E. Guarino

Multimodality Treatment of Thymoma: A Prospective Study

BACKGROUND Thymomas are a heterogeneous group of tumors. Treatment of invasive lesions is not well standardized. The aim of this study is to propose a clinicopathologically based protocol for multimodality therapy. METHODS Between 1965 and 1988, we operated on 83 patients with thymoma who did not receive standardized adjuvant therapy. In 1989, on the basis of the retrospective analysis of the data, we started a multimodality therapy protocol and used it for 65 patients. Twelve patients had medullary thymoma (11 stage I and 1 stage II), 13 had mixed type (6 stage I and 7 stage II), and 40 had cortical thymoma (4 stage I, 11 stage II, 12 stage III, and 13 stage IV). We considered three groups. Group I (n = 18 patients), benign thymoma, included stage I and II medullary and stage I mixed thymomas; radical resection with no adjuvant therapy was performed. Group II (n = 22), invasive thymoma, included stage I and II cortical and stage II mixed thymomas; postoperative chemotherapy plus radiotherapy was always administered. Group III (n = 25), malignant thymoma, comprised stage III and IV cortical thymomas and stage III mixed thymomas; resectable stage III lesions were removed, and highly invasive stage III and stage IV lesions underwent biopsy, neoadjuvant chemotherapy, and surgical resection; postoperative chemotherapy and radiotherapy was administered to all patients. RESULTS The 8-year survival rate for patients in stages I, II, III, and IV was 95%, 100%, 92%, and 68%, respectively. Patients with medullary thymoma had a 92% 8-year survival rate; those with mixed type, 100%; and those with cortical thymoma, 85%. Group I had an 8-year survival rate of 94%; group II, 100%; and group III, 76%. Survival was compared with that of patients operated on before 1989: differences were not significant for group I; survival improved in group II (100% versus 81%; p = not significant); and group III showed significant improvement (76% versus 43%; p < 0.049). CONCLUSIONS Multimodality treatment with neoadjuvant chemotherapy and adjuvant chemotherapy plus radiotherapy may improve the results of radical resection and the survival of patients with invasive and malignant thymoma.

Ambulatory mediastinal biopsy for hematologic malignancies

OBJECTIVE We retrospectively evaluated our experience with outpatient surgical biopsy of mediastinal lesions in patients with hematologic malignancies, its cost-effectiveness and ability to allow diagnosis. METHODS Eighty patients underwent outpatient surgical biopsy of mediastinal lesions related to hematologic malignancies (50 cervical mediastinoscopies, 24 anterior mediastinotomies and six video-assisted thoracoscopies). Eight patients had a superior vena cava syndrome, five had lesions residuing or relapsing after chemo-radiotherapy and six and had been treated with steroids before diagnosis; in five cases the biopsy had been previously performed at other hospitals without achieving a positive diagnosis. RESULTS Ambulatory mediastinal biopsy allowed diagnosis in all cases. Fifty-one patients had Hodgkin disease, 28 had non-Hodgkin lymphoma and one had chronic lymphatic leukemia. There was no operative mortality. Complications were: pneumothorax and bleeding during mediastinoscopy and wound infection after anterior mediastinotomy. CONCLUSIONS Mediastinal biopsy can be safely performed on an outpatient basis in selected patients with mediastinal involvement due to hematologic malignancies. Costs were markedly reduced with respect to in-hospital procedures.

Efficacy of repeated cycles of chemo-immunotherapy with Thymosin α1 and interleukin-2 after intraperitoneal 5-fluorouracil delivery

