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Prognosis of Concurrent Versus Sequential Chemo-Radiotherapy Induction Followed by Surgical Resection in Patients with Advanced Thymic Epithelial Tumors: A Retrospective Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to evaluate the prognosis of concurrent chemo-radiotherapy (CCRT) versus sequential chemo-radiotherapy (SCRT) induction followed by surgical resection in patients with advanced thymic epithelial tumors (TETs).

Methods

This retrospective study included patients with advanced TETs who underwent CCRT or SCRT induction followed by surgical resection at the Second General Hospital of Guangdong Province between January 2008 and December 2019. The primary outcomes were induction response rate and surgical complete resection rate. The secondary outcomes were surgery combined resection, post-induction T staging, postoperative TNM staging, postoperative pathological tumor regression grade, progression-free survival (PFS) and overall survival (OS), and adverse events (AEs).

Results

A total of 31 patients were included, 15 of whom received CCRT and the other 16 SCRT. The induction response rates were 80.0 and 62.5%, respectively, the post-induction step-down rates were 46.7 and 31.3%, respectively, and the post-induction R0 resection rates were 80.0 and 68.8%, respectively, without significant differences between CCRT and SCRT groups (all P > 0.05). The 5-year OS rate was 64.2 and 51.6%, respectively, and PFS was 42.3 and 21.4%, respectively, without significant differences between CCRT and SCRT groups (both P > 0.05). AEs in the hematologic system were significantly higher with CCRT compared with SCRT (P = 0.009).

Conclusions

Patients with advanced TETs might have a good prognosis with both CCRT and SCRT induction therapy, while SCRT induction may result in a lower probability of AEs in the hematologic system.

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Data availability

All data generated or analyzed during this study are included in this published article.

References

  1. Álvarez-Velasco R, Gutiérrez-Gutiérrez G, Trujillo JC, Martínez E, Segovia S, Arribas-Velasco M, Fernández G, Paradas C, Vélez-Gómez B, Casasnovas C, Nedkova V, Guerrero-Sola A, Ramos-Fransi A, Martínez-Piñeiro A, Pardo J, Sevilla T, Gómez-Caravaca MT, López de Munain A, Jericó I, Pelayo-Negro AL, Martín MA, Morgado Y, Mendoza MD, Pérez-Pérez H, Rojas-García R, Turon-Sans J, Querol L, Gallardo E, Illa I, Cortés-Vicente E. Clinical characteristics and outcomes of thymoma-associated myasthenia gravis. Eur J Neurol. 2021;28(6):2083–91. https://doi.org/10.1111/ene.14820.

    Article  PubMed  Google Scholar 

  2. Scorsetti M, Leo F, Trama A, D’Angelillo R, Serpico D, Macerelli M, Zucali P, Gatta G, Garassino MC. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol. 2016;99:332–50. https://doi.org/10.1016/j.critrevonc.2016.01.012.

    Article  PubMed  Google Scholar 

  3. Detterbeck F, Youssef S, Ruffini E, Okumura M. A review of prognostic factors in thymic malignancies. J Thorac Oncol. 2011;6(7 Suppl 3):S1698-1704. https://doi.org/10.1097/JTO.0b013e31821e7b12.

    Article  PubMed  Google Scholar 

  4. Gökmen-Polar Y, Cook RW, Goswami CP, Wilkinson J, Maetzold D, Stone JF, Oelschlager KM, Vladislav IT, Shirar KL, Kesler KA, Loehrer PJ Sr, Badve S. A gene signature to determine metastatic behavior in thymomas. PloS One. 2013;8(7):e66047. https://doi.org/10.1371/journal.pone.0066047.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Gatta G, Trama A, Capocaccia R. Epidemiology of rare cancers and inequalities in oncologic outcomes. Eur J Surg Oncol. 2019;45(1):3–11. https://doi.org/10.1016/j.ejso.2017.08.018.

