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Surgery Followed by Entire Hemithoracic Radiotherapy in Thymoma Patients with Pleural Dissemination: A Prospective
Changlu Wang1, Teng Mao2, Zhitao Gu2
1Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Purpose:
The management of thymoma patients with pleural dissemination remains challenging. We conducted a prospective phase 2 study to investigate the safety and efficacy of surgery followed by entire hemithoracic radiotherapy (EHRT) in these patients.
Materials And Methods:
Thymoma patients with pleural dissemination (de novo or recurrent) were enrolled. After macroscopic resection, intensity-modulated radiotherapy (IMRT) of 14 Gy in 14 fractions was delivered to the entire hemithorax. An additional dose of 30 Gy in 15 fractions was delivered to the mediastinal tumor bed if the stage of the primary tumor was higher than T2.
Results:
Between April 2020 and December 2021, 71 patients completed the study protocol. There were 30 male and 41 female patients, with a median age of 46 years (range, 26-75). There were 32 de novo cases and 39 recurrent cases. During a median follow-up of 57 months, two patients (2.8%) died: one from disease progression and the other from heart disease. A total of 34 patients (47.9%) developed disease progression, including pleural recurrence inside the radiation field (n=24) and outside the field (n=10). The median progression-free survival (PFS) was 50 months (95% CI, 45.95-54.39). The 3-year and 5-year PFS were 68.9% (95% CI, 56.7%-78.3%) and 50.8% (95% CI, 38%-62.3%), respectively. The 3- and 5-year recurrence-free survival rates (defined as no relapse inside the radiation field) were 78.8% (95% CI, 67.4%-86.7%) and 66.5% (95% CI, 53.3%-76.7%), respectively. The 5-year overall survival (OS) was 98.6%. Nausea, fatigue, and vomiting were the most frequent toxicities, and most were mild in severity.
Conclusions:
Surgical resection followed by EHRT is a safe treatment approach for thymoma patients with pleural dissemination, yielding promising local control. The optimal dose and target volume of radiotherapy warrant further investigation.
