[Study of combination therapy for thymoma: a case of stage IV which presented as total spinal block caused by epidural metastasis and which preoperative combination therapy was effective for minimizing the tumor]

Abstract

We experienced 24 cases of thymoma in the past 17 years. Associated syndromes as myasthenia gravis and pure red cell anemia (PRCA) were found in 7 patients. Preoperative therapies were done for the cases of stage IV. Total resection of the tumor was performed except 3 cases which ended in exploratory thoracotomy. Postoperative therapies were done except the cases of stage I. Each one case of stage III and IV a whose operation ended in exploratory thoracotomy died of tumors, but latter case had some period of PR after chemotherapy. A case of stage I with PRCA died from pneumonia but other cases of autoimmune disease had been well controlled by medical treatment. A case of stage IVb was first admitted to the hospital for paralysis of bilateral lower limb. After resecting the epidural tumor of thoracic spine, chemotherapy (CAV 1 kur) and radiotherapy (4,200 rad) was performed which was effective for minimizing the antero-mediastinal tumor. Though operation ended in exploratory thoracotomy, majority of the tumor was found to be replaced for fibrous tissue which suggested the effectiveness of the combination therapy. But this case died from pancreatitis during the postoperative therapy. In conclusion, combination therapy of surgical resection and adjuvant radiotherapy & chemotherapy including the care for autoimmune disease is important in the treatment of thymoma.