Radiotherapy for thymic epithelial tumours: a review

Süveg, Krisztian; Putora, Paul Martin; Joerger, Markus; Iseli, Thomas; Fischer, Galina Farina; Ammann, Karlheinz; Glatzer, Markus

doi:10.21037/tlcr-20-458

Cited by 13 publications

(9 citation statements)

References 105 publications

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“…, putting stages III and IV into one group ( 29 – 31 ). The role of postoperative radiotherapy is controversial in patients with advanced thymic tumors, but some reports have recommended it ( 32 – 34 ). Combined with the current research, considering that advanced thymic tumors cannot be completely resected, postoperative radiotherapy will benefit them.…”

Section: Discussionmentioning

confidence: 99%

The role of surgery in advanced thymic tumors: A retrospective cohort study

Tian

2023

Front. Oncol.

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BackgroundThere is no definitive and detailed treatment guideline for advanced thymic tumors, thus when lymph node and other organ metastasis are present, clinical guidelines recommend chemotherapy-based multidisciplinary treatment. A consensus has been reached that surgery has beneficial effects on partial patients with stage IVA whose metastatic lesions were isolated and resectable, but because of few cases of advanced thymic tumor s and the scarcity of reports, the role of surgery in stage IVB is still unknown. The current study aimed to systematically analyze the role of surgery in advanced thymic tumors based on the Surveillance, Epidemiology, and End Results (SEER) database, with a sufficient number of cases. A secondary aim was to clarify the prognostic value of surgery in advanced thymic tumors.MethodData derived from a total of 979 patients with advanced thymoma or advanced thymic carcinoma were collected from the SEER database. Propensity score matching was performed to eliminate confounding factors, and Cox regression analyses were conducted to assess prognoses.ResultsPatients were assigned to four groups based on pathology and whether surgery was performed; thymoma (surgery), thymoma (no surgery), thymic carcinom a (surgery), and thymic carcinoma (no surgery). Disease-specific survival differed significantly in the thymoma (surgery) and thymoma (no surgery) groups, both before and after propensity score matching (both p < 0.001). Similarly, disease-specific survival differed significantly in the thymic carcinoma (surgery) and the thymic carcinoma (no surgery) groups (p < 0.001 before and p = 0.003 after). No total resection, distant metastasis, and thymic carcinoma were all unfavorable prognostic factors.ConclusionsIn the present study surgery had positive effects on advanced thymoma and advanced thymic carcinoma patients who could undergo surgical resection, significantly improving survival times. Total resection of the primary site was the most advantageous form of surgery. The study provides a reference for the clinical treatment of advanced thymic tumors.

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Section: Discussionmentioning

confidence: 99%

The role of surgery in advanced thymic tumors: A retrospective cohort study

Tian

2023

Front. Oncol.

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“…Preoperatively, it is offered to patients who are deemed unresectable or borderline resectable upfront, to make the lesion resectable afterwards. Postoperatively, radiotherapy is given in patients who have undergone R1, R2 resection or in patients with complete resection of the tumour but who had an advanced stage (IIB-IV) at presentation [ 15 ]. In our study a total of 57 patients received RT, 44 in the adjuvant setting and 13 patients with the intent being radical (7 upfront and 6 after neoadjuvant chemotherapy).…”

Section: Discussionmentioning

confidence: 99%

Intuitive evaluation of contemporary management strategies in thymoma — the largest Indian experience

Chowdhary,

Chufal,

Ismail

et al. 2023

Rep Pract Oncol Radiother.

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Background The aim was perusal of the treatment strategies, clinical outcomes and factors impacting these outcomes in thymoma. Materials and methods A total of 119 patients diagnosed and treated cases of thymoma, at our hospital, were taken for analysis. Thirty-one patients were excluded due to inadequate medical records. Descriptive statistics were used to report demographic and clinical characteristics. Time period between diagnosis and death was defined as overall survival (OS). Multivariate analysis (MVA), using cox regression modelling, was done by including clinicopathological factors in a bid to identify prognostic factors influencing OS. SPSS version 26 was used for statistical analysis. Results The mean age of the patients was 52.17 years and 39 (44.3%), 19 (21.6%), 17 (1.3%) and 13 (4.8%) patients presented with Masaoka stage II, IV, III and I, respectively. Surgery was done in 64 (72.7%) of the patients as a part of the treatment strategy. Radiotherapy was administered to a total of 57 patients with a median dose of 50.4 Gy. Early Masaoka stage at presentation and use of surgery in the treatment plan were statistically significant prognostic factors for a better overall survival on multivariate analysis. Conclusion Judicious use of radiotherapy and chemotherapy in locally advanced cases may render them resectable. In a bid to gain good survival rates, aggressive multimodality treatment should be offered to the patients.

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“…Radiotherapy is widely used to treat type B3 thymomas, but mostly for postoperative adjuvant treatment ( 4 , 5 ). We accidentally found that an aggressive type B3 thymoma lesion shrank significantly after radiotherapy, making radical treatment via single-incision thoracoscopy smoothly.…”

Section: Commentmentioning

confidence: 99%

Neoadjuvant radiotherapy plus single-incision thoracoscopic surgery in the treatment of type B3 thymomas

Huang

2023

Front. Oncol.

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BackgroundAlthough minimally invasive surgery is the standard treatment for thymomas, minimally invasive thymectomy is difficult for patients with type B3 thymomas, especially for giant or aggressive lesions. These tumors are frequently treated with radical radiation therapy or surgery plus adjuvant radiotherapy. Few studies, however, have tested the efficacy of neoadjuvant radiotherapy prior to thoracoscopic surgery.MethodsPatients with type B3 thymomas >5 cm or with infiltrates into vital organs on CT-guided puncture biopsy who underwent neoadjuvant radiotherapy followed by single-incision minimally invasive thymectomy from March 2016 to July 2020 were retrospectively evaluated. Reduction ratios, TNM stage changes according to WHO stage criteria, resectability, long-term survival, and the response in terms of RECIST v1.1 criteria achieved by preoperative RT were analyzed.ResultsThe 11 patients who underwent neoadjuvant radiotherapy plus minimally invasive thymectomy included five men and six women, of mean age 49.5 years. Four patients had myasthenia gravis. Neoadjuvant radiotherapy consisted of 50 Gy in 25 fractions, with all patients showing varying degrees of lesion reduction after radiotherapy. Surgery was performed about 1 month after neoadjuvant radiotherapy, with none of these patients having severe radiation pneumonitis. All patients underwent radical resection of the tumor and adjacent tissue, with none experiencing tumor seeding or rupture during surgery. The median postoperative hospital stay was 3 days (range: 2–6 days) and the frequency of additional regular analgesics (including those for wound pain and neuralgia) was 2.5 times per person. On follow-up, one patient experienced pleural metastasis and one experienced pulmonary metastasis, with the other nine patients showing no evidence of tumor recurrence.ConclusionNeoadjuvant radiotherapy followed by minimally invasive surgery was a safe and efficacious procedure for the treatment of type B3 thymomas, with less postoperative pain and faster recovery. This strategy, of tumor shrinkage prior to surgery, may make possible the easier removal of type B3 thymomas by single-incision thoracoscopy.

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Radiotherapy for thymic epithelial tumours: a review

Cited by 13 publications

References 105 publications

The role of surgery in advanced thymic tumors: A retrospective cohort study

The role of surgery in advanced thymic tumors: A retrospective cohort study

Intuitive evaluation of contemporary management strategies in thymoma — the largest Indian experience

Neoadjuvant radiotherapy plus single-incision thoracoscopic surgery in the treatment of type B3 thymomas

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