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. 1999 Nov;81(5):841–845. doi: 10.1038/sj.bjc.6690773

Primary chemotherapy with adriamycin, cisplatin, vincristine and cyclophosphamide in locally advanced thymomas: a single institution experience

A Berruti 1, P Borasio 2, A Gerbino 1, G Gorzegno 1, T Moschini 3, M Tampellini 1, F Ardissone 2, M P Brizzi 1, A Dolcetti 3, L Dogliotti 4
PMCID: PMC2374302  PMID: 10555755

Abstract

From 1990 to 1997, 16 consecutive patients with stage III and IVa invasive thymoma were treated in a single institution with primary chemotherapy consisting in adriamycin (40 mg m–2), cisplatin (50 mg m–2) administered intravenously on day 1, vincristine (0.6 mg m–2) on day 2 and cyclophosphamide (700 mg m–2) on day 4 (ADOC). The courses were repeated every 3 weeks. The aim was to evaluate the impact of this cytotoxic regimen with respect to response rate, per cent of patients radically resected, time to progression and overall survival. Two complete responses (one clinical and one pathological) and 11 partial responses were observed (overall response rate 81.2%); two patients had stable disease and one progressed. Toxicity was mild as only two patients developed grade III/IV neutropenia and one patient grade III nausea/vomiting. Nine patients were radically resected (five out of ten with stage III, and four out of six with stage IVa). Median time to progression and overall survival was 33.2 and 47.5 months respectively. Three patients were alive and disease free after more than 5 years. The ADOC scheme is highly active and manageable in the treatment of locally advanced thymoma. As a preoperative approach it should be offered to patients not amenable to surgery or to those surgically resectable but with a great deal of morbidity. © 1999 Cancer Research Campaign

