Brief communication
Entire hemithorax irradiation following complete resection in patients with Stage II–III invasive thymoma

https://doi.org/10.1016/0360-3016(96)00086-7Get rights and content

Abstract

Purpose: To evaluate the feasibility and efficacy of prophylactic entire hemithorax irradiation (EH) in radiation to mediastinal irradiation (MRT) following a complete resection in Stage II–III invasive thymona.

Methods and Materials: Forty-three patients with invasive thymoma treated with surgery and radiation therapy between 1978 and 1993 were analyzed retrospectively. All 43 patients underwent a complete surgical resection and were judged to have Masaoka's Stage II–III invasive thymoma. Of these, 23 patients received EH and MRT (EH-MRT) and the remaining 20 received MRT. Of the 23 patients with EH-MRT, 11 were Stage II and 12 Stage III. Of the 20 with MRT, 11 were Stage II and 9 Stage III. In most cases, EH was 15 Gy per 15 fractions over 3 weeks (without lung compensation calculation). In both the EH-MRT and MRT group, the total radiation doses to the mediastinum were similar with a median of 40 Gy. The medial follow-up time after surgery was 63 months and no patients were lost to follow-up.

Results: Only one of the 23 patients with EH-MRT relapsed. On the other hand, eight of the 20 with MRT relapsed, six of whom died of disease. The pleura was the most common site of failure. At 5 years, the relapse-free rate was 100% for those receiving EH-MRT and 66% for those with MRT (p = 0.03); the overall survival rate was 96% for those with EH-MRT, and 74% for those with MRT (p: not signficant). The only significant treatment-related complication was radiation pneumonitis requiring treatment, in one patient who received MRT and three who received EH-MRT, including one death of a 72-year-old man and one 68-year-old woman with severe lung fibrosis.

Conclusion: Except for elderly patients, EH-MRT following a macroscopically complete resection appears to be safe and feasible, and can reduce intrathoracic relapses.

References (12)

  • K. Nakahara et al.

    Thymoma, results with complete mesection and adjavant postoperative irradiation in 141 consecutive patients

    J.Thorac. Cardiovasc. Surg.

    (1988)
  • L.S. Ariaratnum et al.

    The management of malignant thymoma with radiation therapy

    Int. J. Radiat. Oncol. Biol. Phys.

    (1979)
  • J.D. Cox

    The lung and thumus

  • W.J. Curren et al.

    Irreasive thymoma: The role of mediastinal irradiation following complete of incomplete resection

    J. Clin. Oncol.

    (1988)
  • E. Gehan

    A generalized Willcomon test for comparing anti-trarily single-ceasored samples

    Biometrica

    (1965)
  • D.G. Gaardez

    The need for prospective clinical studies in thymoma

    Radiather. Oncol.

    (1991)
There are more references available in the full text version of this article.

Cited by (69)

  • Entire hemithorax irradiation for Masaoka stage IVa thymomas

    2012, Reports of Practical Oncology and Radiotherapy
    Citation Excerpt :

    In this context, radiotherapy doses more often reported have been between 11.2 Gy and 16 Gy in 7–10 fractions. Uematsu et al.27 used total hemithoracic irradiation prophylactically in stages II and III, using doses between 10–16 Gy in 10–16 fractions. Recurrence-free survival of 100% at 5 years was achieved in the entire hemithorax irradiation group (with good clinical tolerance) versus 66% in the group that only received radiotherapy to the thymic bed.

View all citing articles on Scopus
View full text