Clinical outcome of intensity modulated radiotherapy for carcinoma showing thymus-like differentiation

Abstract

PurposeTo evaluate the efficacy and toxicity of adjuvant intensity-modulated radiotherapy (IMRT) after surgery for carcinoma showing thymus-like differentiation (CASTLE).MethodsBetween September 2008 and June 2015, 14 CASTLE patients were retrospectively enrolled. The clinical features, treatment procedure and clinical outcomes were reviewed. All patients received postoperative IMRT. The radiation doses ranged from 56Gy/28 fractions to 66Gy/33 fractions. Treatment-related toxicities were graded by National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 3.0.ResultsAfter a median follow-up period of 42 months, only one patient suffered local recurrence and distant metastasis. The most frequently seen acute toxicities were mucositis and dermatitis (grade 1-2). No grade 3-4 toxicities were observed.ConclusionsAlthough based upon a small series of consecutively treated patients, our study showed that adjuvant IMRT provides satisfactory local-regional control for CASTLE, with acceptable toxicities. Further studies are still warranted to clarify our findings.

Management and Prognostic Factors for Thyroid Carcinoma Showing Thymus-Like Elements (CASTLE): A Case Series Study

“…Disease infiltration to adjacent structures occurred in 79.69% of the included cases and 68.8% of them revealed metastatic disease in regional lymph nodes. The incidence was higher than in previous reports ( 6 , 9 ), and the inclusion of recently reported local progressive tumors might contribute to the high incidence ( 7 , 26 , 32 ). The high risk of tumor invasion indicates that CASTLE tumors may pursue a more aggressive course oncologically ( 6 – 9 ).…”

“…FNAB cytological examinations offer limited diagnostic value for CASTLE ( 9 , 29 ). Reported cytological differential diagnoses vary, with most cases being identified as anaplastic carcinoma or poorly differentiated carcinoma, without further definite classification [( 12 – 32 ), Table 3 ]. CASTLE was correctly identified as malignant in 265 of 269 reported cases using FNAB results, while only in four cases among them, a preoperative diagnosis of CASTLE was given ( 29 ).…”

Genomic variation associated with carcinoma showing thymus‐like elements (CASTLE) in thyroid gland

“…21 Although Dong et al 22 demonstrated a favorable outcome merely by radical surgery, postoperative radiotherapy or chemoradiotherapy is often recommended, especially for patients with extracapsular invasion, positive surgical margins, or regional lymph node metastasis. 23,24 A meta-analysis of 82 cases of CASTLE reported a recurrence rate of 18.57% and the longest follow-up time of 26 years. 25 Salvage surgery combined with adjuvant radiotherapy is the most frequently used treatment for local and regional recurrence.…”

Frequency of Functional and Muscular Changes After Head and Neck Radiation Therapy. A Cross-Sectional Study

“…Currently, most radiotherapy centers in the world have IMRT. In Brazil, it is not widely used due to the high cost, so it is available only in a few centers in the country (NUTTING et al, 2009;KONG et al, 2016).…”