Thymoma radiotherapy: a retrospective multicentre study

Year 2023, , 295 - 304, 28.07.2023

İpek Pınar Aral , Gonca Altınışık İnan , Fatma Betül Ayrak , Feyza Yaşar Daşgın , Nalan Aslan , Yillar Lehimcioğlu , Fatma Yıldırım , Muhammed Bülent Akıncı , Yılmaz Tezcan

https://doi.org/10.38053/acmj.1298365

Abstract

Aims: In this study, we aimed to evaluate the outcomes of thymoma patients who underwent radiotherapy (RT).
Methods: Data from thymoma patients who underwent RT at Ankara Bilkent City Hospital, Ankara Atatürk Education and Research Hospital and Ankara Numune Education and Research Hospital were analysed retrospectively. The primary endpoints of this study were acute and late side effects and the secondary endpoints were overall survival(OS) and disease-free survival(DFS).
Results: Data from 22 patients who received RT between 10.03.2008 and 05.10.2022 were analysed.The median follow-up time was 33 months (range: 1–76). RT-related acute toxicity was observed in 6 patients(27.3%). Late RT-related toxicity was noted in 4 patients (18%). As a late toxicity one patient (4.5%) had a secondary malignancy five years after RT.Patients younger than 40 years of age had significantly higher acute (p=0.039) and late (p=0.01) toxicity. Recurrence was observed in 7 patients (31.8%). The median DFS was 13 months (range: 1–176),the 1-year DFS was 58%, the 5-year DFS was 23%. Lower DFS was observed in patients with myasthenia gravis (MG) (p=0.018). Six patients(27.3%) died, the median OS was 33 months (range: 1–176),the 1-year OS was 84.4%, the 5-year OS was 76.7%. There was a significant correlation between performans status and OS (p=0.047).
Conclusion: Side effects were more frequently observed in patients younger than 40 years of age. Poor prognostic factors were identified as MG for DFS and poor performance status for OS. Thymoma patients have high OS, studies are needed to identify subgroups that do not require RT.

Keywords

Thymic epithelial tumours, radiotherapy, thymic carcinoma, thymoma

References

• Conforti F, Pala L, Giaccone G, De Pas T. Thymic epithelial tumors: From biology to treatment. Cancer Treat Rev. 2020;86:102014.
• Kıraklı EK, Erdem S, Bozkurt MT, Yılmaz H. Role of radiotherapy in Masaoka stage II and III thymomas – single center experience. Ege J Med / Ege Tıp Derg. 2019;58:208-214.
• Fan C, Feng Q, Chen Y, et al. Postoperative radiotherapy for completely resected Masaoka stage III thymoma: a retrospective study of 65 cases from a single institution. Radiat Oncol. 2013;8:199.
• Johnstone C, Simone CB. The role of radiation therapy in the management of primary thymic epithelial neoplasms. J Cancer Metastasis Treat 2022;8:39.
• Marx A, Chan JKC, Chalabreysse L, et al. The 2021 WHO Classification of tumors of the thymus and mediastinum: what is new in thymic epithelial, germ cell, and mesenchymal tumors? J Thorac Oncol. 2022;17:200-213.
• Basse C, Botticella A, Molina TJ, et al. RADIORYTHMIC: Phase III, opened, randomized study of postoperative radiotherapy versus surveillance in stage IIb/III of Masaoka Koga thymoma after complete surgical resection. Clin Lung Cancer. 2021;22:469-472.
• Bruni A, Stefani A, Perna M, et al. The role of postoperative radiotherapy for thymomas: a multicentric retrospective evaluation from three Italian centers and review of the literature. J Thorac Dis. 2020; 12(12):7518-7530.
• Bian D, Zhou F, Yang W, et al. Thymoma size significantly affects the survival, metastasis and effectiveness of adjuvant therapies: a population based study. Oncotarget. 2018;9(15):12273-12283.
• Mou H, Kong Y, Wu Y, Wu Y, Yu L. Effect of postoperative radiotherapy in thymoma patients: a SEER-based study. Oncol Res Treat. 2021;44(1-2):28-35.
• Yang AJ, Choi SH, Byun HK, Kim HJ, Lee CG, Cho J. The role of salvage radiotherapy in recurrent thymoma. Radiat Oncol J. 2019;37(3):193-200.
• WMA, World Medical Association. Declaration of Helsinki. J Am Med Assoc. 2013; 227: 925–926.
• Rich A. Epidemiology of thymoma. J Thorac Dis. 2020;12:7531-5.
• Romi F. Thymoma in myasthenia gravis: from diagnosis to treatment. Autoimmune Dis. 2011; 201:474512.
• Karlin K, Michaels PD. Thymic carcinoma: review and update. J Cancer Metastasis Treat. 2022;8:15.
• Conforti F, Marino M, Vitolo V, et al. Clinical management of patients with thymic epithelial tumors: the recommendations endorsed by the Italian Association of Medical Oncology (AIOM). ESMO Open. 2021;6:100188.
• Rico M, Flamarique S, Casares C, et al. GOECP/SEOR radiotherapy guidelines for thymic epithelial tumours. World J Clin Oncol. 2021;12(4):195-216.
• Song SH, Suh JW, Yu WS, et al. The role of postoperative radiotherapy in stage II and III thymoma: a Korean multicenter database study. J Thorac Dis. 2020;12(11):6680-6689.
• Fan C, Ge H, Zhang S, et al. Impact of definitive radiotherapy and surgical debulking on treatment outcome and prognosis for locally advanced Masaoka-Koga stage III thymoma. Sci Rep. 2020;10(1): 1735.
• Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013; 368(11):987-998.
• Willmann J, Rimner A. The expanding role of radiation therapy for thymic malignancies. J Thorac Dis. 2018;10:2555-64.
• Mercado CE, Hartsell WF, Simone CB, et al. Proton therapy for thymic malignancies: multi-institutional patterns-of-care and early clinical outcomes from the proton collaborative group and the university of Florida prospective registries, Acta Oncologica. 2019;58:1036-40.
• Hao XJ, Peng B, Zhou Z, Yang XQ. Prospective study of stereotactic body radiation therapy for thymoma and thymic carcinoma: therapeutic effect and toxicity assessment. Sci Rep. 2017;7:13549.
• National Comprehensive Cancer Network. Thymomas and Thymic Carcinomas (Version 1.2020). Available online: http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf. Accessed May 1, 2020.
• Lalani N, Brade AM. Radiation dose for thymic tumours. Mediastinum. 2020;4:35.
• Angrisani A, Houben R, Marcuse F, et al. Radiotherapy for thymic epithelial tumors: what is the optimal dose? A systematic review. Clin Transl Radiat Oncol. 2022;34:67-74.
• Süveg K, Putora PM, Joerger M, et al. Radiotherapy for thymic epithelial tumours: a review. Transl Lung Cancer Res. 2021; 10:2088-2100.
• Thymomas and thymic carcinomas, NCCN Clinical Practice Guidelines in Oncology, Version 1.2023, Dec 15, 2022. Avaliable from: https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf