Abstract
Radiation therapy is part of recommendations in the adjuvant settings for advanced stage or as exclusive treatment in unresectable thymic epithelial tumors (TETs). However, first-generation techniques delivered substantial radiation doses to critical organs at risk (OARs), such as the heart or the lungs, resulting in noticeable radiation-induced toxicity. Treatment techniques have significantly evolved for TET irradiation, and modern techniques efficiently spare normal surrounding tissues without negative impact on tumor coverage and consequently local control or patient survival. Considering its dosimetric advantages, hadrontherapy (which includes proton therapy and carbon ion therapy) has proved to be worthwhile for TET irradiation in particular for challenging clinical situations such as cardiac tumoral involvement. However, clinical experience for hadrontherapy is still limited and mainly relies on small-size proton therapy studies. This critical review aims to analyze the current status of hadrontherapy for TET irradiation to implement it at a larger scale.
Highlights
Thymic epithelial tumors (TETs) represent a noticeable heterogeneous group of rare thoracic malignancies, including thymomas and thymic carcinomas, with an estimated incidence of 1.3 and 3.2 cases per million person-years [1]
For R0-resected localized TETs, adjuvant radiation therapy (RT) is recommended in cases of thymic carcinoma histology, since it significantly increases recurrence-free survival and overall survival; the clinical benefit or RT seems inexistent for completely resected stage I thymomas and is debatable in other stages [2]
The purpose of this review is to provide a contextualized analysis of the status of hadrontherapy in TET management
Summary
Thymic epithelial tumors (TETs) represent a noticeable heterogeneous group of rare thoracic malignancies, including thymomas and thymic carcinomas, with an estimated incidence of 1.3 and 3.2 cases per million person-years [1]. Hadrontherapy for Thymic Epithelial Tumors recommendations for locally advanced (stage III–IV) TETs after surgery, especially in cases of thymic carcinomas or positive margins, or as a radical treatment for unresectable patients. The technical evolution of RT allows to better spare OARs without altering the tumor coverage and the local control. Such breakthroughs included intensity-modulated RT (IMRT) and respiratory control techniques such as respiratory gating and deep-inspiration breath hold (DIBH). Despite these advances, some clinical situations (i.e., pericardial or myocardial tumoral involvement) are still challenging even with highly conformal IMRT. The purpose of this review is to provide a contextualized analysis of the status of hadrontherapy in TET management
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