Journal of Clinical Oncology, Vol 15, 3093-3099, Copyright © 1997 by American Society of Clinical Oncology
Cisplatin, doxorubicin, and cyclophosphamide plus thoracic radiation therapy for limited-stage unresectable thymoma: an intergroup trial
Sr Loehrer PJ, M Chen, K Kim, SC Aisner, LH Einhorn, R Livingston and D Johnson
Department of Medicine, Indiana University Medical Center, Indianapolis 46202-5265, USA.
PURPOSE: To determine the response rate of cisplatin plus doxorubicin plus
cyclophosphamide (PAC) in patients with limited-stage unresectable thymoma.
In addition, this study was undertaken to determine the toxicity,
progression-free survival, and overall survival of combined- modality
therapy with PAC plus radiation therapy. PATIENTS AND METHODS: Patients
with a histologic diagnosis of limited-stage unresectable thymoma or thymic
carcinoma were eligible. Further requirements included a Karnofsky
Performance Score of > 60, no prior radiation to the chest, and adequate
bone marrow, hepatic, and renal function. No patient had undergone
chemotherapy previously. Patients received two to four cycles (repeated
every 3 weeks) of cisplatin (50 mg/m2), doxorubicin (50 mg/m2), and
cyclophosphamide (500 mg/m2) followed by a total dosage of 54 Gy to the
primary tumor and regional lymph nodes for patients with a stable, partial,
or complete response to chemotherapy. RESULTS: From November 1983 through
January 1995, 26 patients were entered onto the trial. Three patients were
ineligible on the basis of pathologic review (lung cancer, germ cell
cancer, lymphoma). Toxicity, primarily hematologic, was mild, with only one
early death due to a perforated abdominal viscus. Among the 23 assessable
patients, there were five complete and 11 partial responses to chemotherapy
(overall response rate, 69.6%). The median time to treatment failure was
93.2 months (range, 3 to 99.2+ months), and the median survival time was 93
months (range, 1 to 110 months). The 5-year survival rate is 52.5%.
CONCLUSIONS: PAC combination chemotherapy produces response rates in the
management of patients with limited thymoma. Combined-modality therapy is
feasible and associated with prolonged progressive-free survival. The
benefit of combined-modality therapy over radiation therapy alone is
suggested for patients with unresectable thymoma.
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