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J Thorac Oncol. 2016 Oct;11(10):1785-92. doi: 10.1016/j.jtho.2016.06.011. Epub 2016 Jun 23.

Postoperative Radiation Therapy Is Associated with Longer Overall Survival in Completely Resected Stage II and III Thymoma-An Analysis of the International Thymic Malignancies Interest Group Retrospective Database.

Author information

1
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: rimnera@mskcc.org.
2
Department of Internal Medicine, Yale University, New Haven, Connecticut.
3
Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
4
Department of Thoracic Surgery, Yale University, New Haven, Connecticut.
5
The Daniel and Gloria Blumenthal Cancer Center, Valley Health System, Ridgewood, New Jersey.
6
Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, Texas.

Abstract

OBJECTIVES:

The aim of this study was to determine whether postoperative radiation therapy (PORT) is associated with an overall survival (OS) benefit in patients with completely resected Masaoka or Masaoka-Koga stage II and III thymoma.

METHODS:

All patients with completely resected (R0) stage II or III thymoma were identified in a large database of the International Thymic Malignancy Interest Group. Clinical, pathologic, treatment, and follow-up information were extracted. OS was the primary end point. A univariate analysis using the log-rank test was performed, and a multivariate Cox model was created to identify factors associated with OS.

RESULTS:

Of 1263 patients meeting the selection criteria, 870 (69%) had stage II thymoma. The WHO histologic subtype was A/AB in 360 patients (30%) and B1/B2/B3 in 827 (70%). PORT was given to 55% of patients (n = 689), 15% (n = 180) received chemotherapy, and 10% (n = 122) received both. The 5- and 10-year OS rates for patients having undergone an operation plus PORT were 95% and 86%, respectively, compared with 90% and 79% for patients receiving an operation alone (p = 0.002). This OS benefit remained significant when patients with stage II (p = 0.02) and stage III thymoma (p = 0.0005) were analyzed separately. On multivariate analysis, earlier stage, younger age, absence of paraneoplastic syndrome, and PORT were significantly associated with improved OS.

CONCLUSIONS:

We observed an OS benefit with the use of PORT in completely resected stage II and III thymoma. In the absence of a randomized trial, this represents the most comprehensive analysis of individual patient data and strong evidence in favor of PORT in this patient population.

KEYWORDS:

Complete resection; International Thymic Malignancy Interest Group; Postoperative radiation therapy; Stage II-III; Thymoma

PMID:
27346413
PMCID:
PMC5257334
DOI:
10.1016/j.jtho.2016.06.011
[Indexed for MEDLINE]
Free PMC Article

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