Role of Postoperative Radiation Therapy in Completely Resected Thymoma

Dong, Chao; Chang, Shi Min; Tang, Huiqin

doi:10.1016/j.athoracsur.2016.05.082

Cited by 4 publications

(2 citation statements)

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“…Furthermore, whether postoperative radiation therapy for patients having complete resection of thymoma could prolong their lives has been debated. [ 24 25 ] Some experts questioned if routine adjuvant radiation therapy after complete resection would be helpful in long-term survival. [ 26 27 28 ] In our study, Kaplan-Meier survival curves demonstrate that within 8 years after surgery, there was no significant difference in aspects of overall survival [ Figure 2 ] and disease-free survival among three groups [ Figure 3 ].…”

Section: Discussionmentioning

confidence: 99%

Value of Adjuvant Radiotherapy for Thymoma with Myasthenia Gravis after Extended Thymectomy

Yun

et al. 2018

Chinese Medical Journal

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Background:The co-existence of myasthenia gravis (MG) and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy.Methods:A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery (Group A); whereas the other 24 patients did not receive radiation therapy (Group B). According to the time that patients started mediastinal radiation therapy, we subdivided the 157 patients in Group A into subgroups (1-month subgroup, n = 98; 2-month subgroup, n = 7; and 3-month subgroup, n = 52). We then compared the effect of the mediastinal radiation therapy across these different groups using the survival rate, the rate of postoperative myasthenic crisis, and the complete stable remission (CSR) rate as the primary endpoints.Results:There was a significant difference in the occurrence of postoperative myasthenic crisis between 1-month subgroup and Group B (χ2 = 4.631, P = 0.031). The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group B, respectively. The overall survival rates of 1-month subgroup, 3-month subgroup, and Group B were 88.8%, 83.3%, and 77.3%, respectively. Analysis on the Kaplan-Meier survival curves demonstrated that within 8 years after surgery, there was no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup and Group B, and between 3-month subgroup and Group B; over 8 years after surgery, the disease-free survival rates in 1-month subgroup, 3-month subgroup and Group B were 79.4%, 70.6%, and 55.3%, respectively.Conclusions:Adjuvant radiation within 1 month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing the possibility of postoperative myasthenic crisis, and raising cumulative probabilities of reaching CSR.

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Section: Discussionmentioning

confidence: 99%

Value of Adjuvant Radiotherapy for Thymoma with Myasthenia Gravis after Extended Thymectomy

Yun

et al. 2018

Chinese Medical Journal

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“…For locally advance tumor with adjacent tissue invasion, postoperative radiation treatment (PORT) is recommended if resection margins are close or positive. It has been shown that, especially the patients with thymic carcinomas may benefit from PORT (16).…”

Section: Management Of Unresectable/marginally Resectable Stage Iii-iva Thymic Tumorsmentioning

confidence: 99%

Multimodality approach in treatment of thymic tumors

Turna¹,

Sarbay²

2020

J Thorac Dis

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As it has been well described in the literature, complete (i.e., R0) resection is of great importance in the treatment of thymic tumors (1). Thymomas are usually well capsulated and resectable without a need for resection of adjacent structure. However, extended thymectomy is advised due to the possibility of thymoma foci in the anterior mediastinal compartment (1). Other than stage IVB tumors (i.e., tumors with deep region lymph node metastasis or distant metastases including pulmonary metastases) tumors are considered resectable.The therapeutic role of debulking surgery or subtotal/ incomplete resection in stage III and IV disease has been controversial (1,2). It has been shown that, 5-year survival rate varies between 60% to 75% after incomplete resection and 24% to 40% after incisional biopsy alone (2-4). Radiotherapy after incomplete resection of thymic tumors provides local control rates of 35% to 74% and 5-year survival rates of 50% to 70% for stage III, 20% to 50% stage IVA tumors (4,5). Ciernik et al. reported that, tumor debulking did not improve prognosis when followed by radiation (6). They reported that stage III patients had a 5and 10-year rates of 61% and 57% respectively, whereas 5and 10-year survival rates of patients with stage IV disease 23% and 8%, respectively (6).In essence, multidisciplinary approach to thymic tumors aims to improve the resectability and survival.

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Zhou

Liu

Dai

2017

The Annals of Thoracic Surgery

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Second, in the absence of individual patient data, Tierney's method, as shown in reference 16, was used to obtain hazard ratios and 95% confidence intervals by manipulating published data in references 18 and 24, but the wide confidence intervals mean a significant lack of precision. In addition, when the authors calculated the hazard ratios and confidence intervals from the Kaplan-Meier curves in reference 9, a hazard ratio of 1.32 (95% confidence interval, 1.05 to 1.67) in Figure 5 means that the disease-free survival was significantly better in patients with postoperative radiotherapy than in those without. Surprisingly, the original data from reference 9 is that postoperative radiotherapy for stages II and III thymoma was not associated with relapse-free survival and overall survival (p ¼ 0.350). We think that the authors should explain why the conclusions are contradictory.Last but not least, when the authors isolated the hazard ratio and 95% confidence interval of postoperative radiotherapy on overall survival from reference 9, a hazard ratio of 0.78 (95% confidence interval, 0.47 to 1.31) had already been reported in reference 9. I do not know why the authors used 1.13 (95% confidence interval, 0.70 to 1.80) instead. Above all, we respect the contribution of the authors, and we do not doubt the reliability of the measurements.

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Role of Postoperative Radiation Therapy in Completely Resected Thymoma

Cited by 4 publications

References 1 publication

Value of Adjuvant Radiotherapy for Thymoma with Myasthenia Gravis after Extended Thymectomy

Value of Adjuvant Radiotherapy for Thymoma with Myasthenia Gravis after Extended Thymectomy

Multimodality approach in treatment of thymic tumors

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