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Postoperative radiotherapy results in 192 epithelial thymic tumours patients with 10 years of follow-up

医学 放射治疗 危险系数 阶段(地层学) 胸腺瘤 内科学 多元分析 胃肠病学 外科 置信区间 生物 古生物学
作者
Hugo López,Angela Botticella,Farid Belkhir,Benjamin Besse,Élie Fadel,Olaf Mercier,Antonin Lévy,C. Le Péchoux
出处
期刊:Radiotherapy and Oncology [Elsevier BV]
卷期号:195: 110272-110272 被引量:1
标识
DOI:10.1016/j.radonc.2024.110272
摘要

Purpose To assess the prognostic factors and patterns of failure of patients consecutively treated with surgery and postoperative radiation therapy (PORT) for thymic epithelial tumours (TET). Patients and methods Data from 192 TET patients who were operated and received PORT at a single centre from 1990 to 2019 was retrospectively analysed. Results Most patients had thymoma (77 %, B247%), were classified Masaoka-Koga stage III (35 %) or IV (32 %) and had a R0 (75 %) resection. Radiotherapy was delivered at a median dose of 50.4 Gy (range, 42–66 Gy; ≥ 60 Gy in 17 %), 63 (33 %) patients were treated by intensity-modulated radiation therapy and elective nodal radiotherapy was used for 37 %. At a median follow-up of 10.9 years, the 10-year overall survival (OS) and progression-free survival (PFS) rates were 62 % (95 % CI: 54–70 %) and 47 % (95 % CI: 39–55 %), respectively. Locoregional recurrence (LRR) occurred in 72/192 (38 %) patients, distributed as 6 local, 45 regional and 21 both local and regional. LRR were mainly located to the pleura: 66/72 (92 %) and 16/72 (22 %; 16/192 in total, 8 %) were in-field. Distant relapse (DR) were observed in 30 patients (16 %), resulting in 10-year locoregional (LRC) and distant control rates of 58 % (95 % CI: 50–66 %) and 82 % (95 % CI: 77–88 %), respectively. In the multivariate analysis, Masaoka-Koga stage (HR [hazard ratio]: 1.9; p = 0.001), thymic carcinomas/neuroendocrine tumours (TC) (HR: 1.6; p = 0.045) and ECOG PS > 1 (HR: 1.9; p = 0.02) correlated with poorer OS. Higher Masaoka-Koga stage (HR: 2.6; p < 0.001) associated with a decreased LRC but not R1 status (HR: 1.2; p = 0.5) or WHO histology classification. TC (HR: 3.4; p < 0.001) and a younger age (HR: 2.5; p = 0.02) correlated with DR. Conclusion Approximately one-third of the TET in our study experienced a LRR, mainly to the pleura, and 8% in total were in-field. The place of radiotherapy should be better defined in higher risk thymoma patients within prospective randomized studies.
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