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Zhao K, Liu L, Zhou X, Wang G, Zhang J, Gao X, Yang L, Rao K, Guo C, Zhang Y, Huang C, Liu H, Li S, Chen Y. Re-exploration of prognosis in type B thymomas: establishment of a predictive nomogram model. World J Surg Oncol 2024; 22:26. [PMID: 38263144 PMCID: PMC10804589 DOI: 10.1186/s12957-023-03293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To explore the risk factors for disease progression after initial treatment of type B thymomas using a predictive nomogram model. METHODS A single-center retrospective study of patients with type B thymoma was performed. The Cox proportional hazard model was used for univariate and multivariate analyses. Variables with statistical and clinical significance in the multivariate Cox regression were integrated into a nomogram to establish a predictive model for disease progression. RESULTS A total of 353 cases with type B thymoma were retrieved between January 2012 and December 2021. The median follow-up was 58 months (range: 1-128 months). The 10-year progression-free survival (PFS) was 91.8%. The final nomogram model included R0 resection status and Masaoka stage, with a concordance index of 0.880. Non-R0 resection and advanced Masaoka stage were negative prognostic factors for disease progression (p < 0.001). No benefits of postoperative radiotherapy (PORT) were observed in patients with advanced stage and non-R0 resection (p = 0.114 and 0.284, respectively). CONCLUSION The best treatment strategy for type B thymoma is the detection and achievement of R0 resection as early as possible. Long-term follow-up is necessary, especially for patients with advanced Masaoka stage and who have not achieved R0 resection. No prognostic benefits were observed for PORT.
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Affiliation(s)
- Ke Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xiaoyun Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xuehan Gao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Libing Yang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Ke Rao
- Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Ye Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Daniels P, Liou YL, Scarberry KB, Sharma TR, Korman NJ. Paraneoplastic pemphigus in a patient with a locally invasive, unresectable type B2 thymoma complicated by an intestinal perforation. JAAD Case Rep 2023; 35:103-107. [PMID: 37131866 PMCID: PMC10149147 DOI: 10.1016/j.jdcr.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Affiliation(s)
- Phuong Daniels
- Department of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
- Correspondence to: Phuong Daniels, DPT.
| | - Yujie Linda Liou
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Kelly B. Scarberry
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Timmie R. Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Neil J. Korman
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
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3
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Zhao K, Chen Y, Liu L, Wang G, Zhang J, Zhou M, Gao X, Rao K, Yang L, Guo C, Zhang Y, Huang C, Liu H, Li S. Real-world study of treatment and outcome of type B2 + B3 thymoma: The neglected part of thymoma. Thorac Cancer 2023; 14:1339-1347. [PMID: 37037477 DOI: 10.1111/1759-7714.14875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND This study aimed to examine the treatment and prognosis of patients with type B2 + B3 thymoma and compare it with those patients with type B2 and B3 thymoma. METHODS We conducted a retrospective analysis of the results of 39 patients with type B2 + B3 thymoma, 133 patients with type B2 thymoma, and 64 patients with type B3 thymoma. The Kaplan-Meier technique was used to generate survival curves. For multivariate analysis, the Cox proportional hazard model was applied. RESULTS With a median follow-up of 60 months (range: 1-128 months), the percentage of patients with tumor, node, metastasis (TNM) stage III and IV disease gradually increased from 19.5% to 25.6% to 35.9% among those with histological subtypes B2, B2 + B3, and B3, respectively, p = 0.045. Twenty-three patients experienced recurrence or metastasis. The total 10-year progression-free survival (PFS) rates were 86.0% overall (85.0% in type B2, 87.2% in type B2 + B3, and 87.5% in type B3). Age, R0 resection, and Masaoka-Koga stage were found to have a significant on PFS in all patients. There was no statistically significant difference in PFS between different histotypes of thymoma, p = 0.650. PFS was predicted by R0 resection in all histotypes and by the Masaoka-Koga stage in the type B2 subgroup. CONCLUSION Combining the two staging methods to guide the diagnosis and treatment of patients with B2 + B3 thymoma is recommended. R0 resection is recommended to reduce recurrence. Patients with B2 + B3 thymoma have a prognosis similar to those with a B2 thymoma or a B3 thymoma alone.
