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Radiotherapy for invasive thymoma and thymic carcinoma

Clinicopathological review

Strahlentherapie des invasiven thymoms und thymuskarzinoms

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Abstract

Purpose

This study reports clinicopathological features and outcome of thymic tumors. Twenty-seven patients with invasive thymoma and 6 patients with thymic carcinoma who had received radiotherapy either primary or postoperatively were analyzed retrospectively.

Patients and Methods

All 33 patients were irradiated with a mean dose of 50 Gy after complete resection (16 patients), partial resection (9 patients) or biopsy (8 patients). Staging was done according to the Masaoka classification; there were 12 Stage II, 12 Stage III and 9 Stage IV patients.

Results

In patients with invasive thymoma Stage II to IV (median follow-up 54.4 months) Kaplan-Meier estimates of overall survival (OS), disease-specific (DSS) and disease-free survival (DFS) at 5 years were 63.7% (95% confidence interval [CI], 42 to 84%), 88.3% (CI, 75 to 100%) and 77.4% (CI, 58 to 95%), respectively. Among the prognostic factors tested, such as age, myasthenia gravis, completeness of surgery and histologic subclassification, total radiation dose, and Masaoka Stage, the latter was the only significant predictor of improved survival (p = 0.04). Considering local control, radiation dose was a significant prognostic factor (p = 0.0006). In patients with thymic carcinoma (median follow-up 43.4 months) 5-year DSS, and DFS were 22.2% (CI, 0 to 60%) and 16.7% (CI, 0 to 46%), respectively. Thymoma as compared to thymic carcinoma had a statistically significant better DSS (p = 0.007) and DFS (p = 0.0007).

Conclusion

Postoperative radiotherapy with sufficient doses plays an important role as adjuvant treatment in complete or incomplete resected invasive Stage II to III thymoma. In unresectable thymoma Stage III to IV as well as in thymic carcinoma a multimodality approach should be considered to improve survival.

Zusammenfassung

Ziel

Bericht über 27 Patienten mit invasivem Thymom und sechs Patienten mit Thymuskarzinom nach primärer oder postoperativer Strahlentherapie unter besonderer Berücksichtigung der pathohistologischen Befunde und klinischen Ergebnisse.

Patienten und Methoden

Alle 33 Patienten wurden nach kompletter Resektion (n = 16), Teilresektion (n = 9) oder Biopsie (n = 8) mit einer mittleren Dosis von 50 Gy (30 bis 60 Gy) bestrahlt. Die Stadieneinteilung nach Masaoka (Tabelle 1) ergab jeweils zwolf Patienten in Stadium II und III sowie neun Patienten im Stadium IV (Tabelle 2).

Ergebnisse

Patienten mit einem invasivem Thymom Masaoka-Stadium II bis IV (mediane Nachsorgezeit 54,4 Monate) hatten ein Fünf-Jahres-Gesamüberleben, krankheitsspezifisches und krankheitsfreies Überleben von 63,7% (95%Konfidenzintervall [KI] 42 bis 84%), 88,3% (KI 75 bis 100%) sowie 77,4% (KI 58 bis 95%). Bei den untersuchten prognostischen Faktoren, wie Alter, Myasthenia gravis, chirurgische Radikalität, histologische Subgruppe, Bestrahlungsdosis und Masaoka-Stadium, hatte nur letzteres einen stätistisch signifikanten Einfluß auf das Überleben (p = 0.04). (Tabelle 8). Bei alleiniger Berücksichtigung der lokalen Kontrolle war die Bestrahlungsdosis ein stätistisch signifikanter prognostischer Parameter (p = 0,0006) (Tabelle 7). Patienten mit Thymuskarzinom (mediane Nachsorgezeit 43,3 Monate) hatten ein krankheitsspezifisches und krankheitsfreies Fünf-Jahres-Überleben von 22,2% (KI 0 bis 60%) sowie 16,7% (KI 0 bis 46%). Patienten mit Thymomen hatten im Vergleich zu Patienten mit Thymuskarzinomen sowohl ein statistisch signifikant besseres krankheitsspezifisches (p = 0,007) als auch krankheitsfreies Überleben (p = 0,0007) (Abbildung 1).

Schlußfolgerung

Postoperative Strahlentherapie mit adäquater Dosis spielt eine wichtige Rolle als adjuvante Therapie bei inkomplett und komplett resezierten invasiven Thymomen Stadium II bis III. Bei primär inoperablen Thymomen und bei Thymuskarzinom sollte ein multimodales Vorgehen in Erwägung gezogen werden, urn die Überlebensraten zu verbessern.

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Authors and Affiliations

  1. Department of Radiotherapy, University Medical School of Graz, Austria

    Ramona Mayer M. D., Georg Franz Stuecklschweiger, Ulrike Prettenhofer, Heidi Stranzl & Arnulf Hackl

  2. Department of Pathology, University Medical School of Graz, Austria

    Christine Beham-Schmid

  3. Department of Radiology, University Medical School of Graz, Austria

    Reinhard Groell

  4. Department of Thoracic and Hyperbaric Surgery, University Medical School of Graz, Austria

    Freyja-Maria Smolle-Juettner & Heiko Renner

  5. Department of Medical Informatics, Stätistics and Documentation, University Medical School of Graz, Austria

    Franz Quehenberger

Authors
  1. Ramona Mayer M. D.
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  2. Christine Beham-Schmid
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  3. Reinhard Groell
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  4. Freyja-Maria Smolle-Juettner
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  5. Franz Quehenberger
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  6. Georg Franz Stuecklschweiger
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  7. Ulrike Prettenhofer
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  8. Heidi Stranzl
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  9. Heiko Renner
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  10. Arnulf Hackl
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Correspondence to Ramona Mayer M. D..

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Mayer, R., Beham-Schmid, C., Groell, R. et al. Radiotherapy for invasive thymoma and thymic carcinoma. Strahlentherapie und Onkologie 175, 271–278 (1999). https://doi.org/10.1007/BF02743578

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  • DOI: https://doi.org/10.1007/BF02743578

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