Patterns of Failure Following Postoperative Radiation Therapy Based on “Tumor Bed With Margin” for Stage II to IV Type C Thymic Epithelial Tumor

Lee, Kyung Hwa; Noh, Jae Myoung; Ahn, Yong Chan; Oh, Dongryul; Kim, Young Tae; Shim, Young Mog; Han, Jungho

doi:10.1016/j.ijrobp.2018.07.2022

Cited by 5 publications

(6 citation statements)

References 32 publications

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“…Importantly, we obtained a comparable result despite the higher proportion of patients with Masaoka–Koga stage IVB (25.9%), who are usually not eligible for surgery because of the advanced-stage disease. Compared to a recent study which reported survival outcomes following postoperative RT in thymic carcinoma and thymic neuroendocrine tumors, although the proportion of patients with Masaoka–Koga stage IVB was much higher in our study (25.9% vs. 3.8%), the 5-year rates of OS and PFS were comparable (75.2% vs. 81.0% and 47.7% vs. 49.7%, respectively) [ 8 ]. This reflects that the use of RT can be of benefit even in patients with Masaoka stage IV thymic carcinoma.…”

Section: Discussioncontrasting

confidence: 93%

“…However, the failure pattern according to the target volume after RT delivered in various clinical settings has not been studied previously. Consistent with the findings of Lee et al [ 8 ], the main failure pattern after RT in the present study was outfield failure, observed in 47/53 (88.7%) patients who experienced any type of failure. No isolated infield or marginal failures were observed in our study.…”

Section: Discussionsupporting

confidence: 93%

“…Lee et al [ 8 ] reported failure patterns after PORT in relation to the target volume in thymic carcinoma and concluded that the policy of PORT target volume confined to only the tumor bed seems reasonable. However, the failure pattern according to the target volume after RT delivered in various clinical settings has not been studied previously.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have addressed the failure patterns in thymic carcinoma [ 8 ]. In this study, we aimed to find out the optimal RT field through a detailed analysis of the pattern of failure.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Thymic Carcinoma: The Role of Radiotherapy Combined with Multimodal Treatments

Yang

Lee

Kim

et al. 2023

Cancers

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Introduction: We aimed to identify the role of radiotherapy (RT) in the treatment of thymic carcinoma as well as the optimal RT target volume. Materials and Methods: This single-institution retrospective study included 116 patients diagnosed with thymic carcinoma between November 2006 and December 2021 who received multimodal treatment including RT with or without surgery or chemotherapy. Seventy-nine patients (68.1%) were treated with postoperative RT, 17 patients (14.7%) with preoperative RT, 11 patients (9.5%) with definitive RT, and nine patients (7.8%) with palliative RT. The target volume was defined as the tumor bed or gross tumor with margin, and selective irradiation of the regional nodal area was performed when involved. Results: With a median follow-up of 37.0 (range, 6.7–174.3) months, the 5-year overall survival (OS), progression-free survival, and local recurrence-free survival rates were 75.2%, 47.7% and 94.7%, respectively. The 5-year OS was 51.9% in patients with unresectable disease. Overall, 53 recurrences were observed, of which distant metastasis was the most common pattern of failure (n = 32, 60.4%) after RT. No isolated infield or marginal failures were observed. Thirty patients (25.8%) who had lymph node metastases at the initial diagnosis had regional nodal areas irradiated. There was no lymph node failure inside the RT field. A tumor dimension of ≥5.7 cm (hazard ratio [HR] 3.01; 95% confidence interval [CI] 1.25–7.26; p = 0.030) and postoperative RT (HR 0.20; 95% CI 0.08–0.52; p = 0.001) were independently associated with OS. Intensity-modulated-RT-treated patients developed less overall toxicity (p < 0.001) and esophagitis (p < 0.021) than three-dimensional-conformal-RT-treated patients. Conclusions: A high local control rate was achieved with RT in the primary tumor sites and involved lymph node area in the treatment of thymic carcinoma. A target volume confined to the tumor bed or gross tumor plus margin with the involved lymph node stations seems reasonable. The advanced RT techniques with intensity-modulated RT have led to reduced RT-related toxicity.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

“…Few studies have addressed the failure patterns in thymic carcinoma [ 8 ]. In this study, we aimed to find out the optimal RT field through a detailed analysis of the pattern of failure.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Thymic Carcinoma: The Role of Radiotherapy Combined with Multimodal Treatments

Yang

Lee

Kim

et al. 2023

Cancers

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“…All patients with TET were classified according to the World Health Organization (WHO) classification [ 24 ], Masaoka-Koga staging classification [ 25 , 26 ], and the 8th edition of the TNM staging system, based on their histopathological reports. PORT was delivered 4–6 weeks after surgery, and the target volume included the tumor bed and involved area, according to our institution’s policy [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of radiotherapy techniques in patients with thymic epithelial tumor who underwent postoperative radiotherapy

Lee,

Oh,

Ahn

et al. 2024

Radiat Oncol J

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Purpose: This retrospective study aimed to compare clinical outcomes and dosimetric parameters between radiation therapy (RT) techniques in patients with thymic epithelial tumor (TET).Materials and Methods: From January 2016 to December 2020, 101 patients with TET received adjuvant RT (median, 52.8 Gy; range, 48.4 to 66.0). Three different RT techniques were compared: three-dimensional conformal RT (3D-CRT; n = 59, 58.4%), intensity-modulated RT (IMRT; n = 23, 22.8%), and proton beam therapy (PBT; n = 19, 18.8%).Results: The median age of the patients and the follow-up period were 55 years (range, 28 to 79) and 43.4 months (range, 7.7 to 77.2). Patients in the PBT group were of the youngest age (mean age, 45.4 years), while those in IMRT group had the largest clinical target volume (mean volume, 149.6 mL). Patients in the PBT group had a lower mean lung dose (4.4 Gy vs. 7.6 Gy vs. 10.9 Gy, respectively; p < 0.001), lower mean heart dose (5.4 Gy vs. 10.0 Gy vs. 13.1 Gy, respectively; p = 0.003), and lower mean esophageal dose than patients in the 3D-CRT and IMRT groups (6.3 Gy vs. 9.8 Gy vs. 13.5 Gy, respectively; p = 0.011). Twenty patients (19.8%) showed disease recurrence, and seven patients (6.9%) died. The differences in the survival rates between RT groups were not statistically significant.Conclusion: In patients with TET who underwent adjuvant RT, PBT resulted in a lower dose of exposure to adjacent organs at risk. Survival outcomes for patients in PBT group were not significantly different from those in other groups.

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Surgical, Radiation, and Systemic Treatments of Patients With Thymic Epithelial Tumors: A Systematic Review

Falkson

Vella

Ellis

et al. 2023

Journal of Thoracic Oncology

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Patterns of Failure Following Postoperative Radiation Therapy Based on “Tumor Bed With Margin” for Stage II to IV Type C Thymic Epithelial Tumor

Cited by 5 publications

References 32 publications

Clinical Outcomes of Thymic Carcinoma: The Role of Radiotherapy Combined with Multimodal Treatments

Clinical Outcomes of Thymic Carcinoma: The Role of Radiotherapy Combined with Multimodal Treatments

Comparison of radiotherapy techniques in patients with thymic epithelial tumor who underwent postoperative radiotherapy

Surgical, Radiation, and Systemic Treatments of Patients With Thymic Epithelial Tumors: A Systematic Review

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