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Postoperative radiotherapy of patients with thymic epithelial tumors (TET)

A retrospective analysis of outcome and toxicity

Postoperative Strahlentherapie bei Patienten mit epithelialem Thymuskarzinom (TET)

Eine retrospektive Analyse von Outcome und Toxizität

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Abstract

Purpose

The purpose of this study was to evaluate postoperative radiotherapy regarding outcome and toxicity in patients with thymic epithelial tumors (TET) after surgery.

Materials and methods

We retrospectively analyzed medical records of 41 patients with TET treated with postoperative radiotherapy at our institution between 1995 and 2012. The impact of prognostic factors (e.g., Masaoka stage, histological subtype) was investigated and radiation-related toxicity was assessed.

Results

Median age was 59.8 years and median follow-up was 61 months. In 24.4 %, TETs were associated with paraneoplastic syndromes. The 5-year overall survival (OS) was 89.5 % and the 5-year disease-free survival (DFS) was 88.9 %. Masaoka stage had a significant impact on OS (p = 0.007). Locally limited stages I + II had a 5-year OS of 100 % compared to 80 % for stage III and 66.7 % for stage IV. The 5-year DFS was excellent with 100 % for both WHO groups A/AB/B1 and B2, respectively, and significantly (p = 0.005) differed from B3/C-staged patients with a 5-year DFS of 63.6 %. Resection status, paraneoplastic association, radiation dose, or tumor size did not influence survival. There were no high-grade acute or late side effects caused by radiotherapy.

Conclusion

Masaoka stage has a significant impact on OS as WHO type has on DFS in patients with TETs after surgery and adjuvant irradiation. Postoperative radiotherapy with doses around 50 Gy is safe and not likely to cause high-grade toxicity. Further prospective trials are necessary to separate patient subgroups that benefit from radiotherapy from those that do not.

Zusammenfassung

Ziel

Die vorliegende Studie hatte zum Ziel, die postoperative Radiotherapie von Patienten nach Resektion einer Thymusneoplasie epithelialen Ursprungs (Thymom, Thymuskarzinom, „thymic epithelial tumors“, TET) hinsichtlich prognostischer Relevanz und Nebenwirkungsprofil zu beurteilen.

Material und methoden

Wir analysierten retrospektiv die medizinischen Krankenakten von 41 Patienten mit TET, die zwischen 1995 und 2012 eine postoperative Radiotherapie in unserer Einrichtung erhielten. Hierbei untersuchten wir insbesondere mögliche Prognosefaktoren wie Masaoka-Stadium, histologischen Subtyp sowie weitere und erfassten radiogene Nebenwirkungen.

Ergebnisse

Das mediane Alter betrug 59,8 Jahre, das mediane Follow-up lag bei 61 Monaten. Bei 24,4 % aller Patienten trat ein paraneoplastisches Syndrom auf. Das 5-Jahres-Gesamtüberleben lag bei 89,5 %, das krankheitsfreie 5-Jahres-Übeleben bei 88,9 %. Das Masaoka-Stadium hatte signifikanten Einfluss auf das Gesamtüberleben (p = 0,007). Die lokal begrenzten Stadien I + II hatten ein 5-Jahres-Gesamtüberleben von 100 % im Vergleich zu 80 % bei Masaoka III und 66,7 % bei Masaoka IV. Das krankheitsfreie 5-Jahres-Übeleben war mit jeweils 100 % in den WHO-Gruppen A/AB/B1 bzw. B2 exzellent und damit signifikant besser (p = 0,005) im Vergleich zu 63,6 % bei Patienten mit B3/C. Resektionsstatus, Paraneoplasien, Bestrahlungsdosis oder Tumorgröße hatten keinen Einfluss auf das Überleben. Es traten keine höhergradigen, radiogenen Akut- oder Spätnebenwirkungen auf.

Schlussfolgerung

Das Masaoka-Stadium hat signifikanten Einfluss auf das Gesamtüberleben und der WHO-Subtyp auf das krankheitsfreie Überleben bei Patienten mit postoperativer Radiotherapie nach Resektion eines TET. Eine Bestrahlungsdosis von ca. 50 Gy kann hierbei sicher und ohne besonderes Risiko für höhergradige Nebenwirkungen appliziert werden. Allerdings werden weitere, prospektive Studien benötigt, um zu differenzieren, welche Patientensubgruppen von einer adjuvanten Radiotherapie profitieren und welche nicht.

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Compliance with ethical guidelines

Conflict of interest

M.F. Häfner, F. Roeder, F. Sterzing, D. Krug, S.A. Koerber, J. Kappes, H. Hoffmann, A. Slynko, J. Debus, and M. Bischof state that there are no conflicts of interest. All studies on patient data were carried out with approval of the institutional ethical review committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form).

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Authors and Affiliations

  1. Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Matthias Felix Häfner M.D.,  Falk Roeder M.D.,  Florian Sterzing M.D.,  David Krug M.D.,  Stefan A. Koerber M.D.,  Jürgen Debus M.D., Ph.D. &  Marc Bischof M.D.

  2. Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Matthias Felix Häfner M.D.,  Falk Roeder M.D.,  Florian Sterzing M.D.,  David Krug M.D.,  Stefan A. Koerber M.D. &  Jürgen Debus M.D., Ph.D.

  3. Department of Pneumology, Thoraxklinik Heidelberg, University of Heidelberg, Amalienstr. 5, 69126, Heidelberg, Germany

    Jutta Kappes M.D.

  4. Department of Thoracic Surgery, Thoraxklinik Heidelberg, University of Heidelberg, Amalienstr. 5, 69126, Heidelberg, Germany

    Hans Hoffmann M.D.

  5. Biostatistics, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Alla Slynko Ph.D.

  6. Department of Radiation Oncology, SLK-Kliniken Heilbronn, Am Gesundbrunnen 20-26, 74076, Heilbronn, Germany

    Marc Bischof M.D.

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  1. Matthias Felix Häfner M.D.
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  2. Falk Roeder M.D.
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  3. Florian Sterzing M.D.
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  8. Alla Slynko Ph.D.
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Correspondence to Matthias Felix Häfner M.D..

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Häfner, M., Roeder, F., Sterzing, F. et al. Postoperative radiotherapy of patients with thymic epithelial tumors (TET). Strahlenther Onkol 191, 133–140 (2015). https://doi.org/10.1007/s00066-014-0740-z

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  • DOI: https://doi.org/10.1007/s00066-014-0740-z

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