Clinicopathological profile and treatment outcomes of advanced/unresectable thymic malignancies from a tertiary care centre in India.
Thymomas, though rare, are the most common anterior mediastinal neoplasms in adults, with incidence of 0.13 per 100,000 person-years. Due to indolent nature and lack of randomized trials, treatment relies on retrospective data. Literature on outcomes of unresectable thymomas in India is limited.
This retrospective study was conducted at a tertiary cancer centre in north India, analysing records of patients with advanced/unresectable thymic malignancies (stage III-IV) treated between January 2012 and December 2023. Clinicopathological features, response rates, progression-free survival (PFS), and overall survival (OS) were assessed.
A total of 43 patients (median age 40 years [range 22-72]; 76.7% male) were included. Histology revealed thymoma in 36 (83.7%), thymic carcinoma in 4 (9.3%), and thymic neuroendocrine tumours in 3 (7%). Common symptoms were cough (60.5%), dyspnoea (60.5%), and chest pain (55.8%). Stage distribution was - III (20.9%), IVA (46.5%), and IVB (32.6%). Liver (14%) was the most common site of distant metastasis. Myasthenia gravis and pure red cell aplasia occurred in 7% each. Forty (93%) patients received systemic therapy, primarily Cyclophosphamide-Adriamycin-Cisplatin (75%). The objective response rate for first-line systemic therapy was 37.5% (all partial responses) with a clinical benefit rate of 87.5%. Twelve (30%) underwent surgery, with R0 resection in 6 (15%). Median PFS was 16.4 months, and OS was 56 months.
Systemic therapy and surgery in selected cases provide meaningful outcomes in unresectable thymomas, emphasizing the need for prospective studies to refine treatment strategies.
This retrospective study was conducted at a tertiary cancer centre in north India, analysing records of patients with advanced/unresectable thymic malignancies (stage III-IV) treated between January 2012 and December 2023. Clinicopathological features, response rates, progression-free survival (PFS), and overall survival (OS) were assessed.
A total of 43 patients (median age 40 years [range 22-72]; 76.7% male) were included. Histology revealed thymoma in 36 (83.7%), thymic carcinoma in 4 (9.3%), and thymic neuroendocrine tumours in 3 (7%). Common symptoms were cough (60.5%), dyspnoea (60.5%), and chest pain (55.8%). Stage distribution was - III (20.9%), IVA (46.5%), and IVB (32.6%). Liver (14%) was the most common site of distant metastasis. Myasthenia gravis and pure red cell aplasia occurred in 7% each. Forty (93%) patients received systemic therapy, primarily Cyclophosphamide-Adriamycin-Cisplatin (75%). The objective response rate for first-line systemic therapy was 37.5% (all partial responses) with a clinical benefit rate of 87.5%. Twelve (30%) underwent surgery, with R0 resection in 6 (15%). Median PFS was 16.4 months, and OS was 56 months.
Systemic therapy and surgery in selected cases provide meaningful outcomes in unresectable thymomas, emphasizing the need for prospective studies to refine treatment strategies.
Authors
Upadhya Upadhya, Vasanthraman Vasanthraman, Sharma Sharma, Khurana Khurana, Pushpam Pushpam, Kumar Kumar, Thulkar Thulkar, Jain Jain, Nambirajan Nambirajan, Kumar Kumar, Pathy Pathy, Malik Malik
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