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Chappuy B, Drevet G, Clermidy H, Rosamel P, Duruisseaux M, Couraud S, Grima R, Soldea V, Chalabreysse L, Tronc F, Girard N, Maury JM. Subtotal Pleurectomy with Intrathoracic Chemo Hyperthermia (HITHOC) for IVa Thymomas: De Novo Versus Recurrent Pleural Disease. Cancers (Basel) 2022; 14:cancers14205035. [PMID: 36291819 PMCID: PMC9599523 DOI: 10.3390/cancers14205035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Stage IVa thymomas are rare entities in thoracic oncology without a standard of care. Evidence-based guidelines for the management of located pleural carcinomatosis are lacking. Surgery when feasible has an excellent prognostic factor. However, the technical choice is vast, from extra pleural pneumonectomy with high rates of morbidity and/or mortality to debulking with high rates of relapse. We investigated parietal subtotal pleurectomy combined with HITHOC in highly selected patients. The goal was to determine overall survival (OS) and the disease-free interval (DFI). Our findings suggest a real impact of this surgical procedure in distant relapse (DR) or de novo tumors (DNT). In this orphan disease, prospective and randomized trials are needed to clarify the place of HITHOC in the multimodal modern care of these patients. Abstract Introduction: Stage IVa thymoma is a rare disease without a standard of care. Subtotal pleurectomy and HITHOC introduced in highly selected patients may provide interesting oncologic results. The purpose of this study was to distinguish de novo stage IVa tumors (DNT) from distant relapse (DR) with respect to post-operative and long-term outcomes to provide the procedure efficacy. Methods: From July 1997–December 2021, 40 patients with IVa pleural involvement were retrospectively analyzed. The surgical procedure was subtotal pleurectomy and HITHOC (cisplatin 50 mg/m2, mitomycin 25 mg/m2, 42 °C, 90 min). The post-operative outcome, disease-free interval (DFI) and overall survival (OS) were analyzed. Results: Mean age was 52 ± 12 years. B2 and B3 thymomas were preponderant (27; 67.5%). The median number of pleural nodes were nine (4–81) vs. five (1–36); p = 0.004 * in DNT and DR, respectively. Hospital mortality rate was 2.5%. There were four specific HITHOC complications (10%). DFI were 49 and 85 months (p = 0.02 *), OS were 94 and 118 months (NS), in DNT and DR, respectively. Conclusions: Subtotal pleurectomy with HITHOC in IVa offers satisfying results in highly selected patients, for both DNT and DR. Due to the disease rarity, multicentric studies are needed to define HITHOC as a standard of care.
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Affiliation(s)
- Benjamin Chappuy
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Gabrielle Drevet
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Hugo Clermidy
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Pascal Rosamel
- Department of Anesthesiology and Critical Care Medicine, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Mickael Duruisseaux
- Department of Thoracic Oncology, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
- Claude Bernard University Lyon 1 (UCBL1), 69677 Lyon, France
| | - Sebastien Couraud
- Claude Bernard University Lyon 1 (UCBL1), 69677 Lyon, France
- Department of Thoracic Oncology, University Hospital Lyon-Sud, GH-Sud, 69677 Lyon, France
| | - Renaud Grima
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Valentin Soldea
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Lara Chalabreysse
- Claude Bernard University Lyon 1 (UCBL1), 69677 Lyon, France
- Department of Pathology, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - François Tronc
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Nicolas Girard
- Department of Thoracic Oncology, Institut Curie, 75005 Paris, France
- RYTHMIC Network, Réseau Tumeurs Thymiques et Cancer, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
- Claude Bernard University Lyon 1 (UCBL1), 69677 Lyon, France
- RYTHMIC Network, Réseau Tumeurs Thymiques et Cancer, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif, France
- Correspondence: ; Tel.: +33-4-7235-7590; Fax: +33-4-7235-7323
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