Postoperative Radiotherapy After Surgical Resection of Thymoma: Differing Roles in Localized and Regional Disease

Forquer, Jeffrey A.; Rong, Nan; Fakiris, Achilles J.; Loehrer, Patrick J.; Johnstone, Peter A.S.

doi:10.1016/j.ijrobp.2009.02.016

Cited by 104 publications

(83 citation statements)

References 40 publications

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“…The complete resection (R0) is the gold standard treatment for operable thymic carcinoma. Radiotherapy and chemotherapy appear to benefit inoperable or incompletely resected patients (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

Yuan¹,

Gao²,

Mu³

et al. 2016

J. Thorac. Dis.

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Background: Preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have prognostic value in patients with various operable tumors. The aim of our study was to determine whether NLR and PLR are predictive of survival in thymic carcinoma patients after complete resection. Results: Univariate analysis found that a high level of NLR was associated with lower disease-free survival (DFS) (HR: 3.385, 95% CI: 1.073-10.678, P=0.037) and lower overall survival (OS) (HR: 12.836, 95% CI:1.615-101.990, P=0.016). The optimal NLR threshold of 4.1 could stratify the patients with high risk of recurrence or metastasis (P=0.026) and death (P=0.006). Meanwhile, the NLR value of >4.1 in those patients was associated with bigger tumor size (P=0.035) and more advanced Masaoka stages (P=0.040) compared with NLR ≤4.1. However, the PLR and other variables were not significantly associated with survival in thymic carcinoma patients. Conclusions:The preoperative NLR of >4.1 was significantly associated with larger tumor size, more advanced Masaoka stages and reduced DFS and OS, but was not an independent predictor of survival in thymic carcinoma patients after complete resection.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

Yuan¹,

Gao²,

Mu³

et al. 2016

J. Thorac. Dis.

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“…[3,7] EIII-IV olgularda TE sonrası adjuvan RT önerilirken, EII olup TE timomalı olgularda adjuvan tedavi kararı-nın kötü risk faktörleri varlığında verilmesi gerektiği vurgulanmaktadır. [13][14][15][16] Sağkalım açısından invazivlik, rezeksiyon tipi, MG varlığı, ileri yaş, tümör çapı, hücre siklus protein ekspresyonu gibi birçok PF ortaya konmasına rağmen genel olarak Masaoka ve DSÖ sınıflaması en iyi ve geçerli prediktörler olarak kabul edilmekte ve adjuvan tedavi kararının PF'ye göre verilmesi gerektiği bildirilmektedir. [1,3,[17][18][19][20] Masaoka evresine göre beş yıllık GSK EI-III timoma için %85, EIV için %65 bildirilmektedir.…”

