Abstract
This study was conducted to assess optimal radiation target volume in patients with locally advanced thymic epithelial tumor (TET) treated by surgery and postoperative radiation therapy (PORT). The records of 54 patients with Masaoka-Koga stage III TET, who received surgical resection at Samsung Medical Center, from Jan. 2000 to Dec. 2014, were retrospectively reviewed. The most common TNM stage was T3N0M0 (n=46, 85.2%) according to the new staging system proposed by the International Association for the Study of Lung Cancer and the International Thymic Malignancy Interest Group. The median PORT dose was 54 Gy in 27 fractions. Target volume was confined to the primary tumor bed only, while did not include the regional lymphatics nor pleuro-pericardial space electively. The clinical outcomes, prognostic factors and patterns of failure were analyzed. After median follow-up of 62 months, there were 19 (35.2%) patients who had disease recurrence. Pure local failure within the PORT volume was founded in only one (1.9%) patient who had gross residual mass after surgery, pleuro-pericardial seeding in 5 (9.3%), distant metastases in 10 (18.5%), and regional recurrence in adjacent mediastinum or lymph nodes in 3 (5.6%) patients with WHO type B3 or C TET. Overall survival rate at 5 and 10 years was 83.0% and 43.6%, respectively. Recurrence free survival rate at 5 and 10 years was 62.3% and 57.9%, respectively. The age <60 years old, female gender, and tumor diameter <10 cm were favorable prognostic factors for overall survival on univariate analyses. Radiation toxicity was mild in most patients and no severe toxicity was registered. PORT confined to the primary tumor bed only is suggested to be optimal in patients with Masaoka stage III (T1b-4N0) TET considering excellent in-field control and minimal out-field regional recurrences. Development of effective systemic treatment strategy to reduce the pleuro-pericardial seeding may be warranted.
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