    Article  CAS  PubMed  Google Scholar 

  6. Tang EK, Chang JM, Chang CC, Wu SY, Huang WL, Chen YY, Kam HH, Yen YT, Tseng YL. Prognostic factor of completely resected and pathologic T3 N0 M0 thymic epithelial tumor. Ann Thorac Surg. 2021;111(4):1164–73. https://doi.org/10.1016/j.athoracsur.2020.06.078.

    Article  PubMed  Google Scholar 

  7. Ito T, Suzuki H, Sakairi Y, Wada H, Nakajima T, Yoshino I. 18F-FDG-PET/CT predicts grade of malignancy and invasive potential of thymic epithelial tumors. Gen Thorac Cardiovasc Surg. 2021;69(2):274–81. https://doi.org/10.1007/s11748-020-01439-7.

    Article  PubMed  Google Scholar 

  8. Oramas DM, Moran CA. Thymoma: challenges and pitfalls in biopsy interpretation. Adv Anat Pathol. 2021;28(5):291–7. https://doi.org/10.1097/pap.0000000000000310.

    Article  CAS  PubMed  Google Scholar 

  9. Berghmans T, Durieux V, Holbrechts S, Jungels C, Lafitte JJ, Meert AP, Moretti L, Ocak S, Roelandts M, Girard N. Systemic treatments for thymoma and thymic carcinoma: a systematic review. Lung Cancer. 2018;126:25–31. https://doi.org/10.1016/j.lungcan.2018.10.018.

    Article  PubMed  Google Scholar 

  10. Xu S, Li X, Zhang H, Zu L, Yang L, Shi T, Zhu S, Lei X, Song Z, Chen J. Frequent genetic alterations and their clinical significance in patients with thymic epithelial tumors. Front Oncol. 2021;11:667148. https://doi.org/10.3389/fonc.2021.667148.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Choe J, Lee SM, Lim S, Choi SH, Kim N, Do KH, Seo JB. Doubling time of thymic epithelial tumours on CT: correlation with histological subtype. Eur Radiol. 2017;27(10):4030–6. https://doi.org/10.1007/s00330-017-4795-y.

    Article  PubMed  Google Scholar 

  12. Harnath T, Marx A, Ströbel P, Bölke E, Willers R, Gripp S. Thymoma-a clinico-pathological long-term study with emphasis on histology and adjuvant radiotherapy dose. J Thorac Oncol. 2012;7(12):1867–71. https://doi.org/10.1097/JTO.0b013e3182745f73.

    Article  PubMed  Google Scholar 

  13. Marx A, Chan JKC, Chalabreysse L, Dacic S, Detterbeck F, French CA, Hornick JL, Inagaki H, Jain D, Lazar AJ, Marino M, Marom EM, Moreira AL, Nicholson AG, Noguchi M, Nonaka D, Papotti MG, Porubsky S, Sholl LM, Tateyama H, Thomas de Montpréville V, Travis WD, Rajan A, Roden AC, Ströbel P. 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(2):200–13. https://doi.org/10.1016/j.jtho.2021.10.010.

    Article  PubMed  Google Scholar 

  14. Abou-Alfa GK, Macarulla T, Javle MM, Kelley RK, Lubner SJ, Adeva J, Cleary JM, Catenacci DV, Borad MJ, Bridgewater J, Harris WP, Murphy AG, Oh DY, Whisenant J, Lowery MA, Goyal L, Shroff RT, El-Khoueiry AB, Fan B, Wu B, Chamberlain CX, Jiang L, Gliser C, Pandya SS, Valle JW, Zhu AX. Ivosidenib in IDH1-mutant, chemotherapy-refractory cholangiocarcinoma (ClarIDHy): a multicentre, randomised, double-blind, placebo-controlled, phase 3 study. Lancet Oncol. 2020;21(6):796–807. https://doi.org/10.1016/s1470-2045(20)30157-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Wang CL, Gao LT, Lv CX, Zhu L, Fang WT. Outcome of nonsurgical treatment for locally advanced thymic tumors. J Thorac Dis. 2016;8(4):705–10. https://doi.org/10.21037/jtd.2016.01.79.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Willmann J, Rimner A. The expanding role of radiation therapy for thymic malignancies. J Thorac Dis. 2018;10(Suppl 21):S2555–64. https://doi.org/10.21037/jtd.2018.01.154.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chen YY, Huang CH, Tang Y, Eng HL. Concurrent chemo-radiotherapy for unresectable thymic carcinoma. Chang Gung Med J. 2004;27(7):515–22.