Abstract We have used chemo-immunotherapy with 5-fluorouracil (5-FU), thymosin α1 (Tα1) and interleukin-2 (IL-2) to treat multiple liver metastases from colorectal cancer induced by DHD/K12 cells in syngeneic BDIX rats, comparing one and two cycles of treatment, and different treatment combinations. 5-FU was delivered loco-regionally as a continuous infusion via an intraperitoneal (i.p.) catheter from a subcutaneously implanted mini-pump, a method we developed for this study. We show here that two cycles of a triple chemo-immunotherapy regimen significantly increased the average survival time compared to one cycle, and compared to untreated controls or those treated with two cycles of 5-FU alone. At 150 days, two rats treated with two cycles of triple therapy were cured, showing no signs of cancer at autopsy; all the other rats died before this time. Triple chemo-immunotherapy resulted in significantly fewer extra-hepatic metastases than in the controls and in those treated with 5-FU only. Further, we found that two cycles of triple treatment significantly increased the absolute number of peripheral T cells expressing IL-2 receptor, CD4 and CD8 compared to controls. We conclude that two cycles of chemo-immunotherapy with 5-FU, Tα1 and IL-2 were superior to one cycle of treatment and to other treatments tested. Our results suggest that the triple therapy acts by increasing numbers of effector T cells. This method shows promise for the use of multi-cycle chemo-immunotherapy in the treatment of unresectable metastases of colorectal cancer in humans.

A new human tumor-associated antigen (TLP) is naturally expressed in rat DHD-K12 colorectal tumor cells

Renewed interest in cancer immunotherapy has been raised by the availability of a variety of tumor‐associated antigens and animal models. We have recently described the presence of a new antigen, TLP, in sera and cancer tissue from lung and colorectal cancer patients. In order to develop an experimental model suitable for preclinical studies on cancer vaccines, we investigated the presence of TLP antigen in vitro, in the DHD‐K12 cell line and in vivo, in metastases induced in syngeneic BDIX rats by DHD‐K12 cell injection. TLP was not detected in any tissue of healthy rats nor in normal tissues of tumor‐bearing rats. This is in agreement with our previous studies, in which we had demonstrated that TLP is expressed in human colorectal cancer and adenomas but not in normal colonic mucosa. Our results indicate TLP as a possible human tumor‐specific antigen naturally expressed in DHD‐K12 tumor syngeneic to immunocompetent BDIX rats. Int. J. Cancer 85:540–544, 2000.

382 Is primary surgery for N2 non small cell lung cancer (NSCLC) still justified

37.0%, 47.1% in resected cases. Especially, improvement in resected cases was marked. Analysis of resected cases resulted in increase of cases detected by mass survey, cases of early stage, cases of adenocarcinoma of peripheral type, and cases of female. The proportions of stage I lung cancer in cases detected by mass survey were increasing as 36.7%, 47.3%, 49.0%, 52.0% in group A to D, so mass survey seemed to contribute to early detection of lung cancer. It was also important that accurate diagnosis of staging became possible by the progress of diagnostic technology such as CT and MRI. In conclusion, the result of treatment for lung cancer in the Natronal Chest Hospitals in Japan have been improving because of increase of early cases detected by mass survey. However, the proportion of cases found by mass survey is less than 30% even lately, and it is a problem left in the future that more than half of lung cancer patients are still discovered through their subjective symptoms. We conclude that N2 NSCLC can be effectively treated by primary surgery if radical resection can be performed. We believe that CT-negative patients can procede to resection without further invasive staging. Mediastinoscopy may screen out unsuspected N2 disease and shift the patient to neoadjuvant treatment. The latter can however hardly offer the 40% 5 year survival rate which we have obtained by primary surgery. CT-positive patients should not be denied primary surgery if the primary tumor and the N2 lymphnodes are resectable. Invasive staging (mediastinoscopy, thoracoscopy) and careful screening of clinical N2 may markedly reduce non radical procedures. Nevertheless, when the resection is deemed radical, primary surgery can offer good long term survival.

Report of a case of video-assisted thoracoscopic resection of bronchogenic cyst developed in the aorto-pulmonary window.

We report the case of a 28-years-old male with a bronchogenic cyst developed in the aorto-pulmonary window. Left video-assisted thoracoscopy was performed and the cyst was removed intact and completely. Operative time was 48 minutes. The postoperative course was uneventful and the patient was discharged on the third postoperative day. We believe that an uncomplicated mediastinal bronchogenic cyst can be successfully approached by video-assisted thoracoscopy. In the case of an intraparenchymal or complicated cyst, thoracoscopic resection can be technically difficult and hazardous, and open approach is preferable.