Postoperative Radiotherapy After Surgical Resection of Thymoma

Differing Roles in Localized and Regional Disease

Jeffrey A. Forquer, Nan Rong, Achilles J. Fakiris, Patrick Loehrer, Peter A S Johnstone

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Purpose: To analyze the Surveillance, Epidemiology and End Results (SEER) registry data to determine the impact of postoperative radiotherapy (PORT) for thymoma and thymic carcinoma (T/TC). Methods and Materials: Patients with surgically resected localized (LOC) or regional (REG) malignant T/TC with or without PORT were analyzed for overall survival (OS) and cause-specific survival (CSS) by querying the SEER database from 1973-2005. Patients dying within the first 3 months after surgery were excluded. Kaplan-Meier and multivariate analyses with Cox proportional hazards were performed. Results: A total of 901 T/TC patients were identified (275 with LOC disease and 626 with REG disease). For all patients with LOC disease, PORT had no benefit and may adversely impact the 5-year CSS rate (91% vs. 98%, p = 0.03). For patients with REG disease, the 5-year OS rate was significantly improved by adding PORT (76% vs. 66% for surgery alone, p = 0.01), but the 5-year CSS rate was no better (91% vs. 86%, p = 0.12). No benefit was noted for PORT in REG disease after extirpative surgery (defined as radical or total thymectomy). On multivariate OS and CSS analysis, stage and age were independently correlated with survival. For multivariate CSS analysis, the outcome of PORT is significantly better for REG disease than for LOC disease (hazard ratio, 0.167; p = 0.001). Conclusions: Our results from SEER show that PORT for T/TC had no advantage in patients with LOC disease (Masaoka Stage I), but a possible OS benefit of PORT in patients with REG disease (Masaoka Stage II-III) was found, especially after non-extirpative surgery. The role of PORT in T/TC needs further evaluation.

Original languageEnglish
Pages (from-to)440-445
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume76
Issue number2
DOIs
StatePublished - Feb 1 2010

Fingerprint

Thymoma
radiation therapy
Radiotherapy
epidemiology
surgery
cancer
surveillance
Survival
causes
Epidemiology
Survival Rate
Survival Analysis
hazards
Thymectomy
Kaplan-Meier Estimate
Registries
Multivariate Analysis
Databases

Keywords

  • Postoperative radiation
  • Regional disease
  • SEER
  • Thymic carcinoma
  • Thymoma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Postoperative Radiotherapy After Surgical Resection of Thymoma : Differing Roles in Localized and Regional Disease. / Forquer, Jeffrey A.; Rong, Nan; Fakiris, Achilles J.; Loehrer, Patrick; Johnstone, Peter A S.

In: International Journal of Radiation Oncology Biology Physics, Vol. 76, No. 2, 01.02.2010, p. 440-445.

Research output: Contribution to journalArticle

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abstract = "Purpose: To analyze the Surveillance, Epidemiology and End Results (SEER) registry data to determine the impact of postoperative radiotherapy (PORT) for thymoma and thymic carcinoma (T/TC). Methods and Materials: Patients with surgically resected localized (LOC) or regional (REG) malignant T/TC with or without PORT were analyzed for overall survival (OS) and cause-specific survival (CSS) by querying the SEER database from 1973-2005. Patients dying within the first 3 months after surgery were excluded. Kaplan-Meier and multivariate analyses with Cox proportional hazards were performed. Results: A total of 901 T/TC patients were identified (275 with LOC disease and 626 with REG disease). For all patients with LOC disease, PORT had no benefit and may adversely impact the 5-year CSS rate (91{\%} vs. 98{\%}, p = 0.03). For patients with REG disease, the 5-year OS rate was significantly improved by adding PORT (76{\%} vs. 66{\%} for surgery alone, p = 0.01), but the 5-year CSS rate was no better (91{\%} vs. 86{\%}, p = 0.12). No benefit was noted for PORT in REG disease after extirpative surgery (defined as radical or total thymectomy). On multivariate OS and CSS analysis, stage and age were independently correlated with survival. For multivariate CSS analysis, the outcome of PORT is significantly better for REG disease than for LOC disease (hazard ratio, 0.167; p = 0.001). Conclusions: Our results from SEER show that PORT for T/TC had no advantage in patients with LOC disease (Masaoka Stage I), but a possible OS benefit of PORT in patients with REG disease (Masaoka Stage II-III) was found, especially after non-extirpative surgery. The role of PORT in T/TC needs further evaluation.",
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