    PubMed  Google Scholar 

  18. Kunitoh H, Tamura T, Shibata T, Takeda K, Katakami N, Nakagawa K, Yokoyama A, Nishiwaki Y, Noda K, Watanabe K, Saijo N. A phase II trial of dose-dense chemotherapy, followed by surgical resection and/or thoracic radiotherapy, in locally advanced thymoma: report of a Japan Clinical Oncology Group trial (JCOG 9606). Br J Cancer. 2010;103(1):6–11. https://doi.org/10.1038/sj.bjc.6605731.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Korst RJ, Bezjak A, Blackmon S, Choi N, Fidias P, Liu G, Marx A, Wright C, Mock S, Rutledge JR, Keshavjee S. Neoadjuvant chemo-radiotherapy for locally advanced thymic tumors: a phase II, multi-institutional clinical trial. J Thorac Cardiovasc Surg. 2014;147(1):36–46. https://doi.org/10.1016/j.jtcvs.2013.08.061.

    Article  PubMed  Google Scholar 

  20. Fornasiero A, Daniele O, Ghiotto C, Piazza M, Fiore-Donati L, Calabró F, Rea F, Fiorentino MV. Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991;68(1):30–3.

    Article  CAS  PubMed  Google Scholar 

  21. Bruni A, Scotti V, Borghetti P, Vagge S, Cozzi S, D’Angelo E, GiajLevra N, Fozza A, Taraborrelli M, Piperno G, Vanoni V, Sepulcri M, Trovò M, Nardone V, Lattanzi E, Bou Selman S, Bertolini F, Franceschini D, Agustoni F, Jereczek-Fossa BA, Magrini SM, Livi L, Lohr F, Filippi AR. A real-world, multicenter, observational retrospective study of durvalumab after concomitant or sequential chemoradiation for unresectable stage III non-small cell lung cancer. Front Oncol. 2021;11:744956. https://doi.org/10.3389/fonc.2021.744956.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Park S, Park IK, Kim YT, Lee GD, Kim DK, Cho JH, Choi YS, Lee CY, Lee JG, Kang CH. Comparison of neoadjuvant chemotherapy followed by surgery to upfront surgery for thymic malignancy. Ann Thorac Surg. 2019;107(2):355–62. https://doi.org/10.1016/j.athoracsur.2018.08.055.

    Article  PubMed  Google Scholar 

  23. Johnson GB, Aubry MC, Yi ES, Koo CW, Jenkins SM, Garces YI, Marks RS, Cassivi SD, Roden AC. Radiologic response to neoadjuvant treatment predicts histologic response in thymic epithelial tumors. J Thorac Oncol. 2017;12(2):354–67. https://doi.org/10.1016/j.jtho.2016.09.118.

    Article  PubMed  Google Scholar 

  24. Wang S, Jiang J, Gao J, Chen G, Fan Y, Xu B, Dong J, Du S, Liu J, Ding J. Induction therapy followed by surgery for unresectable thymic epithelial tumours. Front Oncol. 2021;11:791647. https://doi.org/10.3389/fonc.2021.791647.

    Article  PubMed  Google Scholar 

  25. Boothe D, Orton A, Thorpe C, Kokeny K, Hitchcock YJ. Postoperative radiotherapy in locally invasive malignancies of the thymus: patterns of care and survival. J Thorac Oncol. 2016;11(12):2218–26. https://doi.org/10.1016/j.jtho.2016.07.032.

