Postoperative radiotherapy for patients with completely resected thymoma

Abstract

BACKGROUND Optimal management of postoperative radiotherapy for patients with completely resected thymoma remains controversial. This study was conducted to assess the efficacy of postoperative mediastinal irradiation in patients with completely resected thymoma. METHODS The records of 103 patients with completely resected thymoma who received postoperative mediastinal irradiation during the period between 1979 and 1998 were reviewed. The distribution according to Masaoka stage was Stage I in 17 patients, Stage II in 61 patients, and Stage III in 25 patients. Fifty‐two patients were treated with involved field (IF) irradiation, and 51 patients were treated with irradiation of the whole mediastinal field with or without boost (WM irradiation). The total radiation dose to the primary tumor bed was 30–61 grays (Gy), with a median dose of 40 Gy. No patients received chemotherapy during the initial treatment. The median follow‐up of the 82 living patients was 112 months (range, 24–244 months). RESULTS The 10‐year actuarial overall and disease free survival rates for all patients were 81% and 79%, respectively. The 10‐year actuarial overall survival rate was 100% for patients with Stage I disease, 90% for patients with Stage II disease, and 48% for patients with Stage III disease. In the analysis, clinical stage alone had a statistically significant impact on both overall survival and disease free survival (P < 0.0001 for both). Recurrent disease was observed in 17 patients, and the pleura was the most frequent site of first recurrence. Of 12 patients who had pleural recurrences, 11 patients had pleural dissemination remote from the initial tumor site. No recurrence was observed in any of the 17 patients with Stage I disease, and 6 of 61 patients (10%) with Stage II disease and 11 of 25 patients (44%) with Stage III disease experienced recurrences. With regard to intrathoracic recurrences, there were no recurrences within the irradiated field in any of the 103 patients, and no dose response correlation was seen in intrathoracic control (incidence of intrathoracic recurrence: 2 of 19 patients in the group that received < 40 Gy, 6 of 45 patients in the group that received 40 Gy, and 7 of 39 patients in the group that received > 40 Gy). With respect to treatment field, mediastinal recurrences were observed in 4 of 52 patients (8%) who were treated with IF irradiation, whereas 0 of 51 patients who were treated with WM irradiation experienced mediastinal recurrences. Pleural‐based recurrences were observed both in patients who were treated with IF irradiation (7 of 52 patients) and in patients who were treated with WM irradiation (5 of 51 patients). According to the degree of pathologic tumor invasion, 0 of 71 patients without pleural invasion had pleural‐based recurrences (0 of 17 patients with Stage I disease, 0 of 51 patients with Stage II disease, and 0 of 3 patients with Stage III disease), whereas 12 of 32 patients (38%) with pleural invasion had pleural‐based recurrences (4 of 10 patients with Stage II disea...

A phase-II trial of dose-dense chemotherapy in patients with disseminated thymoma: report of a Japan Clinical Oncology Group trial (JCOG 9605)

“…Even when the tumour invades neighbouring organs, as stage-III disease, surgical resection with postoperative radiotherapy is the preferred treatment when complete resection can be achieved (Curran et al, 1988;Urgesi et al, 1990;Ogawa et al, 2002;Strobel et al, 2004).…”

Thymoma Presenting as a Giant Intrathoracic Mass

“…Findings indicating the tumor was type B1 thymoma. Depending on tumor stage, multimodality treatment includes the use of radiation therapy and chemotherapy with or without surgery 22,23 . After surgery we referred our case to oncology department to Dhaka Medical College Hospital for further management.…”

Thymic tumors and outcomes after radiotherapy

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