Kundel Adjuvant RT Thymoma

Background

Retrospective single-institution series. N=47 (invasive thymoma 35, thymic carcinoma 6) treated with thoracotomy → adjuvant RT at Rabin Medical Center, Israel, 1984–2003. All received adjuvant RT (26–60 Gy); analyzed prognostic factors and RT dose impact.

Interventions and follow up

Treatment: Adjuvant radiotherapy (26–60 Gy) after complete or incomplete thymoma resection
Primary endpoint: Local recurrence and overall survival by Masaoka stage
mFollow up: Median 7 years

Results

5-yr OS (all): 73% (95% CI 60–88%); thymoma 77% vs thymic carcinoma 33%, P=.14
Better survival (univariate): Lower stage (II vs III/IVA, P=.01), resection (P=.0004), myasthenia gravis (P=.04), RT dose >45 Gy (P=.02)
Locoregional recurrence: 11/47 patients
Distant metastasis: 4/47 patients
5-yr DFS: 67%; median time to recurrence 8.3 years

Adverse events

Reporting: Not systematically reported in detail
Dose range: 26–60 Gy over 19 years; toxicity data limited by retrospective nature and variable techniques over time

Conclusions

Adjuvant RT after surgery for invasive thymoma is associated with long-term DFS and OS. Doses >45 Gy were associated with significantly better OS and DFS vs ≤45 Gy, particularly for stage II. Lower stage, complete resection, and myasthenia gravis were favorable prognostic factors.

Key Limitations

Small retrospective single-institution series over 19 years; heterogeneous dose/technique; no comparator without RT; dose-response confounded by selection.

Clinical Context

Supports adjuvant RT for invasive (stage II–III) thymoma after resection; consistent with later international data (ITMIG/Ahmad) favoring adjuvant RT in higher-risk disease.

References