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Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e3181d0a4a7
Case Reports

S-1 Plus Cisplatin Chemotherapy with Concurrent Radiation for Thymic Basaloid Carcinoma

Tagawa, Tetsuzo MD*; Ohta, Mitsuhiko MD*; Kuwata, Taiji MD*; Awaya, Hirokazu MD†; Ishida, Teruyoshi MD*

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Departments of *Surgery and †Respirology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors hospital, Hiroshima, Japan.

Disclosure: The authors declare no conflicts of interest.

Address for correspondence: Tetsuzo Tagawa, MD, Department of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima 730-8619, Japan. E-mail: tetagawa@yahoo.co.jp

Athymic basaloid carcinoma is extremely rare. The clinical benefits of surgical resection and other therapies remain to be clarified. Herein, we report a case of thymic basaloid carcinoma with distant metastases successfully treated with concurrent chemoradiotherapy and salvage surgery.

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CASE REPORT

An asymptomatic 61-year-old woman presenting with an abnormal shadow in the mediastinum was admitted to our hospital. Computed tomography revealed a heterogenous mass in the anterior mediastinum with right hilar lymphadenopathy and a small nodule in the right lung (Figure 1A). A fluorodeoxyglucose (FDG) positron emission tomographic scan, revealed high uptake of FDG in the mediastinal tumor, right hilar lymph node, and pulmonary nodule at a maximal standardized uptake value of 9.49, 5.74, and 3.66, respectively, suggesting lymph node and pulmonary metastases (Figure 1A). A percutaneous computed tomography-guided needle biopsy revealed the tumor composed of large nests of basal cells. There was prominent palisading of the tumor cells around the neoplastic nests (Figure 2). Immunohistochemically, the tumor cells were positive for CD5 and negative for CD1a and terminal deoxynucleotidyl transferase. The histologic diagnosis was thymic basaloid carcinoma. Chemoradiotherapy consisted of two 4-week cycles of intravenous cisplatin (60 mg/m2 on day 1) and oral administration of S-1 (40 mg/m2, twice a day, between days 1 and 14) administered concurrently with 50 Gy of radiation. Radiotherapy was directed to all tumors including metastatic lesions. After chemoradiotherapy, two cycles of consolidation chemotherapy were performed with cisplatin and S-1. The mediastinal tumor showed a 52% reduction in size, and the right hilar lymph nodes and pulmonary nodule disappeared completely. In a FDG-positron emission tomographic scan, although the mediastinal tumor still showed a slight uptake of FDG, the other lesions showed none (Figure 1B). The patient underwent extended thymectomy with partial resection of the left lung. The resected tumor was solid, with no cystic lesions. Microscopically, there were scattered tumor cells among hyalinized collagenous fibers. Granulation tissue was also seen in the tumor, suggesting that chemoradiotherapy had induced tumor cell degeneration. The patient has survived without recurrence for 11 months since surgery, to date.

Figure 1
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Figure 2
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DISCUSSION

Thymic basaloid carcinoma is one of the rarest subtypes of thymic carcinoma and only 29 cases have been reported in the English literature.1–3 Twenty-three of 24 patients whose clinical information was available underwent surgical resection, and 11 patients received additional treatment. Only one patient received neoadjuvant chemoradiotherapy followed by surgery. Nevertheless, the patient died of the disease at 12 months from the time of diagnosis. Because our case had distant metastases, chemoradiotherapy was administered as the initial therapy. S-1 shows a synergistic effect with radiation, and phase I study of S-1 plus cisplatin chemotherapy with concurrent radiotherapy was reported to be feasible.4,5 In our case, we administered S-1 plus cisplatin chemotherapy with concurrent radiotherapy to a thymic basaloid carcinoma, with remarkable effectiveness. We believe that this case may offer some useful information for patients with thymic carcinoma. Further follow-up is required to determine the long-term efficacy of this treatment strategy on this unusual tumor.

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REFERENCES

1. Snover DC, Levine GD, Rosai J. Thymic carcinoma. Five distinctive histological variants. Am J Surg Pathol 1982;6:451–470.

2. Suster S, Rosai J. Thymic carcinoma. A clinicopathologic study of 60 cases. Cancer 1991;67:1025–1032.

3. Brown JG, Familiari U, Papotti M, et al. Thymic basaloid carcinoma: a clinicopathologic study of 12 cases, with a general discussion of basaloid carcinoma and its relationship with adenoid cystic carcinoma. Am J Surg Pathol 2009;33:1113–1124.

4. Kaira K, Sunaga N, Yanagitani N, et al. Phase I study of oral S-1 plus cisplatin with concurrent radiotherapy for locally advanced non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2009;75:109–114.

5. Chikamori K, Kishino D, Takigawa N, et al. A phase I study of combination S-1 plus cisplatin chemotherapy with concurrent thoracic radiation for locally advanced non-small cell lung cancer. Lung Cancer 2009;65:74–79.

© 2010International Association for the Study of Lung Cancer

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