1
|
Chun SG, Rimner A, Amini A, Chang JY, Donington J, Edelman MJ, Geng Y, Gubens MA, Higgins KA, Iyengar P, Movsas B, Ning MS, Park HS, Rodrigues G, Wolf A, Simone CB. American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma. JAMA Oncol 2023:2805042. [PMID: 37186595 DOI: 10.1001/jamaoncol.2023.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Importance Thymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management. Objective To develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma. Evidence Review Case variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. Variants and procedures were evaluated by the panel using modified Delphi methodology. Agreement/consensus was defined as less than or equal to 3 rating points from median. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures. Findings The ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs. Conclusions and Relevance The ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.
Collapse
Affiliation(s)
- Stephen G Chun
- The University of Texas MD Anderson Cancer Center, Houston
| | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Arya Amini
- City of Hope National Medical Center, Duarte, California
| | - Joe Y Chang
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Martin J Edelman
- Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania
| | - Yimin Geng
- The University of Texas MD Anderson Cancer Center, Houston
| | - Matthew A Gubens
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | | | - Puneeth Iyengar
- The University of Texas at Southwestern Medical Center, Dallas
| | | | - Matthew S Ning
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - George Rodrigues
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Andrea Wolf
- Mount Sinai Health System, New York, New York
| | | |
Collapse
|
3
|
Ruffini E, Guerrera F, Brunelli A, Passani S, Pellicano D, Thomas P, Van Raemdonck D, Rocco G, Venuta F, Weder W, Detterbeck F, Falcoz PE. Report from the European Society of Thoracic Surgeons prospective thymic database 2017: a powerful resource for a collaborative global effort to manage thymic tumours. Eur J Cardiothorac Surg 2020; 55:601-609. [PMID: 30649256 DOI: 10.1093/ejcts/ezy448] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/23/2018] [Accepted: 11/17/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES We queried the European Society of Thoracic Surgeons (ESTS) prospective thymic database for descriptive analysis and for comparison with the ESTS retrospective thymic database (1990-2010). METHODS Data were retrieved (January 2007-November 2017) for 1122 patients from 75 ESTS institutions. RESULTS There were 484 (65%) thymomas, 207 (28%) thymic carcinomas and 49 (7%) neuroendocrine thymic tumours. Staging (Masaoka) included 483 (67%) stage I and II, 100 (14%) stage III and 70 (10%) stage IV tumours. The new International Association for the Study of Lung Cancer/International Thymic Malignancies Interest Group tumour, node and metastasis (TNM) classification was available for 224 patients and including 177 (85%) stage I-II, 37 (16%) stage IIIA and 10 (4%) stage IIIB tumours. Chemotherapy as induction and adjuvant treatment was used in 14% and 15% of the patients. Radiotherapy was almost exclusively used postoperatively (24%). A minimally invasive surgical approach (video-assisted thoracic surgery/robotic-assisted thoracic surgery) was used in 276 (33%) patients. The overall recurrence rate was 10.8% (N = 38). Compared to the ESTS retrospective database, the increased prevalence of thymic carcinomas (from 9% to 28%) and neuroendocrine thymic tumours (from 2% to 7%), an increase in the use of minimally invasive techniques (from 6% to 34%) and a wider use of chemotherapy as induction (from 9% to 15%) and adjuvant (from 2% to 16%) treatment were observed in the prospective database. The introduction of a set of variables considered essential for the data use ('minimum dataset') resulted in an increased average completeness rate. CONCLUSIONS The reported data from the ESTS prospective thymic database confirm the recent trends in the management of thymic tumours. The ESTS prospective thymic database represents a powerful resource open to all ESTS members for the global effort to manage these rare tumours.
Collapse
Affiliation(s)
- Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | | | | | | | | | - Pascal Thomas
- Department of Thoracic Surgery, Aix-Marseille University, Marseille, France
| | | | - Gaetano Rocco
- Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Federico Venuta
- Thoracic Surgery, University of Rome "Sapienza", Policlinico Umberto I, Rome, Italy
| | - Walter Weder
- Thoracic Surgery, University Hospital, Zurich, Switzerland
| | | | | |
Collapse
|
4
|
Kanzaki R, Kanou T, Ose N, Funaki S, Shintani Y, Minami M, Kida H, Ogawa K, Kumanogoh A, Okumura M. Long-term outcomes of advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy followed by surgery: a 20-year experience. Interact Cardiovasc Thorac Surg 2019; 28:360-367. [PMID: 30256943 DOI: 10.1093/icvts/ivy276] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/25/2018] [Accepted: 08/15/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The results of preoperative chemotherapy or chemoradiotherapy followed by surgery for locally advanced thymoma were analysed. METHODS Between 1997 and 2016, 29 patients with a thymoma underwent preoperative chemotherapy or chemoradiotherapy followed by surgery. These cases were retrospectively reviewed. RESULTS The study population included 9 men and 20 women, with a mean age of 48.8 years (range 31-68 years). The preoperative Masaoka stage was III in 12, IVa in 13 and IVb in 4 patients, whereas histological type was B3 in 11, B2 in 9 and others in 5 patients. The mean tumour size was 8.0 ± 2.5 cm (3.4-15.0 cm). The site of infiltration shown in preoperative radiological examinations was the aorta in 6 patients, the superior vena cava in 14 patients and the pulmonary artery trunk in 3 patients, with pleural dissemination detected in 14. Three patients underwent chemoradiotherapy. Chemotherapy regimens given were cisplatin + doxorubicin + vincristine + cyclophosphamide in 9 patients, carboplatin + paclitaxel in 6 patients, cisplatin + doxorubicin + methylprednisolone in 5 patients and others in 9 patients, with partial response obtained in 11 patients and stable disease noted in 18 patients. Complete resection was achieved in 24 (83%) cases. There were no perioperative mortalities, whereas 6 (21%) patients developed postoperative complications. The 5- and 10-year overall survival rates were 100% and 87%, respectively, and 5- and 10-year disease-free survival rates were 50% and 50%, respectively. CONCLUSIONS Preoperative chemotherapy or chemoradiotherapy followed by surgery for locally advanced thymoma can be performed with an acceptable degree of surgical risk. Such a strategy should be proactively considered, as it can lead to favourable long-term results.
Collapse
Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Hiroshi Kida
- Respiratory Center, Osaka University Hospital, Osaka, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Ogawa
- Respiratory Center, Osaka University Hospital, Osaka, Japan.,Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Kumanogoh
- Respiratory Center, Osaka University Hospital, Osaka, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| |
Collapse
|
5
|
Chiappetta M, Petracca Ciavarella L, Margaritora S. Can Pemetrexed Also Have a Potential Role Preoperatively in the Management of Advanced Thymic Epithelial Tumors? J Thorac Oncol 2019; 14:e89. [DOI: 10.1016/j.jtho.2018.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 11/16/2022]
|