Failure patterns relative to radiation treatment fields for stage II-IV thymoma Journal Article
| Authors: | Rimner, A.; Gomez, D. R.; Wu, A. J.; Shi, W.; Yorke, E. D.; Moreira, A. L.; Rice, D.; Komaki, R.; Rosenzweig, K. E.; Riely, G. J.; Huang, J. |
| Article Title: | Failure patterns relative to radiation treatment fields for stage II-IV thymoma |
| Abstract: | INTRODUCTION: The optimal radiation therapy (RT) field design for thymomas remains unclear. Here we report the failure patterns in stage II-IV thymoma after RT at two tertiary referral centers, classified according to the new International Thymic Malignancy Interest Group definitions. METHODS: We reviewed 156 stage II-IV patients with thymoma treated with definitive (n=24) or adjuvant (n=132) RT. All RT was delivered without elective nodal irradiation (median dose 5040 cGy). Intrathoracic failures were classified as (1) in-field failures (within 100% isodose line [IDL]), (2) marginal recurrences (<100% and ≥50% IDL), and (3) out-of-field failures (outside the 50% IDL). RESULTS: The median follow-up was 61 months. Surgical margins were positive in 39%. The median tumor size was 9 cm. The 5-year cumulative incidence of all intrathoracic failures was 24% (n=34). Failures occurred within the RT field (n=5), marginally (n=1), out-of-field (n=22), and synchronously in- and out-of-field (n=6). The 5-year cumulative incidence of in-field failures was 7%. These were associated with Masaoka stage and tumor size. Macroscopically positive margins were associated with more local failures. Intrathoracic failures occurred most commonly in the pleural space (n=29) and lymph nodes (n=9). Patients with more advanced stage, and those treated with intensity-modulated radiation therapy had more intrathoracic failures. RT dose and chemotherapy did not impact failure patterns. CONCLUSIONS: Although there were few in-field failures in patients who received RT for stage II-IV thymomas, a high rate of out-of-field intrathoracic failures still occurred. Further study is necessary to identify treatment approaches that prevent pleural recurrences. Copyright © 2014 by the International Association for the Study of Lung Cancer. |
| Keywords: | radiation therapy; thymoma; failure pattern |
| Journal Title: | Journal of Thoracic Oncology |
| Volume: | 9 |
| Issue: | 3 |
| ISSN: | 1556-0864 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2014-03-01 |
| Start Page: | 403 |
| End Page: | 409 |
| Language: | English |
| DOI: | 10.1097/jto.0000000000000099 |
| PROVIDER: | scopus |
| PUBMED: | 24518091 |
| DOI/URL: | |
| Notes: | Export Date: 2 April 2014 -- Source: Scopus |
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