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. 2022 Oct 14;14(20):5035.
doi: 10.3390/cancers14205035.

Subtotal Pleurectomy with Intrathoracic Chemo Hyperthermia (HITHOC) for IVa Thymomas: De Novo Versus Recurrent Pleural Disease

Benjamin Chappuy  1 , Gabrielle Drevet  1 , Hugo Clermidy  1 , Pascal Rosamel  2 , Mickael Duruisseaux  3   4 , Sebastien Couraud  4   5 , Renaud Grima  1 , Valentin Soldea  1 , Lara Chalabreysse  4   6 , François Tronc  1 , Nicolas Girard  7   8 , Jean-Michel Maury  1   4   8
Affiliations

Subtotal Pleurectomy with Intrathoracic Chemo Hyperthermia (HITHOC) for IVa Thymomas: De Novo Versus Recurrent Pleural Disease

Benjamin Chappuy et al. Cancers (Basel). .

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.

Keywords: HITHOC; IVa Masaoka; intrathoracic chemotherapy; pleural involvement; subtotal pleurectomy; thymic surgery; thymomas.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Post-operative peak of plasmatic levels of urea (µmol/L) and creatinine (mmol/L). * p < 0.05; ** p < 0.001.
Figure 2
Figure 2
Disease-free interval (DFI) and overall survival (OS) overview. (A) Analysis of disease-free interval (DFI) of the entire cohort, comparing IVa de novo vs. distant relapse. (B) Analysis of overall survival (OS). (C) Analysis of DFI and OS in <10 or >10 resected pleural nodule groups.
Figure 2
Figure 2
Disease-free interval (DFI) and overall survival (OS) overview. (A) Analysis of disease-free interval (DFI) of the entire cohort, comparing IVa de novo vs. distant relapse. (B) Analysis of overall survival (OS). (C) Analysis of DFI and OS in <10 or >10 resected pleural nodule groups.
See this image and copyright information in PMC

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