Section: Discussionunclassified

Thymic tumors and outcomes after radiotherapy

Sarıhan¹

2013

TJ Oncol

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OBJECTIVESWe evaluated the results of treatment in patients with thymic tumors treated with postoperative adjuvant radiotherapy. METHODSEighteen patients were treated median 5400 cGy radiotherapy between 1995-2010. Diagnosis of patients were thymoma (n=10), thymic carcinoma (n=7), thymic neuroendocrin carcinoma (n=1). R0 resection was made on 12 of them. According to prognostic stratification with Masaoka stage and WHO classification, there were 5 good, 7 moderate, and 6 poor risk patients. Survival was calculated from diagnosis. RESULTSA total of 33% patients were recurred median 29.5 months with 34 months follow-up. Local control, median overall and disease-free survival for all patients were 77%, 113 months, and 105 months. Local control for good, moderate, poor risk groups were found 100%, 71%, 50%. There were significant differences survival rates for Masaoka stage, R0 resection, and prognostic groups. CONCLUSIONPrognostic risk classification was found to be better predictive in terms of local control and survival.Key words: Thymic tumor; adjuvant radiotherapy; local control; prognostic group; survival. AMAÇCerrahi sonrası adjuvan radyoterapi uygulanan timik tümörlü olgularda tedavi sonuçları değerlendirildi. GEREÇ VE YÖNTEMOn sekiz olgu 1995-2010 arasında ortanca 5400 cGy radyoterapi ile tedavi edildi. Tanı; timoma (n=10), timik karsinom (n=7), timik nöroendokrin karsinom (n=1) olarak sıralanıyor-du. Olguların 12'sine R0 rezeksiyon yapılmıştı. Masaoka evre ve Dünya Sağlık Örgütü sınıflamasını içeren prognostik risk sınıflamasına göre; 5 iyi, 7 orta ve 6 kötü riskli hasta vardı. Sağkalım tanıdan itibaren hesaplandı. BULGULAROtuz dört aylık izlem süresi içinde olguların %33'ünde ortanca 29.5 ayda nüks görüldü. Lokal kontrol, ortanca genel ve hastalıksız sağkalım tüm olgular için; %77, 113 ay, 105 ay bulundu. İyi-orta-kötü prognostik gruplar için lokal kontrol %100, %71, %50 oldu. Masaoka evre, R0 rezeksiyon, prognostik risk grupları için sağkalım oranlarında anlamlı fark vardı. SONUÇPrognostik risk sınıflamasının lokal kontrol ve sağkalım açı-sından daha iyi prediktör olduğu görüldü.

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“…A Chinese trial including 29 patients compared adjuvant radiotherapy versus exclusive surgery in patients with completely resected stage I thymomas, and, although underpowered, failed to show any differences in patient outcome [43]. Furthermore, a recent report from the Survival, Epidemiology, and End Results (SEER) database including 275 stage I thymic tumours suggested a possible adverse impact of post-operative radiotherapy on 5-yr cause-specific survival (91% versus 98% without radiotherapy; p50.03) [44]. Adjuvant radiotherapy is then rarely administered in stage I thymomas after complete surgical resection ( fig.…”

Section: Radiotherapy Principlesmentioning

confidence: 99%

“…Moreover, it has become clear that recurrences occur outside the mediastinum in .60% of cases, especially in stage II-III tumours. A SEER database analysis included 626 invasive thymic tumours, and showed that 5-year survival was significantly better after postoperative radiotherapy (76% versus 66%; p50.01), but causespecific survival was similar (91% versus 86%; p50.12) [44]. This finding may be potentially related to the high late toxicity rates of radiotherapy before the conformal era.…”

Section: Radiotherapy Principlesmentioning

confidence: 99%

Thymic epithelial tumours: from basic principles to individualised treatment strategies

Girard¹

2013

Eur Respir Rev

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Thymic epithelial tumours represent a wide range of anatomical, clinical, histological and molecular malignant entities that may be aggressive and difficult to treat. The histopathological classification distinguishes thymomas from thymic carcinomas. Thymomas may be associated with autoimmune disorders.The management of thymic epithelial tumours is a paradigm of co-operation between clinicians, surgeons and pathologists, from establishing the diagnosis to organising the multimodal therapeutic strategy. Surgery is the mainstay of the curative-intent treatment, as complete resection represents the most significantly favourable prognostic factor on overall survival. In case of invasion of intra-thoracic structures and/or dissemination to the pleura and the pericardium, precluding complete resection to be achieved, primary chemotherapy has been used to reduce the tumour burden, possibly allowing subsequent surgery and/or radiotherapy.Novel strategies are needed, especially for refractory, recurrent tumours and thymic carcinomas, which carry a poor prognosis. Personalised approaches are currently being developed, as potentially ''druggable'' molecular targets are emerging from recent integrated genomic analyses. Along with the large variety of questions relative to the treatment strategy, thymic epithelial tumours represent a model of therapeutic implementation and achievement in orphan thoracic oncology, showing how the advent of new results induces new questions, as well as diversifies further clinical research directions and international collaborative initiatives.

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Postoperative Radiotherapy After Surgical Resection of Thymoma: Differing Roles in Localized and Regional Disease

Cited by 104 publications

References 40 publications

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

Thymic tumors and outcomes after radiotherapy

Thymic epithelial tumours: from basic principles to individualised treatment strategies

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