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P1.17-006 Radiographic Assessment for Tumor Responses of Thymic Carcinoma Using the ITMIG Modified Criteria
November 2017 thymoma (range 1-88 months, median 56.5 months), 2 patients before 60 months and 1month of surgical resection. Ciclosporin was used for PRCA in 6 patients with or without corticosteroid and immunosuppressive agents were not used in the other 2 patients only with occasional transfusion. As treatment-related complications of ciclosporin, pneumonia was seen in 5 patients and renal insufficiency in 1 patient of 6 patients who received it. Follow-up period ranged 9-137 months (median 49.5 months) after PRCA diagnosis. Two patients obtained complete remission of anemia by ciclosporin with and without corticosteroid. Two patients remained transfusion-dependent. Four patients have died. In one patient, ciclosporin could be stopped because of complete remission of anemia. However, re-administration of ciclosporin was needed following 6 years interruption. Main causes of the death were diagnosed as pneumonia (n¼2), thymoma (n¼1), and cardiac failure (n¼1). Conclusion: PRCA associated with thymoma was diagnosed postoperatively in three quarter patients. We should pay attention to the occurrence of PRCA even after the resection of thymoma especially in patients with incomplete resection or advanced disease. Ciclosporin was effective for PRCA, but treatment-related complications occurred, particularly as pneumonia. As treatment for PRCA associated with thymoma and its complications were combined complexly, it is not easy to treat PRCA associated with thymoma. Keywords: Thymoma, pure red cell aplasia
P1.17-006 Radiographic Assessment for Tumor Responses of Thymic Carcinoma Using the ITMIG Modified Criteria T. Hakozaki, Y. Okuma, Y. Hosomi Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo/JP Background: Pleural metastases of thymic carcinoma are relatively common, and their unique growth pattern makes accurate and consistent tumor measurement difficult. To minimize intra-observer variability, The ITMIG proposed modified criteria for measurement of tumor response to nonsurgical therapies for thymic carcinoma. Method: We conducted a retrospective review of the medical record of advanced or recurrent thymic carcinoma patients treated with chemotherapy between 1980 and 2016 in our institution. The best objective responses were assessed and concorded using the Response Evaluation Criteria in Solid Tumor version 1.1 (RECIST 1.1) and the ITMIG modified criteria. Result: 27 patients ——. All of 6 patients showing PR assessed by the RECIST criteria remained PR using the ITMIG criteria. Of 19 patients showing SD assessed by RECIST, 18 remained SD and 1 reclassified as PR using the ITMIG criteria. Both of 2 patients showing PD assessed by the RECIST criteria remained PD using the ITMIG criteria. The overall response rate assessed by the two methods did not differ significantly, with kappa value of 0.996. Conclusion: ITMIG modified criteria showed a high concordance rate with RECIST 1.1 criteria in response assessment of thymic carcinoma. Keywords: ITMIG, Thymic carcinoma, RECIST
P1.17-007 Platinum Based Chemotherapy in Locally Advanced Non-Metastatic Thymic Carcinoma T. Mehmood Radiation Oncology, Northwest General Hospital and Research Centre, Peshawar/PK Background: Thymic carcinoma is a rare malignant tumor. At present, cisplatin based doublet or triplet antitumor drugs are used in neoadjuvant setting for advanced thymic carcinomas. However, no optimal chemotherapeutic regimen is well established and recent small case studies with carboplatin and paclitaxel doublet demonstrates the
Abstracts
S2063
similar efficacy with less toxicity. We retrospectively evaluated effectiveness and toxicity of platinum based doublet chemotherapy for patients with advanced thymic carcinoma. Method: Between 2013 and 2016, we retrospectively identified 21 patients from hospital information system with pathologically confirmed advanced thymic carcinoma, who were treated with platinum based doublet chemotherapy followed by surgical resection. The most commonly used regimen being carboplatin plus docetaxel in 75% of the patients. Other regimens included cisplatin plus gemcitabine, carboplatin plus gemcitabine and cisplatin plus doxorubicin plus cyclophosphamide. Result: The clinical response rate was achieved in 61.5% of the patients. The disease control rate was achieved in 92% of the patients. The median progression-free survival was 7.9 months (95% CI 1.3e10.0) and median overall survival was 33.8 months (95% CI 8.3e45.9). The toxicity profiles of platinum doublets demonstrated grade 3-4 hematological and non-hematological toxicities in 18% and 24% of the patients respectively. No febrile neutropenia and toxic death was recorded. Conclusion: We concluded that platinum doublet chemotherapy is active and tolerable for advanced thymic carcinoma in the front-line setting with regard to efficacy, toxicity, and usage in clinical setting. Keywords: Thymic carcinoma
