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The role of salvage radiotherapy in recurrent thymoma

Radiation Oncology Journal 2019년 37권 3호 p.193 ~ 200
 ( Yang Andrew Ji-Hoon ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology

 ( Choi Seo-Hee ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
 ( Byun Hwa-kyung ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
 ( Kim Hyun-Ju ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
 ( Lee Chang-Geol ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
 ( Cho Jae-Ho ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology

Abstract


Purpose: To explore the role of salvage radiotherapy (RT) for recurrent thymoma as an alternative to surgery.

Materials and Methods: Between 2007 and 2015, 47 patients who received salvage RT for recurrent thymoma at Yonsei Cancer Center were included in this study. Recurrent sites included initial tumor bed (n = 4), pleura (n = 19), lung parenchyma (n = 10), distant (n = 9), and multiple regions (n = 5). Three-dimensional conformal and intensity-modulated RT were used in 29 and 18 patients, respectively. Median prescribed dose to gross tumor was 52 Gy (range, 30 to 70 Gy), with equivalent doses in 2-Gy fractions (EQD2). We investigated overall survival (OS), progression-free survival (PFS), and patterns of failure. Local failure after salvage RT was defined as recurrence at the target volume receiving >50% of the prescription dose.

Results: Median follow-up time was 83 months (range, 8 to 299 months). Five-year OS and PFS were 70% and 22%, respectively. The overall response rate was 97.9%; complete response, 34%; partial response, 44.7%; and stable disease, 19.1%. In multivariate analysis, histologic type and salvage RT dose (≥52 Gy, EQD2) were significantly associated with OS. The high dose group (≥52 Gy, EQD2) had significantly better outcomes than the low dose group (5-year OS: 80% vs. 59%, p = 0.046; 5-year PFS: 30% vs. 14%, p=0.002). Treatment failure occurred in 34 patients; out-of-field failure was dominant (intra-thoracic recurrence 35.3%; extrathoracic recurrence 11.8%), while local failure rate was 5.8%.

Conclusion: Salvage RT for recurrent thymoma using high doses and advanced precision techniques produced favorable outcomes, providing evidence that recurrent thymoma is radiosensitive.

키워드

Thymoma; Radiotherapy; Survival; Recurrence
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