Adaptive radiation therapy using weekly hypofractionation for thymoma treatment: A retrospective study of 10 rabbits

Radiation therapy (RT) is being utilized more commonly for rabbit thymomas due to high perioperative mortality rates with surgery. Median overall survival times reported for rabbit thymomas treated with a variety of RT protocols and techniques range from 6 months to greater than 2 years. As thymomas are radiation-responsive tumours and may shrink rapidly after RT, adaptive radiotherapy (ART) is often warranted. The purpose of this single-institution retrospective case series was to investigate the tumour volume reduction during RT, the frequency of replanning during RT, and survival time in rabbit thymomas treated using intensity-modulated/image-guided radiation therapy (IMRT/IGRT) and a weekly hypofractionated protocol delivering a total dose of 30 Gy. Ten rabbits met the inclusion criteria from October 2014 to October 2019. The median progression-free survival was 561 days and the median overall survival was 634 days (range: 322-1118 days). The tumour volume gradually decreased with each RT fraction. On post-hoc analysis, only the first RT fraction was associated with a significant GTV reduction (of more than 50% on average, p < .001). All subsequent RT fractions did not further reduce the GTV significantly (p > .06). Hypofractionated RT using a weekly protocol of 5 fractions of 6 Gy is a reasonable option to treat rabbit thymomas and replanning should be anticipated. The results of this study support the use of RT to rapidly relieve thymoma-induced dyspnoea in rabbits.