Postoperative radiotherapy: Not all thymic malignancies are created equal

Rimner, Andreas

doi:10.1002/cncr.29164

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Since the survey was conducted, there have been 3 publications demonstrating the benefit of adjuvant RT in large cohorts of completely resected thymic carcinoma 5,7,9 . Adjuvant RT demonstrated an overall survival benefit 5,9,13 . Because of these recent data, the group recommended the use of adjuvant RT in patients with Masaoka Stage II and III disease.…”

Section: Discussionmentioning

confidence: 97%

Thymic Carcinoma Management Patterns among International Thymic Malignancy Interest Group (ITMIG) Physicians with Consensus from the Thymic Carcinoma Working Group

Shepherd

Riely

Detterbeck

et al. 2017

Journal of Thoracic Oncology

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Introduction Thymic carcinomas are rare epithelial malignancies with limited data to guide management. Methods In order to identify areas of agreement and variability in current clinical practice, a 16-question electronic survey was given to members of the International Thymic Malignancy Interest Group (ITMIG). Areas of controversy were discussed with the Thymic Carcinoma Working Group and consensus was achieved, as described. Results One hundred ITMIG members responded. There was general agreement regarding the role for multimodality therapy with definitive surgical resection in physically fit patients with advanced, but resectable disease. Areas of controversy included the need for histologic confirmation prior to surgery, the role of adjuvant therapy, the optimal first-line chemotherapy regimen, and the recommended treatment course for marginally resectable disease with invasion into the great vessels, pericardium, and lungs. Conclusions The results of the questionnaire provide a description of the management of thymic carcinoma by 100 ITMIG members with a specific interest or expertise in thymic malignancies. Although there was agreement in some areas, clinical practice appears to vary significantly. There is a great need for collaborative research to identify optimal evaluation and treatment strategies. Given the need for multimodality therapy in many cases, a multidisciplinary discussion of the management of patients with thymic carcinoma is critical.

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Section: Discussionmentioning

confidence: 97%

Thymic Carcinoma Management Patterns among International Thymic Malignancy Interest Group (ITMIG) Physicians with Consensus from the Thymic Carcinoma Working Group

Shepherd

Riely

Detterbeck

et al. 2017

Journal of Thoracic Oncology

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“…Many studies include patients with thymomas of various stages (I to IV), variable resection status (R0, R1, R2), and other histologies such as thymic carcinomas or neuroendocrine tumors of the thymus which are likely associated with a different biologic behavior and potentially different response to therapies. 15–19 …”

Section: Discussionmentioning

confidence: 99%

Postoperative Radiation Therapy Is Associated with Longer Overall Survival in Completely Resected Stage II and III Thymoma—An Analysis of the International Thymic Malignancies Interest Group Retrospective Database

Rimner

Yao

Huang

et al. 2016

Journal of Thoracic Oncology

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Purpose To determine whether postoperative radiation therapy (PORT) is associated with an overall survival benefit in patients with completely resected Masaoka or Masaoka-Koga stage II and III thymoma. Patients and Methods All patients with completely resected (R0) stage II–III thymoma were identified in a large database of the International Thymic Malignancy Interest Group (ITMIG). Clinical, pathologic, treatment, and follow up information were extracted. Overall survival (OS) was the primary endpoint. A univariate analysis using log-rank test and a multivariate Cox model were created to identify factors associated with OS. Results In 1263 patients meeting the selection criteria 870 (69%) patients had stage II thymoma. The WHO histologic subtype was A/AB in 360 (30%) and B1/B2/B3 in 827 (70%) patients. PORT was given to 55% (n=689) of patients, 15% (n=180) received chemotherapy, and 10% (n=122) both. The 5- and 10-year OS rates for patients having undergone surgery + PORT were 95% and 86%, respectively, compared to 90% and 79% for patients with surgery alone(p = 0.002). This OS benefit remained significant when separately analyzing patients with stage II (p= 0.02) and stage III thymoma (p=0.0005). On multivariate analysis, earlier stage, younger age, absence of paraneoplastic syndrome and PORT were significantly associated with improved OS. Conclusions We observed an OS benefit with the use of PORT in completely resected stage II and III thymoma. In the absence of a randomized trial, this represents the most comprehensive individual patient data analysis and strong evidence in favor of PORT in this patient population.

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“…Patients with gross residual disease after surgery might have more advanced tumors or a histologically more aggressive subtype. There might often be certain patterns that lead to more patients with adverse high-risk tumor characteristics or suboptimal surgical management such as incomplete resections being referred for PORT (23,24). If despite such imbalances of unfavorable characteristics, the overall survival (OS) of patients receiving PORT and those who only undergo surgery is similar this might indicate that PORT was effective at reducing the risk of recurrence in patients with incomplete resection to a level that is comparable to those of patients with completely resected thymoma (24).…”

Section: Thymomamentioning

confidence: 99%

The expanding role of radiation therapy for thymic malignancies

Willmann

Rimner

2018

J. Thorac. Dis.

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The role of radiation therapy (RT) in thymic malignancies has long been subject to considerable controversy. The main role for RT is in the setting of adjuvant therapy after surgical tumor resection, especially in advanced or incompletely resected cases. However, recent studies with larger patient numbers and cleaner study populations than previous studies have indicated a potentially clearer than previously assumed benefit after post-operative RT (PORT) even for completely resected patients with earlier stages of thymoma. In marginally resectable patients RT may be used in combination with neoadjuvant chemotherapy to shrink tumors and thereby potentially enable resection. In unresectable patients concurrent or sequential chemotherapy and RT can be employed as the definitive nonsurgical approach. The tendency of thymic tumors to recur in the pleural space highlights the necessity for more effective approaches to identify and treat high risk patients. Experiences in other pleural malignancies may pave the way to novel treatment modalities, for example pleural IMRT. The role of these techniques in thymic malignancies has yet to be determined and is not advisable at the current time outside of a clinical study. As the disease often takes an indolent course with excellent long-term local control (LC) and survival, late toxicities related to radiation of the mediastinum and adjacent organs at risk (OARs) have to be taken into consideration and may jeopardize the benefit patients experience from RT, especially in younger patients with a long-anticipated life expectancy. Radiation techniques, such as intensity modulated RT (IMRT) and proton beam therapy (PBT), have substantially reduced the exposure of OARs to ionizing radiation which is expected to translate into reduced long-term toxicities. Hence, the risk-benefit ratio of RT in early stage thymoma patients may be shifted favorably.

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Postoperative radiotherapy: Not all thymic malignancies are created equal

Abstract: The key finding of Omasa et al.'s study is that postoperative radiotherapy is associated with an improvement in recurrence‐free survival in patients with thymic carcinoma but not in patients with thymoma.

Cited by 5 publications

References 20 publications

Thymic Carcinoma Management Patterns among International Thymic Malignancy Interest Group (ITMIG) Physicians with Consensus from the Thymic Carcinoma Working Group

Thymic Carcinoma Management Patterns among International Thymic Malignancy Interest Group (ITMIG) Physicians with Consensus from the Thymic Carcinoma Working Group

Postoperative Radiation Therapy Is Associated with Longer Overall Survival in Completely Resected Stage II and III Thymoma—An Analysis of the International Thymic Malignancies Interest Group Retrospective Database

The expanding role of radiation therapy for thymic malignancies

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