Abstract
Background: Aim of the study was to identify and evaluate the prognostic efficacy of standard clinicopathological factors of thymic epithelial tumors (TETs) for treatment-related outcomes. Materials and Methods: All patients treated between 1993–2008 at Ege University Faculty of Medicine Departments of Radiation Oncology and Thoracic Surgery were reviewed retrospectively. Results: Forty-seven patients with a median age of 51 (range: 24–72) were identified. Complete resection was performed in 23 (51.1 %), incomplete resection with microscopic residues in 17 (37.8 %), subtotal resection with gross residues in 2 (4.4 %) and biopsy in 5 (11.1 %) patients. Radiotherapy was administered to 39 (83 %) patients. Median follow-up duration was 51 months (range: 3–168 months). Five-year local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) rates were 93 %, 90 % and 85 % for thymoma and 80 %, 66 % and 72 % for thymic carcinoma patients, respectively. In multivariate analysis, the extent of resection was the only significant prognostic factor for OS (p = 0.001). Conclusions: The most important prognostic factor for overall survival was the extent of resection. Further studies with larger numbers of patients are required to confirm the prognostic factors and to obtain a better understanding of the biological behavior of TETs.
Key words
thymus (incl. thymoma) - radiation therapy - outcomes (includes mortality - morbidity)
References
-
1 Halperin E C, Perez C A, Brady L W. Perez and Brady's Principles and Practice of Radiation Oncology.. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008: 1110-1131
-
2
Wright C D.
Management of thymomas.
Crit Rev Oncol Hematol.
2008;
65
109-120
-
3 Gunderson L L, Tepper J E. Clinical Radiation Oncology.. 2nd ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2007: 973-1005
-
4
Hsu H C, Huang E Y, Wang C J, Sun L M, Chen H C.
Postoperative radiotherapy in thymic carcinoma: treatment results and prognostic factors.
Int J Radiat Oncol Biol Phys.
2002;
52
801-805
-
5
Fuller C D, Housman D M, Thomas C R.
Radiotherapy for thymoma and thymic carcinoma.
Hematol Oncol Clin North Am.
2008;
22
489-507
-
6
Haniuda M, Morimoto M, Nishimura H et al.
Adjuvant radiotherapy after complete resection of thymoma.
Ann Thorac Surg.
1992;
54
311-315
-
7
Kondo K, Monden Y.
Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan.
Ann Thorac Surg.
2003;
76
878-884
discussion 884
-
8
Ruffini E, Mancuso M, Oliaro A et al.
Recurrence of thymoma: analysis of clinicopathologic features, treatment, and outcome.
J Thorac Cardiovasc Surg.
1997;
113
55-63
-
9
Myojin M, Choi N C, Wright C D et al.
Stage III thymoma: pattern of failure after surgery and postoperative radiotherapy and its implication for future study.
Int J Radiat Oncol Biol Phys.
2000;
46
927-933
-
10
Venuta F, Rendina E A, Longo F et al.
Long-term outcome after multimodality treatment for stage III thymic tumors.
Ann Thorac Surg.
2003;
76
1866-1872
discussion 1872
-
11
Zhu G, He S, Fu X, Jiang G, Liu T.
Radiotherapy and prognostic factors for thymoma: a retrospective study of 175 patients.
Int J Radiat Oncol Biol Phys.
2004;
60
1113-1119
-
12
Awad W I, Symmans P J, Dussek J E.
Recurrence of stage I thymoma 32 years after total excision.
Ann Thorac Surg.
1998;
66
2106-2108
-
13
Kondo K.
Optimal therapy for thymoma.
J Med Invest.
2008;
55
17-28
-
14
Mayer R, Beham-Schmid C, Groell R et al.
Radiotherapy for invasive thymoma and thymic carcinoma. Clinicopathological review.
Strahlenther Onkol.
1999;
175
271-278
-
15
Eng T Y, Fuller C D, Jagirdar J, Bains Y, Thomas Jr C R.
Thymic carcinoma: state of the art review.
Int J Radiat Oncol Biol Phys.
2004;
59
654-664
-
16
Masaoka A, Monden Y, Nakahara K, Tanioka T.
Follow-up study of thymomas with special reference to their clinical stages.
Cancer.
1981;
48
2485-2492
-
17
Strobel P, Marx A, Zettl A, Muller-Hermelink H K.
Thymoma and thymic carcinoma: an update of the WHO Classification 2004.
Surg Today.
2005;
35
805-811
-
18
Cox J D, Stetz J, Pajak T F.
Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC).
Int J Radiat Oncol Biol Phys.
1995;
31
1341-1346
-
19
Kaplan E L, Meier P.
Nonparametric estimation from incomplete observations.
J Am Stat Assoc.
1958;
53
457-481
-
20
Fornasiero A, Daniele O, Ghiotto C et al.
Chemotherapy of invasive thymoma.
J Clin Oncol.
1990;
8
1419-1423
-
21 National Comprehensive Cancer Network .Clinical Practice Guidelines in Oncology 2009. Online: http://www.thymic.org/wp-content/uploads/2009/03/nccn-guidelines.pdf [accessed November 2010]
-
22
Liu H C, Hsu W H, Chen Y J et al.
Primary thymic carcinoma.
Ann Thorac Surg.
2002;
73
1076-1081
-
23
Rea F, Marulli G, Girardi R et al.
Long-term survival and prognostic factors in thymic epithelial tumours.
Eur J Cardiothorac Surg.
2004;
26
412-418
-
24
Kim H K, Choi Y S, Kim J et al.
Type B thymoma: is prognosis predicted only by World Health Organization classification?.
J Thorac Cardiovasc Surg.
2010;
139
1431-1435
-
25
Chen G, Marx A, Wen-Hu C et al.
New WHO histologic classification predicts prognosis of thymic epithelial tumors: a clinicopathologic study of 200 thymoma cases from China.
Cancer.
2002;
95
420-429
-
26
Wright C D, Wain J C, Wong D R et al.
Predictors of recurrence in thymic tumors: importance of invasion, World Health Organization histology, and size.
J Thorac Cardiovasc Surg.
2005;
130
1413-1421
-
27
Okumura M, Ohta M, Tateyama H et al.
The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients.
Cancer.
2002;
94
624-632
-
28
Nakagawa K, Asamura H, Matsuno Y et al.
Thymoma: a clinicopathologic study based on the new World Health Organization classification.
J Thorac Cardiovasc Surg.
2003;
126
1134-1140
-
29
Detterbeck F C.
Clinical value of the WHO classification system of thymoma.
Ann Thorac Surg.
2006;
81
2328-2334
-
30
Kim B K, Cho B C, Choi H J et al.
A single institutional experience of surgically resected thymic epithelial tumors over 10 years: clinical outcomes and clinicopathologic features.
Oncol Rep.
2008;
19
1525-1531
Dr. Senem Demirci
Department of Radiation Oncology
Ege University
Faculty of Medicine
35100 Izmir
Turkey
Telefon: +90 23 23 90 44 76
Fax: +90 23 23 88 42 94
eMail: senem.demirci@ege.edu.tr