PDF herunterladen
Thorac Cardiovasc Surg 2020; 68(05): 440-445
DOI: 10.1055/s-0039-1688723
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Debulking Surgery Plus Radiation: Treatment Choice for Unresectable Stage III Thymic Carcinoma

Yirui Zhai
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Zhouguang Hui
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2   Department of VIP Medical Service, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Yushun Gao
3   Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Jun Liang
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Zongmei Zhou
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Luhua Wang
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Qinfu Feng
1   Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
› Institutsangaben Funding This research work was supported by the PUMC FUND of the Funds for the Central Universities (No. 3332018075) and the National Key Projects of Research and Development of China (2016YFC 0904600).
Weitere Informationen

Publikationsverlauf

01. Januar 2019

29. März 2019

Publikationsdatum:
28. Mai 2019 (online)

    Lizenzen und Reprints Alle Artikel dieser Rubrik

Abstract

Background Total resection may not be achieved in patients with thymic carcinoma, particularly those with Masaoka stage III disease. Debulking surgery plus postoperative radiotherapy and radiation alone are treatment options for such patients. We aimed to compare the overall survival (OS) between patients with thymic carcinoma who underwent debulking surgery plus postoperative radiotherapy and those who underwent radiation alone.

Methods This was a single-center retrospective study of patients histologically diagnosed as having Masaoka stage III thymic carcinoma between January 1980 and January 2010. Patients were classified into the following groups according to treatments received: debulking surgery plus radiotherapy (group A) and radiotherapy alone (group B). Data on demographics, histology, invasion, radiotherapy, chemotherapy, and survival were collected. Survival time was calculated and compared between the groups using the Kaplan–Meier method. Toxicities were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0.

Results Of the 47 enrolled patients, 26 and 21 patients were categorized into groups A and B, respectively. There are no significant differences in the Eastern Cooperative Oncology Group performance status score, histological type, great vessel invasion, and chemotherapy proportion between the groups. The median radiation dose was 60 Gy in both groups. The 5-year OS rates were 54.4 and 0% in groups A and B, respectively (p = 0.019). No operation-induced mortality was recorded.

Conclusion For patients with unresectable Masaoka stage III disease, debulking surgery with radiotherapy is preferred, as this was proven to be more efficient than the radiation-alone procedure.

Keywords

debulking surgery - radiation - thymic carcinoma

Note

A brief abstract of the article was accepted for poster viewing in the 58th ASTRO annual meeting.


 

