Clinicopathological profile and treatment outcomes of advanced/unresectable thymic malignancies from a tertiary care centre in India.

BACKGROUND: Thymomas, though rare, are the most common anterior mediastinal neoplasms in adults, with incidence of 0.13 per 100,000 person-years. Due to indolent nature and lack of randomized trials, treatment relies on retrospective data. Literature on outcomes of unresectable thymomas in India is limited. METHODS: This retrospective study was conducted at a tertiary cancer centre in north India, analysing records of patients with advanced/unresectable thymic malignancies (stage III-IV) treated between January 2012 and December 2023. Clinicopathological features, response rates, progression-free survival (PFS), and overall survival (OS) were assessed. RESULTS: A total of 43 patients (median age 40 years [range 22-72]; 76.7% male) were included. Histology revealed thymoma in 36 (83.7%), thymic carcinoma in 4 (9.3%), and thymic neuroendocrine tumours in 3 (7%). Common symptoms were cough (60.5%), dyspnoea (60.5%), and chest pain (55.8%). Stage distribution was - III (20.9%), IVA (46.5%), and IVB (32.6%). Liver (14%) was the most common site of distant metastasis. Myasthenia gravis and pure red cell aplasia occurred in 7% each. Forty (93%) patients received systemic therapy, primarily Cyclophosphamide-Adriamycin-Cisplatin (75%). The objective response rate for first-line systemic therapy was 37.5% (all partial responses) with a clinical benefit rate of 87.5%. Twelve (30%) underwent surgery, with R0 resection in 6 (15%). Median PFS was 16.4 months, and OS was 56 months. CONCLUSION: Systemic therapy and surgery in selected cases provide meaningful outcomes in unresectable thymomas, emphasizing the need for prospective studies to refine treatment strategies.