Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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The role of salvage radiotherapy in recurrent thymoma

  • Yang, Andrew Jihoon (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Choi, Seo Hee (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Byun, Hwa Kyung (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Kim, Hyun Ju (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Lee, Chang Geol (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Cho, Jaeho (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine)
  • Received : 2019.01.22
  • Accepted : 2019.06.27
  • Published : 2019.09.30
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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.

Keywords

References

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