P1.17-008 Clinical and Oncological Outcomes on Resected Thymomas over a Decade at the National Cancer Institute at Mexico City R. López Saucedo,1 E. Jiménez Fuentes,1 J. De La Garza,2 O. Arrieta,2 M. Moscoso Fernández Salvador,1 J. González Luna,1 F. Corona Cruz1 1Thoracic Oncology Unit, National Cancer Institute, México City/MX, 2Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerologia, Mexico City/MX Background: Despite the fact that thymic tumors are considered as an orphan disease, they represent the most common adult tumor in the anterior mediastinum. Most of evidence in this neoplasm comes from small, single institution reports. Moreover, the low incidence and a wide spectrum of clinical and morphological characteristics are wellknown factors that difficult treatment decisions. Method: Single Institution, retrospective chart review of patients with resected thymoma, from January 2005 to December 2016. Result: We found 25 patients, with complete clinical data available for review, who underwent thymectomy for epithelial thymic neoplasm. There were 14 females (56%) and 11 males (44%), mean age 56.6 years (27 to 82 years). A total of 22 patients underwent up-front surgery and only 3 patients required neoadjuvant treatment due to advanced disease. Trans-esternal thymectomy was the most common approach with 18 cases (72%), lateral thoracotomy in 4 cases (16%) and VATS in 3 cases (12%). A complete resection was achieved in 92% of patients. Most of cases, 15 (60%) required an extended thymectomy due to their extension, in 7 (28%) a standard thymectomy was performed,1 case (4%) required a maximal thymectomy and in 2 cases (8%) only a biopsy was performed. R0 resection was achieved in 88% (22 cases) and one patient (4%) was reported as R1 and 2 cases were R2 resections (8%). Distribution according to WHO classification was: A 12%, AB 36%, B1 8%, B2 28%, B3 8% and C 8%. Staging according to Masaoka-Koga Classification was: I 28%, IIA 16%, IIB 24%, III 8%, IVA 12% and IVB 8% Median size of thymomas was 82mm (47-140mm). Mean operative time was 194 minutes (88 e 480), mean blood loss was 362 ml (15 e 2000). Chest tube mean duration was 5.4 days, with a mean hospital stay of 6.2 days (3-18) Morbidity was 24%, but none of patients required re-intervention. Only 2 patients die in the 90 days after surgery for an 8% mortality. In 12 patients (48%) adjuvant treatment was required. Median follow-up was 11.03 months (1.8-108.5) and Median OS was 12.4 months. To date, 21 patients (84%) still alive and only 2 relapses
P1.17-006 Radiographic Assessment for Tumor Responses of Thymic Carcinoma Using the ITMIG Modified Criteria T. Hakozaki, Y. Okuma, Y. Hosomi Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo/JP Background: Pleural metastases of thymic carcinoma are relatively common, and their unique growth pattern makes accurate and consistent tumor measurement difficult. To minimize intra-observer variability, The ITMIG proposed modified criteria for measurement of tumor response to nonsurgical therapies for thymic carcinoma. Method: We conducted a retrospective review of the medical record of advanced or recurrent thymic carcinoma patients treated with chemotherapy between 1980 and 2016 in our institution. The best objective responses were assessed and concorded using the Response Evaluation Criteria in Solid Tumor version 1.1 (RECIST 1.1) and the ITMIG modified criteria. Result: 27 patients ——. All of 6 patients showing PR assessed by the RECIST criteria remained PR using the ITMIG criteria. Of 19 patients showing SD assessed by RECIST, 18 remained SD and 1 reclassified as PR using the ITMIG criteria. Both of 2 patients showing PD assessed by the RECIST criteria remained PD using the ITMIG criteria. The overall response rate assessed by the two methods did not differ significantly, with kappa value of 0.996. Conclusion: ITMIG modified criteria showed a high concordance rate with RECIST 1.1 criteria in response assessment of thymic carcinoma. Keywords: ITMIG, Thymic carcinoma, RECIST