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Affiliation(s)
- Ke Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Mengxin Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xuehan Gao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Ke Rao
- Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Libing Yang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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4
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Yan M, Wu J, Xue M, Mo J, Zheng L, Zhang J, Gao Z, Bao Y. The Studies of Prognostic Factors and the Genetic Polymorphism of Methylenetetrahydrofolate Reductase C667T in Thymic Epithelial Tumors. Front Oncol 2022; 12:847957. [PMID: 35734597 PMCID: PMC9207241 DOI: 10.3389/fonc.2022.847957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To describe the clinical features of a cohort of patients with thymic epithelial tumors (TETs) and to analyze their prognostic factors. In particular, we investigated the correlation between the genetic polymorphism of methylenetetrahydrofolate reductase (MTHFR) C667T and the incidence of TETs. Methods Pathological records were reviewed from the database of the Second Affiliated Hospital of Jiaxing University, from January 2010 to December 2020, and 84 patients with TETs were recruited for this study. Univariate and multivariate analyses were performed to determine the prognostic factors. The genetic polymorphism of MTHFR C667T was examined in the patients with TETs and in a group of healthy individuals. The correlation between MTHFR transcriptional levels and methylation was analyzed using The Cancer Genome Atlas (TCGA) thymoma dataset from the cBioPortal platform. Results Kaplan–Meier univariate survival analysis showed that sex, age, the maximum tumor diameter, surgery, chemotherapy, radiotherapy, WHO histological classification, Masaoka–Koga stage, and 8th UICC/AJCC TNM staging, were statistically significantly correlated with the prognosis of patients with TETs. The Masaoka–Koga stage and 8th UICC/AJCC TNM staging were strongly correlated with each other in this study (r=0.925, P<0.001). Cox multivariate survival analysis showed that the maximum tumor diameter, Masaoka–Koga stage, and 8th UICC/AJCC TNM staging were independent prognostic factors affecting the overall survival (OS) of patients with TETs (P<0.05). The MTHFR C667T genotype (χ2 = 7.987, P=0.018) and allele distribution (χ2 = 5.750, P=0.016) were significantly different between the patients and healthy controls. CT heterozygous and TT homozygous genotypes at this MTHFR polymorphism significantly increased the risk of TETs (odds ratio [OR] =4.721, P=0.008). Kaplan–Meier univariate survival analysis showed that there was no correlation between different genotypes and the prognosis of TETs (CC versus CT + TT, χ2 =0.003, P=0.959). Finally, a negative correlation between the transcriptional and methylation levels of MTHFR was observed in the TCGA thymoma dataset (r=-0.24, P=0.010). Conclusions The Masaoka–Koga stage, 8th UICC/AJCC TNM staging, and maximum tumor diameter were independent prognostic factors for TETs. Reduced methylation levels of MTHFR and particular polymorphic variants may contribute to the susceptibility to developing TETs.
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Affiliation(s)
- Miaolong Yan
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.,The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jiayuan Wu
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Min Xue
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.,Graduate School, Bengbu Medical College, Bengbu, China
| | - Juanfen Mo
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Li Zheng
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jun Zhang
- The Department of Thoracic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhenzhen Gao
- The Department of Oncology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yi Bao
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.,The Department of Oncology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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5
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Georgiev A, Hilendarov A, Tsvetkova S, Vasilska A. Thymoma type B2 progression, due to fear of contamination, in association with hydrocephalus: A case report of avoidant behavior during COVID-19 pandemic. Radiol Case Rep 2022; 17:680-684. [PMID: 34976266 PMCID: PMC8712279 DOI: 10.1016/j.radcr.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/04/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022] Open
Abstract
The novel coronavirus pandemic outbreak caused extreme public fear, health concerns, and psychological distress, especially in oncology patients. The presented rare case is of a 40-year-old female with thymoma type B, with rapid progression, due to fear from the COVID-19 pandemic. Biopsy and histological verification of the tumor show a B-type thymoma with a high proliferative index. The fear of infection is causing avoidant behavior and leads to suboptimal therapy in some oncology patients that will have severe consequences. We can conclude that adequate, personalized, and most importantly, active psychological care is necessary and should be implemented for cancer patients. To be prepared for a future lockdown, it may be helpful to urge patients to seek alternative forms of social contact, such as online and mobile communications, to combat depression lockdown effects.
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6
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Muslim Z, Baig MZ, Weber JF, Detterbeck FC, Connery CP, Spera JA, Bhora FY. Invasive thymoma - Which patients benefit from post-operative radiotherapy? Asian Cardiovasc Thorac Ann 2021; 29:935-942. [PMID: 33975467 DOI: 10.1177/02184923211017094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study is to identify patients with thymoma who should receive post-operative radiotherapy. METHODS The Surveillance, Epidemiology, and End Results database was queried for stage IIB-IV thymoma patients diagnosed during 1988-2015. We analyzed the prognostic implications of various clinical-pathological factors by comparing the outcomes of those who received surgery with and without post-operative radiotherapy. RESULTS A total of 1120 patients were identified; 62% received post-operative radiotherapy and 38% underwent surgery alone. In a propensity-matched cohort of 812 patients, no survival difference was seen in World Health Organization A, AB, B1, B2, or B3 tumors with the addition of post-operative radiotherapy to surgery (p>0.05). Post-operative radiotherapy also did not improve survival over surgery alone for tumors ≥ or < less than the 4 cm, 7 cm, 10 cm, and 13 cm cutoffs, all p>0.05. Post-operative radiotherapy was an independent, positive prognostic indicator only in the subgroup with stage III disease and in those receiving chemotherapy in addition to post-operative radiotherapy, both p<0.05. CONCLUSIONS Patients with stage III thymoma are most likely to benefit from the addition of post-operative radiotherapy to surgical treatments. Tumor size or World Health Organization histology alone should not be criteria for determining the need for post-operative radiotherapy in locally advanced thymoma. Masaoka-Koga stage, which has traditionally been used to help make such decisions, appears to be the most reliable determinant of the use of post-operative radiotherapy.