Keywords: primary chemotherapy, thymome, radiotherapy

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Selected References

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  1. Anderson J. R., Cain K. C., Gelber R. D. Analysis of survival by tumor response. J Clin Oncol. 1983 Nov;1(11):710–719. doi: 10.1200/JCO.1983.1.11.710. [DOI] [PubMed] [Google Scholar]
  2. Berruti A., Borasio P., Roncari A., Gorzegno G., Mossetti C., Dogliotti L. Neoadjuvant chemotherapy with adriamycin, cisplatin, vincristine and cyclophosphamide (ADOC) in invasive thymomas: results in six patients. Ann Oncol. 1993 May;4(5):429–431. doi: 10.1093/oxfordjournals.annonc.a058527. [DOI] [PubMed] [Google Scholar]
  3. Curran W. J., Jr, Kornstein M. J., Brooks J. J., Turrisi A. T., 3rd Invasive thymoma: the role of mediastinal irradiation following complete or incomplete surgical resection. J Clin Oncol. 1988 Nov;6(11):1722–1727. doi: 10.1200/JCO.1988.6.11.1722. [DOI] [PubMed] [Google Scholar]
  4. Decarli A., La Vecchia C., Cislaghi C., Negri E. Cancer mortality in Italy, 1994, and an overview of trends from 1955 to 1994. Tumori. 1998 May-Jun;84(3):312–334. doi: 10.1177/030089169808400305. [DOI] [PubMed] [Google Scholar]
  5. Fornasiero A., Daniele O., Ghiotto C., Piazza M., Fiore-Donati L., Calabró F., Rea F., Fiorentino M. V. Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991 Jul 1;68(1):30–33. doi: 10.1002/1097-0142(19910701)68:1<30::aid-cncr2820680106>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  6. Giaccone G., Ardizzoni A., Kirkpatrick A., Clerico M., Sahmoud T., van Zandwijk N. Cisplatin and etoposide combination chemotherapy for locally advanced or metastatic thymoma. A phase II study of the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol. 1996 Mar;14(3):814–820. doi: 10.1200/JCO.1996.14.3.814. [DOI] [PubMed] [Google Scholar]
  7. Giaccone G., Musella R., Bertetto O., Donadio M., Calciati A. Cisplatin-containing chemotherapy in the treatment of invasive thymoma: report of five cases. Cancer Treat Rep. 1985 Jun;69(6):695–697. [PubMed] [Google Scholar]
  8. Kirschner P. A. Reoperation for thymoma: report of 23 cases. Ann Thorac Surg. 1990 Apr;49(4):550–555. doi: 10.1016/0003-4975(90)90300-u. [DOI] [PubMed] [Google Scholar]
  9. Kohman L. J. Controversies in the management of malignant thymoma. Chest. 1997 Oct;112(4 Suppl):296S–300S. doi: 10.1378/chest.112.4_supplement.296s. [DOI] [PubMed] [Google Scholar]
  10. Lewis J. E., Wick M. R., Scheithauer B. W., Bernatz P. E., Taylor W. F. Thymoma. A clinicopathologic review. Cancer. 1987 Dec 1;60(11):2727–2743. doi: 10.1002/1097-0142(19871201)60:11<2727::aid-cncr2820601125>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  11. Loehrer P. J., Sr, Chen M., Kim K., Aisner S. C., Einhorn L. H., Livingston R., Johnson D. Cisplatin, doxorubicin, and cyclophosphamide plus thoracic radiation therapy for limited-stage unresectable thymoma: an intergroup trial. J Clin Oncol. 1997 Sep;15(9):3093–3099. doi: 10.1200/JCO.1997.15.9.3093. [DOI] [PubMed] [Google Scholar]
  12. Loehrer P. J., Sr, Kim K., Aisner S. C., Livingston R., Einhorn L. H., Johnson D., Blum R. 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 Jun;12(6):1164–1168. doi: 10.1200/JCO.1994.12.6.1164. [DOI] [PubMed] [Google Scholar]
  13. Macchiarini P., Chella A., Ducci F., Rossi B., Testi C., Bevilacqua G., Angeletti C. A. Neoadjuvant chemotherapy, surgery, and postoperative radiation therapy for invasive thymoma. Cancer. 1991 Aug 15;68(4):706–713. doi: 10.1002/1097-0142(19910815)68:4<706::aid-cncr2820680407>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  14. Maggi G., Casadio C., Cavallo A., Cianci R., Molinatti M., Ruffini E. Thymoma: results of 241 operated cases. Ann Thorac Surg. 1991 Jan;51(1):152–156. doi: 10.1016/0003-4975(91)90478-9. [DOI] [PubMed] [Google Scholar]
  15. Maggi G., Giaccone G., Donadio M., Ciuffreda L., Dalesio O., Leria G., Trifiletti G., Casadio C., Palestro G., Mancuso M. Thymomas. A review of 169 cases, with particular reference to results of surgical treatment. Cancer. 1986 Aug 1;58(3):765–776. doi: 10.1002/1097-0142(19860801)58:3<765::aid-cncr2820580326>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  16. Masaoka A., Monden Y., Nakahara K., Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981 Dec 1;48(11):2485–2492. doi: 10.1002/1097-0142(19811201)48:11<2485::aid-cncr2820481123>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  17. Miller A. B., Hoogstraten B., Staquet M., Winkler A. Reporting results of cancer treatment. Cancer. 1981 Jan 1;47(1):207–214. doi: 10.1002/1097-0142(19810101)47:1<207::aid-cncr2820470134>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  18. Pollack A., el-Naggar A. K., Cox J. D., Ro J. Y., Sahin A., Komaki R. Thymoma. The prognostic significance of flow cytometric DNA analysis. Cancer. 1992 Apr 1;69(7):1702–1709. doi: 10.1002/1097-0142(19920401)69:7<1702::aid-cncr2820690710>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  19. Rea F., Sartori F., Loy M., Calabrò F., Fornasiero A., Daniele O., Altavilla G. Chemotherapy and operation for invasive thymoma. J Thorac Cardiovasc Surg. 1993 Sep;106(3):543–549. [PubMed] [Google Scholar]
  20. Schmidt R., Mönig S. P., Selzner M., Krug B. Surgical therapy of malignant thymoma. J Cardiovasc Surg (Torino) 1997 Jun;38(3):317–322. [PubMed] [Google Scholar]
  21. Shin D. M., Walsh G. L., Komaki R., Putnam J. B., Nesbitt J., Ro J. Y., Shin H. J., Ki K. H., Wimberly A., Pisters K. M. A multidisciplinary approach to therapy for unresectable malignant thymoma. Ann Intern Med. 1998 Jul 15;129(2):100–104. doi: 10.7326/0003-4819-129-2-199807150-00006. [DOI] [PubMed] [Google Scholar]
  22. Tomiak E. M., Evans W. K. The role of chemotherapy in invasive thymoma: a review of the literature and considerations for future clinical trials. Crit Rev Oncol Hematol. 1993 Oct;15(2):113–124. doi: 10.1016/1040-8428(93)90051-5. [DOI] [PubMed] [Google Scholar]
  23. Urgesi A., Monetti U., Rossi G., Ricardi U., Maggi G., Sannazzari G. L. Aggressive treatment of intrathoracic recurrences of thymoma. Radiother Oncol. 1992 Aug;24(4):221–225. doi: 10.1016/0167-8140(92)90227-l. [DOI] [PubMed] [Google Scholar]
  24. Verley J. M., Hollmann K. H. Thymoma. A comparative study of clinical stages, histologic features, and survival in 200 cases. Cancer. 1985 Mar 1;55(5):1074–1086. doi: 10.1002/1097-0142(19850301)55:5<1074::aid-cncr2820550524>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  25. Yagi K., Hirata T., Fukuse T., Yokomise H., Inui K., Ike O., Mizuno H., Aoki M., Hitomi S., Wada H. Surgical treatment for invasive thymoma, especially when the superior vena cava is invaded. Ann Thorac Surg. 1996 Feb;61(2):521–524. doi: 10.1016/0003-4975(95)00983-3. [DOI] [PubMed] [Google Scholar]

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