086 * pleural recurrence of thymoma: surgical resection followed by hyperthermic intra-thoracic perfusion chemotherapy

Objectives: Recurrences of thymoma are described in 10–40% of cases up to 10 years after surgical resection. Herein we report our experience with surgical removal of pleural recurrences followed by hyperthermic intrathoracic perfusion chemotherapy (HITHOC). Methods: We prospectively collected data of patients with pleural recurrence of thymoma who underwent surgery followed by HITHOC. After thoracotomy was closed, drainages have been connected to a dedicated perfusion machine, pleural space filled with saline solution, progressively heated up to 42.5°C. At this time chemotherapeutic agents (doxorubicin and cisplatin) were injected and perfusion lasted 60 min. Results: In the period 2005–2012, 13 consecutive patients have been treated (8 males, 5 females, mean age 46 years). Initial Masaoka's stage was: 2 IIa, 5 IIb, 5 III, 1 IVa. Disease-free interval was 54 months on average (range 29–104). Eight patients presented paraneoplastic syndromes (9 myasthenia gravis and 1 medullar aplasia). Complete resection was achieved in all cases except one. HITHOC was successfully performed in all cases and no signs or symptoms of toxicity were recorded in the perioperative period. At a median follow-up period of 50 months (range 6–99), 1 patient died for toxicity following systemic chemotherapy, 4 patients developed pleural relapses (2 ipsilateral, 2 contralateral) and 1 developed lymphatic metastases. Mean survival was 56 months, median survival by Kaplan–Meier method was not reached and 4-year actuarial survival was 91%. Conclusion: HITHOC seems to be feasible and safe. In terms of efficacy, it seems promising although multicentre studies and a longer follow-up period are required to ascertain its effectiveness.