P1.17-007 Platinum Based Chemotherapy in Locally Advanced Non-Metastatic Thymic Carcinoma T. Mehmood Radiation Oncology, Northwest General Hospital and Research Centre, Peshawar/PK Background: Thymic carcinoma is a rare malignant tumor. At present, cisplatin based doublet or triplet antitumor drugs are used in neoadjuvant setting for advanced thymic carcinomas. However, no optimal chemotherapeutic regimen is well established and recent small case studies with carboplatin and paclitaxel doublet demonstrates the
Abstracts
S2063
similar efficacy with less toxicity. We retrospectively evaluated effectiveness and toxicity of platinum based doublet chemotherapy for patients with advanced thymic carcinoma. Method: Between 2013 and 2016, we retrospectively identified 21 patients from hospital information system with pathologically confirmed advanced thymic carcinoma, who were treated with platinum based doublet chemotherapy followed by surgical resection. The most commonly used regimen being carboplatin plus docetaxel in 75% of the patients. Other regimens included cisplatin plus gemcitabine, carboplatin plus gemcitabine and cisplatin plus doxorubicin plus cyclophosphamide. Result: The clinical response rate was achieved in 61.5% of the patients. The disease control rate was achieved in 92% of the patients. The median progression-free survival was 7.9 months (95% CI 1.3e10.0) and median overall survival was 33.8 months (95% CI 8.3e45.9). The toxicity profiles of platinum doublets demonstrated grade 3-4 hematological and non-hematological toxicities in 18% and 24% of the patients respectively. No febrile neutropenia and toxic death was recorded. Conclusion: We concluded that platinum doublet chemotherapy is active and tolerable for advanced thymic carcinoma in the front-line setting with regard to efficacy, toxicity, and usage in clinical setting. Keywords: Thymic carcinoma
P1.17-008 Clinical and Oncological Outcomes on Resected Thymomas over a Decade at the National Cancer Institute at Mexico City R. López Saucedo,1 E. Jiménez Fuentes,1 J. De La Garza,2 O. Arrieta,2 M. Moscoso Fernández Salvador,1 J. González Luna,1 F. Corona Cruz1 1Thoracic Oncology Unit, National Cancer Institute, México City/MX, 2Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerologia, Mexico City/MX Background: Despite the fact that thymic tumors are considered as an orphan disease, they represent the most common adult tumor in the anterior mediastinum. Most of evidence in this neoplasm comes from small, single institution reports. Moreover, the low incidence and a wide spectrum of clinical and morphological characteristics are wellknown factors that difficult treatment decisions. Method: Single Institution, retrospective chart review of patients with resected thymoma, from January 2005 to December 2016. Result: We found 25 patients, with complete clinical data available for review, who underwent thymectomy for epithelial thymic neoplasm. There were 14 females (56%) and 11 males (44%), mean age 56.6 years (27 to 82 years). A total of 22 patients underwent up-front surgery and only 3 patients required neoadjuvant treatment due to advanced disease. Trans-esternal thymectomy was the most common approach with 18 cases (72%), lateral thoracotomy in 4 cases (16%) and VATS in 3 cases (12%). A complete resection was achieved in 92% of patients. Most of cases, 15 (60%) required an extended thymectomy due to their extension, in 7 (28%) a standard thymectomy was performed,1 case (4%) required a maximal thymectomy and in 2 cases (8%) only a biopsy was performed. R0 resection was achieved in 88% (22 cases) and one patient (4%) was reported as R1 and 2 cases were R2 resections (8%). Distribution according to WHO classification was: A 12%, AB 36%, B1 8%, B2 28%, B3 8% and C 8%. Staging according to Masaoka-Koga Classification was: I 28%, IIA 16%, IIB 24%, III 8%, IVA 12% and IVB 8% Median size of thymomas was 82mm (47-140mm). Mean operative time was 194 minutes (88 e 480), mean blood loss was 362 ml (15 e 2000). Chest tube mean duration was 5.4 days, with a mean hospital stay of 6.2 days (3-18) Morbidity was 24%, but none of patients required re-intervention. Only 2 patients die in the 90 days after surgery for an 8% mortality. In 12 patients (48%) adjuvant treatment was required. Median follow-up was 11.03 months (1.8-108.5) and Median OS was 12.4 months. To date, 21 patients (84%) still alive and only 2 relapses