The Impact of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma

Jackson, Mary; Palma, David A.; Camidge, D. Ross; Jones, Bernard L.; Robin, Tyler P.; Sher, David J.; Koshy, Matthew; Kavanagh, Brian D.; Gaspar, Laurie E.; Rusthoven, Chad G.

doi:10.1016/j.jtho.2017.01.002

Cited by 104 publications

(100 citation statements)

References 35 publications

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“…The use of postoperative radiation for stage II thymomas remains controversial. Jackson et al demonstrated that younger age, early Masao–Koga stage, chemotherapy, and postoperative radiation were independently associated with longer OS in patients with thymomas . In contrast, we observed that postoperative radiation is not independently associated with longer OS.…”

Section: Discussioncontrasting

confidence: 84%

“…Jackson et al demonstrated that younger age, early Masao-Koga stage, chemotherapy, and postoperative radiation were independently associated with longer OS in patients with thymomas. 14 In contrast, we observed that postoperative radiation is not independently associated with longer OS. Consistent with the results of a Chinese study, we also observed that postoperative radiation is not an independent prognostic factor of OS.…”

Section: Discussioncontrasting

confidence: 68%

“…Surgical resection remains independently prognostic of improved survival . Zhao et al reported that complete resection improves disease‐free survival; however, the complex structure in the anterior mediastinum makes it difficult to completely resect tumors, particularly advanced‐stage tumors . Thus, multimodality treatment, including postoperative radiation and chemotherapy, has been adopted to prolong survival.…”

Section: Discussionmentioning

confidence: 99%

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Nomogram to predict thymoma prognosis: A population‐based study of 1312 cases

et al. 2019

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Background A thymoma is a common cancer within the anterior mediastinum; however, the prognostic characteristics have not been established. The aim of this study was to identify the prognostic factors and develop a nomogram for the prognostic prediction of patients with thymoma based on data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods Patients with thymomas diagnosed between 1983 and 2014 were selected. Overall survival (OS) was estimated using the Kaplan–Meier method with the log‐rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the independent prognostic factors, from which a nomogram for thymomas was created. External validation of the nomogram was performed using data from our center. Results A total of 1312 patients with thymomas were enrolled. Age, tumor size, Masaoka–Koga stage, chemotherapy administered, and surgery type were independent prognostic factors for OS. A nomogram for OS was formulated based on the independent prognostic factors and validated using an internal bootstrap resampling approach, which showed that the nomogram exhibited a sufficient level of discrimination according to the C‐index in training (0.713, 95% confidence interval 0.685–0.741) and (0.746, 95% confidence interval 0.625–0.867) validation cohorts. Conclusion Several prognostic factors for thymomas were identified. The nomogram developed in this study accurately predicted the 5‐year and 10‐year OS rates of patients with thymomas based on individual characteristics. Risk stratification using the survival nomogram could optimize individual therapy and follow‐up.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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Nomogram to predict thymoma prognosis: A population‐based study of 1312 cases

et al. 2019

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Section: Discussionmentioning

confidence: 99%

“…The role of adjuvant RT after complete resection in Masaoka stage II disease is controversial (26). Recently, well powered large sized studies showed increase in OS in Masaoka stage II and III thymoma with adjuvant RT (9,26,27). Radiotherapy planning should be established cautiously in adjuvant setting in terms of benefit versus toxicity, since thymomas grow in close proximity to critical organs (28).…”

Section: Discussionmentioning

confidence: 99%

Role of radiotherapy in Masaoka stage II and III thymomas - single center experience

Kıraklı¹,

Erdem²,

Bozkurt³

et al. 2019

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Aim: Thymomas are rare neoplasms. Complete surgical resection is the cornerstone of the treatment. The role of adjuvant radiotherapy (RT) in Masaoka stage II disease is controversial, but in more advanced stages and the role of radical RT in inoperable cases are clear. This study is conducted to evaluate local control, relapse free survival and overall survival rates in Masaoka stage II and III thymoma patients after adjuvant or radical RT. Materials and Methods: The medical records of thymoma patients who were treated and completed their RT course between January 2010 and August 2016 in a single center were evaluated retrospectively. Results: Twenty-two patients were available for analysis. Treatment planning was adjuvant in 18 patients and radical in 5 patients. Median age at diagnosis was 59 (50-62). Type of resection was R0 in all cases. The adjuvant RT dose was 50 Gy; radical RT dose was 60-66 Gy. The most common acute toxicity was grade 1 pneumonitis which was reported in 9 patients (39%). Grade 2 acute pneumonitis was experienced by 3 patients (13%), grade 2 acute esophagitis was experienced by 2 patients (9%). One patient had late grade 3 esophageal toxicity. Follow-up time ranged from 6 to 99 months, median 18 months, local control rate was 100%, relapse free survival (RFS) was 96%, cancer specific survival was 96%, 2 years overall survival (OS) was 83%. Conclusion: Although our results seem to be in concordance with the literature, longer follow-up is needed to be able to make a conclusion in terms of LC, RFS and OS, since thymoma has an indolent course with low relapse rate and long RFS.

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American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma

et al. 2023

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ImportanceThymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management.ObjectiveTo develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma.Evidence ReviewCase variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. Variants and procedures were evaluated by the panel using modified Delphi methodology. Agreement/consensus was defined as less than or equal to 3 rating points from median. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures.FindingsThe ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs.Conclusions and RelevanceThe ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.

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The Impact of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma

Cited by 104 publications

References 35 publications

Nomogram to predict thymoma prognosis: A population‐based study of 1312 cases

Nomogram to predict thymoma prognosis: A population‐based study of 1312 cases

Role of radiotherapy in Masaoka stage II and III thymomas - single center experience

American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma

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