Postoperative Radiation Therapy for Thymic Carcinoma: An Analysis of the ITMIG/ESTS Database
Menée à l'aide de données portant sur 462 patients atteints d'un carcinome thymique, cette étude analyse l'efficacité, du point de vue de la survie globale, d'une radiothérapie postopératoire et identifie les facteurs pronostiques associés
Objectives: R0 resection and radiation therapy have been associated with improved OS in thymic carcinoma (TC) patients. Here we analyzed which subgroups of patients derive the greatest benefit from postoperative radiation therapy (PORT). Methods: Clinical, pathologic, treatment and survival information of 462 patients with TC from the ITMIG/ESTS database were analyzed. Variables included age, gender, continent of treatment, paraneoplastic syndrome, carcinoma subtype, tumor size, pathologic Masaoka stage, resection status and use of chemotherapy. Overall survival (OS) was the primary endpoint using the Kaplan-Meier method. Time to relapse (TTR) was the secondary endpoint using a competing risk analysis. A 3-month landmark analysis was performed. Results: PORT was associated with a significant OS benefit (5-year OS 68 vs 53%; p=0.002). In patients with R0 resection, PORT was associated with increased OS for advanced (stage III-IV, p=0.04), but not early (stage I-II, p=0.14) stage TC. In patients with an R1/2 resection of advanced stage TC, PORT was associated with significantly longer OS (5-year OS 53 vs 38%; p<0.001). Subset analyses did not reveal clear associations of PORT with TTR. On multivariable analysis, lower pathologic stage, PORT and R0 resection status were associated with an OS benefit, whereas only higher age and lower pathologic stage showed an association with longer TTR. Conclusions: In the largest individual patient dataset on patients with thymic carcinoma reported to date, PORT was associated with a significant OS benefit in patients with advanced stage TC after an R0 or R1/2 resection.