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Affiliation(s)
- Zaid Muslim
- Department of Thoracic Surgery, Nuvance Health System, Connecticut & New York, USA.,Rudy L. Ruggles Biomedical Research Institute, Connecticut, USA
| | - Mirza Zain Baig
- Department of Thoracic Surgery, Nuvance Health System, Connecticut & New York, USA.,Rudy L. Ruggles Biomedical Research Institute, Connecticut, USA
| | - Joanna F Weber
- Department of Thoracic Surgery, Nuvance Health System, Connecticut & New York, USA.,Rudy L. Ruggles Biomedical Research Institute, Connecticut, USA
| | - Frank C Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, USA
| | - Cliff P Connery
- Department of Thoracic Surgery, Nuvance Health System, Connecticut & New York, USA
| | - John A Spera
- Division of Radiation Oncology, Danbury Hospital, Nuvance Health System, Connecticut, USA
| | - Faiz Y Bhora
- Department of Thoracic Surgery, Nuvance Health System, Connecticut & New York, USA.,Rudy L. Ruggles Biomedical Research Institute, Connecticut, USA
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7
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吴 旭, 李 想, 冯 长, 王 武. [Surgical treatment of giant thymoma in a patient with myasthenia gravis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1280-1282. [PMID: 28951377 PMCID: PMC6765495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Indexed: 07/30/2024]
Abstract
We report a case report of giant thymoma (17 cm×14 cm×4 cm) in a 32-year-old male patient with myasthenia gravis. Examinations revealed that the tumor invaded the mediastinum, blood vessels and pericardium, and was histologically classified as WHO type B1 and Masaoka stage III. The patient developed myasthenia gravis crisis after radical resection of the thymoma and appropriate treatments with tracheotomy were administered. The patient recovered and was discharged after a hospital stay for 252 days with a mechanical ventilation time of 102 days.
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Affiliation(s)
- 旭 吴
- 南南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
| | - 想 李
- 南方医科大学南方医院胸外科,广东 广州 510515Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 长江 冯
- 北京大学人民医院胸外科,北京 100044Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - 武军 王
- 南南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
- 南方医科大学南方医院胸外科,广东 广州 510515Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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8
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吴 旭, 李 想, 冯 长, 王 武. [Surgical treatment of giant thymoma in a patient with myasthenia gravis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1280-1282. [PMID: 28951377 PMCID: PMC6765495 DOI: 10.3969/j.issn.1673-4254.2017.09.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Indexed: 06/07/2023]
Abstract
We report a case report of giant thymoma (17 cm×14 cm×4 cm) in a 32-year-old male patient with myasthenia gravis. Examinations revealed that the tumor invaded the mediastinum, blood vessels and pericardium, and was histologically classified as WHO type B1 and Masaoka stage III. The patient developed myasthenia gravis crisis after radical resection of the thymoma and appropriate treatments with tracheotomy were administered. The patient recovered and was discharged after a hospital stay for 252 days with a mechanical ventilation time of 102 days.
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Affiliation(s)
- 旭 吴
- 南南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
| | - 想 李
- 南方医科大学南方医院胸外科,广东 广州 510515Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 长江 冯
- 北京大学人民医院胸外科,北京 100044Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - 武军 王
- 南南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
- 南方医科大学南方医院胸外科,广东 广州 510515Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Lombe DC, Jeremic B. A Review of the Place and Role of Radiotherapy in Thymoma. Clin Lung Cancer 2015; 16:406-12. [PMID: 26074303 DOI: 10.1016/j.cllc.2015.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 05/03/2015] [Accepted: 05/05/2015] [Indexed: 11/18/2022]
Abstract
Thymomas, tumors that arise from the epithelial cells of the thymus gland, are the most common tumors of the anterior mediastinum despite their overall rarity. They are not classified together with malignancies although it is recognized that they can be invasive and persistent even after attempted treatment. Because of their rarity, optimal treatment protocols remain a challenging topic. Although surgery is recognized as the cornerstone of management, the role and benefit of use of postoperative radiotherapy (PORT), remains questionable. Unequivocal evidence, although exclusively from retrospective studies, indicates that stage I thymoma is adequately treated with complete resection alone. As for stage II there is still a need to better determine the indications of PORT. For stage III and IV, existing data point to the fact that PORT plays a significant role in the management of thymoma. In patients for whom radiotherapy (RT) is indicated, 50 Gy appears to be adequate for microscopic disease and higher doses should be used for macroscopic tumor. With advances in RT delivery techniques, which allow for higher doses to be delivered to larger areas affected by tumor while sparing normal tissue, it is prudent to identify a place for this modality in the optimal management of thymoma patients.
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Affiliation(s)
- Dorothy C Lombe
- Division of Radiation Oncology, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Branislav Jeremic
- Institute of Lung Diseases, Sremska Kamenica, Serbia; BioIRC Center for Biomedical Engineering, Kragujevac, Serbia
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