Radiotherapy and prognostic factors for thymoma: A retrospective study of 175 patients

Zhu, Guoding; He, Shasha; Fu, Xiaolong; Jia, Guanghong; Liu, Taifu

doi:10.1016/j.ijrobp.2004.05.013

Cited by 65 publications

(64 citation statements)

References 37 publications

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“…This study illustrated that complete microscopic resection is achievable in a large proportion of thymoma patients and that survival after an R0 resection was significantly higher, establishing that complete surgical resection is the best therapeutic modality for thymoma. Similar results have been reported in other series (4)(5)(6)(7)(8)(9). Interestingly, in the study by Rea et al, no significant survival difference was seen between those undergoing debulking surgery compared to biopsy alone, further supporting the importance of achieving an R0 resection if possible (6).…”

supporting

confidence: 81%

Minimally invasive thymectomy for thymoma: does surgical approach matter or is it a question of stage?

Kaufman

Flores

2016

J. Thorac. Dis.

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Complete (R0) surgical resection remains the primary treatment modality for thymoma in both early and advanced stage disease. Following trends seen in surgery for other malignancies, minimally invasive thymectomy (MIT) utilizing VATS or robotic approaches have increased in popularity due to the short term and cosmetic benefits associated with minimally invasive surgery. However, the efficacy of MIT for thymoma compared to open surgery (which utilizes a median sternotomy or thoracotomy) based on oncologic results or survival outcomes remains controversial. The theoretical risk of incomplete resection or capsular disruption causing recurrence and decreased survival with MIT has led many surgeons to avoid MIT for the treatment of thymoma. Because of the relative rarity of the diagnosis and the indolent course of thymoma, comparisons of surgical technique have relied mainly on small single-center retrospective reports which provide limited levels of evidence to support any specific treatment paradigm. Historically, MIT was performed using the transcervical approach popularized as a method for treating myasthenia gravis (MG), not thymoma, although one series does report their experience with the technique for thymic tumors (1). The relative difficulty of transcervical thymectomy compared to VATS or robotic approaches has resulted in the much wider adoption of VATS/Robotic MIT as the preferred minimally invasive approach. Other questions regarding thymoma management such as which staging system to use, how to utilize the World Health Organization (WHO) histologic classification, what induction or adjuvant therapies are indicated and for which stage of disease, and whether partial thymectomy, debulking surgery, or re-operative surgery are beneficial remain unanswered. These issues and the different treatment strategies employed per patient and per institution are important confounding factors whenever one analyzes any particular surgical technique.Open Surgical resection has been the gold standard of treatment for thymoma because the overwhelming majority of thymomas are localized at the time of diagnosis and amenable to local therapy. A comprehensive review of the literature that complied studies that included at least 100 patients revealed that 40% of thymomas presented as stage I, 25% as stage II, 25% stage III, 10% stage IVa, and 1-2% stage IVb (2). Thus 65% of patients presented with disease confined to the thymus gland without invasion into adjacent structures. In that review, the ability to perform an R0 resection for early stage disease was nearly 100% for stage I, with 85% for stage II (range, 43-100%). The average rate of R0 resection rate diminished significantly with advanced stage, only 47% for stage III and 26% for stage IV. In stage III and IV disease, the rate of complete resection varied widely between studies reflecting the heterogeneity of advanced stage thymomas in terms of the degree and location of invasion and the differences in institutional practice patterns concerning aggressiveness of resecti...

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supporting

confidence: 81%

Minimally invasive thymectomy for thymoma: does surgical approach matter or is it a question of stage?

Kaufman

Flores

2016

J. Thorac. Dis.

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“…Although thymomas have been recognised as highly radiosensitive for years, the benefit of dose escalation on local control has not clearly been established. ARRIAGADA et al [40] reported similar local control rates with total doses inferior to 48 Gy or superior to 60 Gy, while in more recent series, no improvement regarding local control was observed with doses of 50 Gy or .60 Gy [41]. Ultimately, higher doses are usually delivered, if possible, in the setting of definite treatment, as compared to that of post-operative treatment, with total doses of 40-50 Gy and 50-60 Gy with a boost up to 60-66 Gy, respectively.…”

Section: Radiotherapy Principlesmentioning

confidence: 89%

“…In the landmark Japanese cohort including 257 stage II thymomas, no significant difference was observed regarding recurrence rates in patients who received surgery alone or surgery followed by adjuvant radiotherapy [6]. However, more recent series, involving the use of modern radiation delivery techniques, suggested post-operative radiotherapy might improve disease-free and overall survival even more in these patients; by up to 100% and 95%, respectively [41,[48][49][50][51]. Differences in outcome may exist depending on the extent of capsular invasion, i.e.…”

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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“…The efficacy of adjuvant chemotherapy/radiotherapy for patients with stage III or IV thymoma remains controversial [4,9].…”

Section: Discussionmentioning

confidence: 99%

Ectopic thymoma simulating a pericardial cyst

Caramori

Calia

Pasquini

et al. 2005

Monaldi Arch Chest Dis

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Radiotherapy and prognostic factors for thymoma: A retrospective study of 175 patients

Cited by 65 publications

References 37 publications

Minimally invasive thymectomy for thymoma: does surgical approach matter or is it a question of stage?

Minimally invasive thymectomy for thymoma: does surgical approach matter or is it a question of stage?

Thymic epithelial tumours: from basic principles to individualised treatment strategies

Ectopic thymoma simulating a pericardial cyst

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