An exploratory study of CT-guided percutaneous radiofrequency ablation for stage I thymoma

Postoperative radiotherapy after extirpative surgery may not improve survival in patients with Masaoka-Koga stage IIB thymoma: a propensity-matched study based on the SEER database

Background

The exact role of postoperative radiotherapy (PORT) in patients with Masaoka-Koga stage IIB thymoma following extirpative surgery (defined as radical surgery or total thymectomy) is still under debate. This study was designed to evaluate the effect of PORT on survival in patients with stage IIB thymoma following extirpative surgery in a population-based registry.

Methods

Patients with Masaoka-Koga stage IIB thymoma who underwent extirpative surgery between 2000 and 2019 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. One-to-one propensity score matching (PSM) with Kaplan-Meier and Cox regression analyses were used to assess overall survival (OS) and cancer-specific survival (CSS). To identify potential patients who may benefit from PORT, exploratory subgroup analyses on survival and further analyses stratified by Asian patients were performed.

Results

A total of 273 eligible patients were included, 164 (60.1%) in the PORT group and 109 (39.9%) in the non-PORT group. After 1:1 PSM, OS and CSS were not significantly different between the two groups. The 10-year OS and CSS rates were 83.5% in the PORT group vs. 80.1% in the non-PORT group (P=0.95) and 97.8% vs. 97.7% (P=0.31), respectively. The multivariate analyses further demonstrated no significant association between PORT and either OS [hazard ratio (HR) =1.219, P=0.53] or CSS (HR =2.304, P=0.32). Exploratory subgroup analyses revealed that PORT did not significantly improve survival in any subgroup of patients with stage IIB thymoma, and further analyses based on the Asian patients yielded the same negative results.

Conclusions

According to the SEER database, adding PORT to extirpative surgery may not improve survival in patients with Masaoka-Koga stage IIB thymomas.

Continuing challenges of primary neuroendocrine tumours of the thymus: A concisereview

Primary neuroendocrine tumours of the thymus (NETTs) are exceedingly rare tumours, usually presenting around mid-life, which have a propensity towards males and smokers. They are seen more often in those with MEN-1, but multiple different genetic mutations have been found to be involved in the tumorigenesis of NETTs. Histologically, NETTs are classified according to number of mitoses, the presence of necrosis, and the presence or absence of small cell features. NETTs display a wide spectrum of behavior, and they can be incidentally found on chest imaging, on screening in MEN-1, or present with symptoms of local compression. Advanced disease and paraneoplastic syndromes are common. CT-, PET/CT-, MRI-scans, and somatostatin receptor scintigraphy are the imaging modalities of choice both for the initial assessment as well as for monitoring after treatment. For patients with localized disease, complete surgical resection with lymphadenectomy provides the best chance of long-term, disease-free survival, and can be achieved through either an open or thoracoscopic approach. While chemotherapy-regimens based on platinum, taxane, and temozolomide are used most often, the optimum chemotherapy regimen in the adjuvant and palliative settings remains unclear, as does the role of radiotherapy. Ongoing research on the most effective use of somatostatin analogues, peptide receptor radionuclide therapy (PPRT), kinase inhibitors and immunotherapy in patients with other types of advanced neuroendocrine tumours may lead to further treatment options for NETTs in the future.

A Large Thymoma Resected via Left Antero-lateral Thoracotomy

Background/Aim

Thymomas are a rare type of mediastinal tumors with a slow growth rate. Because of this, they are well tolerated and patients usually present with large masses, which can extend in either of the thoracic cavities. The surgical approach for such tumors is dictated by the size and localization of the mass.

Case Report

We present the case of a patient with a large thymoma, resected through surgery performed by left antero-lateral thoracotomy. The patient presented in our clinic with a persistent cough, dyspnea, chest pain and tightness. Standard thoracic X-ray revealed a bilateral increase in size of the mediastinal shadow, mainly on the left side, with well-defined margins and subcostal intensity. A thoracic computed tomography (CT) scan discovered a tumoral mass within the antero-superior mediastinum, with compression of the mediastinal organs; presentation being suggestive for a thymoma. Surgery was performed, removing a 15/13/10 cm thymoma with a weight of 1126 g. Pathological examination as well as immunohistochemistry confirmed our diagnosis of type AB thymoma, stage I Masaoka-Koga.

Conclusion

In conclusion, surgical treatment remains the main therapeutic option in thymomas, but it is often difficult to perform due to tumor size and local invasion. However, even in large thymomas of stages I and II, surgery can be performed using an antero-lateral thoracotomy.

Predicting Masaoka-Koga Clinical Stage of Thymic Epithelial Tumors Using Preoperative Spectral Computed Tomography Imaging

Objectives

To investigate the utility of spectral computed tomography (CT) parameters for the prediction of the preoperative Masaoka-Koga stage of thymic epithelial tumors (TETs).

Materials and Methods

Fifty-four patients with TETs, aged from 37 to 73 years old, an average age of 55.56 ± 9.79 years, were included in the study.According to the Masaoka-Koga staging method, there were 19 cases of stage I, 15 cases of stage II, 8 cases of stage III, and 12 cases of stage IV disease. All patients underwent dual-phase enhanced energy spectral CT scans. Regions of interest (ROIs) were defined in sections of the lesion with homogeneous density, the thoracic aorta at the same level as the lesion, the outer fat layer of the lesion, and the anterior chest wall fat layer. The single-energy CT value at 40-140 keV, iodine concentration, and energy spectrum curve of all lesion and thoracic aorta were obtained. The energy spectrum CT parameters of the lesions, extracapsular fat of the lesions, and anterior chest wall fat in stage I and stage II were obtained. The energy spectrum CT parameters of the lesions, enlarged lymph nodes and intravascular emboli in the 3 groups were obtained. The slope of the energy spectrum curve and the normalized iodine concentration were calculated.

Results

In stage I lesions, there was a statistically significant difference between the slope of the energy spectrum curve for the lesion and those of the fat outside the lesion and the anterior chest wall in the arteriovenous phase (P<0.001, P<0.001). The energy spectrum curve of the tumor parenchyma was the opposite of that of the extracapsular fat. In stage II lesions, there was a statistically significant difference between the slope of the energy spectrum curve for the anterior chest wall and those of the lesion and the fat outside the lesion in the arteriovenous phase(P<0.001, P<0.001). The energy spectrum curve of the tumor parenchyma was consistent with that of the extracapsular fat. Distinction between stage I and II tumors be evaluated by comparing the energy spectrum curves of the mass and the extracapsular fat of the mass. The accuracy rate of is 79.4%. For stages III and IV, there was no significant difference in the slope of the energy spectrum curve of the tumor parenchyma, metastatic lymph node, and intravascular embolism (P>0.05). The energy spectrum curve of the tumor parenchyma was consistent with that of the enlarged lymph nodes and intravascular emboli. The two radiologists have strong consistency in evaluating TETs Masaoka-Koga staging, The Kappa coefficient is 0.873,(95%CI:0.768-0.978).

Conclusion

Spectral CT parameters, especially the energy spectrum curve and slope, are valuable for preoperative TET and can be used in preoperative staging prediction.