vs. 100.0% surgery‐only, p = 0.157) but longer trending 5‐year disease‐free (85.7% vs. 40.0%, p = 0.18) and 5‐year locoregional recurrence‐free survival (85.7% vs. 68.6%, p = 0.75).
Conclusions
This retrospective cohort study treating Stage IVa thymic malignancy with radical pleurectomy, with or without HIOC, found addition of HIOC‐signaled delayed recurrence and improved disease‐free survival.