    Article  PubMed  Google Scholar 

  26. Ma K, Gu Z, Han Y, Fu J, Shen Y, Wei Y, Tan L, Zhang P, Chen C, Zhang R, Li Y, Chen K, Chen H, Liu Y, Cui Y, Wang Y, Pang L, Yu Z, Zhou X, Liu Y, Liu Y, Fang W. The application of postoperative chemotherapy in thymic tumors and its prognostic effect. J Thorac Dis. 2016;8(4):696–704. https://doi.org/10.21037/jtd.2016.03.31.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Chiappetta M, Aprile V, Lococo F, Zanfrini E, Nachira D, Meacci E, Korasidis S, Ambrogi M, Lucchi M, Margaritora S. Prognostic factors for survival in advanced thymomas: the role of the number of involved structures. J Surg Oncol. 2021;124(5):858–66. https://doi.org/10.1002/jso.26593.

    Article  PubMed  Google Scholar 

  28. Filosso PL, Evangelista A, Ruffini E, Rendina EA, Margaritora S, Novellis P, Rena O, Casadio C, Andreetti C, Guerrera F, Lausi PO, Diso D, Mussi A, Venuta F, Oliaro A, Lucchi M. Does myasthenia gravis influence overall survival and cumulative incidence of recurrence in thymoma patients? A retrospective clinicopathological multicentre analysis on 797 patients. Lung Cancer. 2015;88(3):338–43. https://doi.org/10.1016/j.lungcan.2015.03.007.

    Article  PubMed  Google Scholar 

  29. Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, Strobel P, Mazia C, Oger J, Cea JG, Heckmann JM, Evoli A, Nix W, Ciafaloni E, Antonini G, Witoonpanich R, King JO, Beydoun SR, Chalk CH, Barboi AC, Amato AA, Shaibani AI, Katirji B, Lecky BR, Buckley C, Vincent A, Dias-Tosta E, Yoshikawa H, Waddington-Cruz M, Pulley MT, Rivner MH, Kostera-Pruszczyk A, Pascuzzi RM, Jackson CE, Garcia Ramos GS, Verschuuren JJ, Massey JM, Kissel JT, Werneck LC, Benatar M, Barohn RJ, Tandan R, Mozaffar T, Conwit R, Odenkirchen J, Sonett JR, Jaretzki A 3rd, Newsom-Davis J, Cutter GR, Group MS. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med. 2016;375(6):511–22. https://doi.org/10.1056/NEJMoa1602489.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Aprile V, Korasidis S, Bacchin D, Petralli G, Petrini I, Ricciardi R, Ambrogi MC, Lucchi M. Thymectomy in myasthenic patients with thymoma: killing two birds with one stone. Ann Thorac Surg. 2021;112(6):1782–9. https://doi.org/10.1016/j.athoracsur.2020.12.010.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Chest Wall Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China

    Shubin Guan MD, Weiguang Long BS, Yang Liu MS, Bin Cai MS & Juan Luo MS

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Contributions

SG and WL carried out the studies, participated in collecting data, and drafted the manuscript. YL performed the statistical analysis and participated in its design. BC and JL participated in the acquisition, analysis, or interpretation of data and drafted the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shubin Guan MD.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical approval

This study was approved by the Ethics Committee of the Guangdong Second Provincial General Hospital, and informed consent was obtained from all patients (or their families) (2022-KY-KZ-246-01).

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Guan, S., Long, W., Liu, Y. et al. Prognosis of Concurrent Versus Sequential Chemo-Radiotherapy Induction Followed by Surgical Resection in Patients with Advanced Thymic Epithelial Tumors: A Retrospective Study. Ann Surg Oncol 30, 6739–6747 (2023). https://doi.org/10.1245/s10434-023-13954-x

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