  • References

  • 1 de Jong WK, Blaauwgeers JL, Schaapveld M, Timens W, Klinkenberg TJ, Groen HJ. Thymic epithelial tumours: a population-based study of the incidence, diagnostic procedures and therapy. Eur J Cancer 2008; 44 (01) 123-130
    CrossrefPubMedSuche in Google Scholar
  • 2 Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg 2003; 76 (03) 878-884 , discussion 884–885
    CrossrefPubMedSuche in Google Scholar
  • 3 Tseng YL, Wang ST, Wu MH, Lin MY, Lai WW, Cheng FF. Thymic carcinoma: involvement of great vessels indicates poor prognosis. Ann Thorac Surg 2003; 76 (04) 1041-1045
    CrossrefPubMedSuche in Google Scholar
  • 4 Weksler B, Dhupar R, Parikh V, Nason KS, Pennathur A, Ferson PF. Thymic carcinoma: a multivariate analysis of factors predictive of survival in 290 patients. Ann Thorac Surg 2013; 95 (01) 299-303
    CrossrefPubMedSuche in Google Scholar
  • 5 Ahmad U, Yao X, Detterbeck F. , et al. Thymic carcinoma outcomes and prognosis: results of an international analysis. J Thorac Cardiovasc Surg 2015; 149 (01) 95-100 , 101.e1–101.e2
    CrossrefPubMedSuche in Google Scholar
  • 6 Zhai Y, Hui Z, Ji W. , et al. A single-center analysis of the treatment and prognosis of patients with thymic carcinoma. Ann Thorac Surg 2017; 104 (05) 1718-1724
    CrossrefPubMedSuche in Google Scholar
  • 7 Liu HC, Chen YJ, Tzen CY, Huang CJ, Chang CC, Huang WC. Debulking surgery for advanced thymoma. Eur J Surg Oncol 2006; 32 (09) 1000-1005
    CrossrefPubMedSuche in Google Scholar
  • 8 Hishida T, Nomura S, Yano M. , et al; Japanese Association for Research on the Thymus (JART). Long-term outcome and prognostic factors of surgically treated thymic carcinoma: results of 306 cases from a Japanese Nationwide Database Study. Eur J Cardiothorac Surg 2016; 49 (03) 835-841
    CrossrefPubMedSuche in Google Scholar
  • 9 Hamaji M, Kojima F, Omasa M. , et al. A meta-analysis of debulking surgery versus surgical biopsy for unresectable thymoma. Eur J Cardiothorac Surg 2015; 47 (04) 602-607
    CrossrefPubMedSuche in Google Scholar
  • 10 Xu C, Feng QF, Fan CC. , et al. Patterns and predictors of recurrence after radical resection of thymoma. Radiother Oncol 2015; 115 (01) 30-34
    CrossrefPubMedSuche in Google Scholar
  • 11 Rimner A, Gomez DR, Wu AJ. , et al. Failure patterns relative to radiation treatment fields for stage II-IV thymoma. J Thorac Oncol 2014; 9 (03) 403-409
    CrossrefPubMedSuche in Google Scholar
  • 12 Yano M, Sasaki H, Yokoyama T. , et al. Thymic carcinoma: 30 cases at a single institution. J Thorac Oncol 2008; 3 (03) 265-269
    CrossrefPubMedSuche in Google Scholar
  • 13 Detterbeck FC, Parsons AM. Thymic tumors. Ann Thorac Surg 2004; 77 (05) 1860-1869
    CrossrefPubMedSuche in Google Scholar
  • 14 Weissferdt A, Moran CA. Thymic carcinoma, part 1: a clinicopathologic and immunohistochemical study of 65 cases. Am J Clin Pathol 2012; 138 (01) 103-114
    CrossrefPubMedSuche in Google Scholar
  • 15 Filosso PL, Guerrera F, Rendina AE. , et al. Outcome of surgically resected thymic carcinoma: a multicenter experience. Lung Cancer 2014; 83 (02) 205-210
    CrossrefPubMedSuche in Google Scholar
  • 16 Zhao Y, Zhao H, Hu D, Fan L, Shi J, Fang W. Surgical treatment and prognosis of thymic squamous cell carcinoma: a retrospective analysis of 105 cases. Ann Thorac Surg 2013; 96 (03) 1019-1024
    CrossrefPubMedSuche in Google Scholar
  • 17 Priola AM, Priola SM, Cataldi A. , et al. CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures. Radiol Med (Torino) 2008; 113 (01) 3-15
    CrossrefPubMedSuche in Google Scholar
  • 18 Yonemori K, Tsuta K, Tateishi U. , et al. Diagnostic accuracy of CT-guided percutaneous cutting needle biopsy for thymic tumours. Clin Radiol 2006; 61 (09) 771-775
    CrossrefPubMedSuche in Google Scholar
  • 19 Ogawa K, Uno T, Toita T. , et al. Postoperative radiotherapy for patients with completely resected thymoma: a multi-institutional, retrospective review of 103 patients. Cancer 2002; 94 (05) 1405-1413
    CrossrefPubMedSuche in Google Scholar
  • 20 Yoshida H, Yasuda S, Aruga T. , et al. Whole mediastinal irradiation with or without entire hemithoracic irradiation for invasive thymoma [. in Japanese ]. Nippon Igaku Hoshasen Gakkai Zasshi 1995; 55 (14) 968-971
    PubMedSuche in Google Scholar
  • 21 Wang J, Zhou Z, Liang J. , et al. Intensity-modulated radiation therapy may improve local-regional tumor control for locally advanced non-small cell lung cancer compared with three-dimensional conformal radiation therapy. Oncologist 2016; 21 (12) 1530-1537
    CrossrefPubMedSuche in Google Scholar
  • 22 Chun SG, Hu C, Choy H. , et al. Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer: a secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial. J Clin Oncol 2017; 35 (01) 56-62
    PubMedSuche in Google Scholar
  • 23 Dooley SA, Anderson CM. Definitive IMRT for stage III thymic carcinoma: a brief report and literature review. Front Oncol 2016; 6: 219
    PubMedSuche in Google Scholar
  • 24 Bradley JD, Paulus R, Komaki R. , et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol 2015; 16 (02) 187-199
    CrossrefPubMedSuche in Google Scholar
  • 25 Shintani Y, Inoue M, Kawamura T, Funaki S, Minami M, Okumura M. Multimodality treatment for advanced thymic carcinoma: outcomes of induction therapy followed by surgical resection in 16 cases at a single institution. Gen Thorac Cardiovasc Surg 2015; 63 (03) 159-163
    CrossrefPubMedSuche in Google Scholar
  • 26 Kim ES, Putnam JB, Komaki R. , et al. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer 2004; 44 (03) 369-379
    CrossrefPubMedSuche in Google Scholar