[Thymoma: therapeutic and diagnostic aspects].

Ten patients with malignant inoperable thymoma were treated January 1972 and December 1978 in the Department of Radiotherapy, University Hospital, Basel. The average age at the time of diagnosis was 36 years. The youngest patient with an ectopic thymoma was 5 1/2 years old and the oldest 66. Accompanying autoimmune diseases were not observed. Histological verification was obtained 9 times by biopsy and once by tumor excision: 3 patients had a fusiform cell thymoma, 3 presented with a mixed-cell thymoma, 2 patients had a granulomatous and 2 mainly an epithelial or unclassified type of thymoma. Four patients died. One died within one year from generalized varicella infection and was free from tumor at autopsy. The other three developed metastases later. One developed a recurrence 2 1/2 years after receiving 6500 rads; following resection, a radiogold implant was given and additional irradiation of 4000 rad administered. Eighteen months later this patient developed lung metastases which exhibited slow progression under chemotherapy. 5 3/12 years after beginning of treatment laminectomy was performed, in the postoperative phase of which the patient contracted edema of the lung and died. The operation site showed a large recurrence invading the spinal channel per continuitatem. The other two patients died 1 3/12 years after the beginning of radiotherapy in spite of chemotherapy for disseminated metastases. Six patients who have been followed-up for one to 5 5/12 years are asymptomatic and show no evidence of disease. The dose administered was 4200-6500 rads. The therapeutic approach and factors affecting prognosis are discussed. In the experience of the authors and others, the best results are achieved with surgery and curative irradiation.