The Impact of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma

Matthew W. Jackson, David A. Palma, D. Ross Camidge, Bernard L. Jones, Tyler P. Robin, David J. Sher, Matthew Koshy, Brian D. Kavanagh, Laurie E. Gaspar, Chad G. Rusthoven

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Introduction The optimal role for postoperative radiotherapy (PORT) for thymoma and thymic carcinoma remains controversial. We used the National Cancer Data Base to investigate the impact of PORT on overall survival (OS). Methods Patients who underwent an operation for thymoma or thymic carcinoma were categorized into Masaoka-Koga stage groups I to IIA, IIB, III, and IV. Patients who did not undergo an operation or those who received preoperative radiation were excluded. Kaplan-Meier estimates of OS and univariate and multivariate Cox proportional hazards regression analyses were performed. Propensity score–matched analyses were performed to further control for baseline confounders. Results From 2004 to 2012, 4056 patients were eligible for inclusion, 2001 of whom (49%) received PORT. On multivariate analysis of OS in the thymoma cohort adjusted for age, WHO histologic subtype, Masaoka-Koga stage group, surgical margins, and chemotherapy administration, PORT was associated with superior OS (hazard ratio [HR] = 0.72, p = 0.001). Propensity score–matched analyses confirmed the survival advantage associated with PORT. Subset analysis indicated longer OS in association with PORT for patients with stage IIB thymoma (HR = 0.61, p = 0.035), stage III (HR = 0.69, p = 0.020), and positive margins (HR = 0.53, p < 0.001). The impact of PORT for stage I to IIA disease did not reach significance (HR = 0.76, p = 0.156). Conclusions In this large database analysis of PORT for thymic tumors, PORT was associated with longer OS, with the greatest relative benefits observed for stage IIB to III disease and positive margins. In the absence of randomized studies assessing the value of PORT, these data may inform clinical practice.

Original languageEnglish (US)
Pages (from-to)734-744
Number of pages11
JournalJournal of Thoracic Oncology
Volume12
Issue number4
DOIs
StatePublished - Apr 1 2017

Fingerprint

Thymoma
Radiotherapy
Survival
Databases
Thymus Neoplasms
Kaplan-Meier Estimate
Survival Analysis
Multivariate Analysis
Regression Analysis
Radiation
Drug Therapy

Keywords

  • Adjuvant radiation
  • National Cancer Data Base
  • Postoperative radiotherapy
  • Thymic carcinoma
  • Thymoma

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Jackson, M. W., Palma, D. A., Camidge, D. R., Jones, B. L., Robin, T. P., Sher, D. J., ... Rusthoven, C. G. (2017). The Impact of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma. Journal of Thoracic Oncology, 12(4), 734-744. https://doi.org/10.1016/j.jtho.2017.01.002

The Impact of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma. / Jackson, Matthew W.; Palma, David A.; Camidge, D. Ross; Jones, Bernard L.; Robin, Tyler P.; Sher, David J.; Koshy, Matthew; Kavanagh, Brian D.; Gaspar, Laurie E.; Rusthoven, Chad G.

In: Journal of Thoracic Oncology, Vol. 12, No. 4, 01.04.2017, p. 734-744.

Research output: Contribution to journalArticle

Jackson, MW, Palma, DA, Camidge, DR, Jones, BL, Robin, TP, Sher, DJ, Koshy, M, Kavanagh, BD, Gaspar, LE & Rusthoven, CG 2017, 'The Impact of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma', Journal of Thoracic Oncology, vol. 12, no. 4, pp. 734-744. https://doi.org/10.1016/j.jtho.2017.01.002
Jackson, Matthew W. ; Palma, David A. ; Camidge, D. Ross ; Jones, Bernard L. ; Robin, Tyler P. ; Sher, David J. ; Koshy, Matthew ; Kavanagh, Brian D. ; Gaspar, Laurie E. ; Rusthoven, Chad G. / The Impact of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma. In: Journal of Thoracic Oncology. 2017 ; Vol. 12, No. 4. pp. 734-744.
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abstract = "Introduction The optimal role for postoperative radiotherapy (PORT) for thymoma and thymic carcinoma remains controversial. We used the National Cancer Data Base to investigate the impact of PORT on overall survival (OS). Methods Patients who underwent an operation for thymoma or thymic carcinoma were categorized into Masaoka-Koga stage groups I to IIA, IIB, III, and IV. Patients who did not undergo an operation or those who received preoperative radiation were excluded. Kaplan-Meier estimates of OS and univariate and multivariate Cox proportional hazards regression analyses were performed. Propensity score–matched analyses were performed to further control for baseline confounders. Results From 2004 to 2012, 4056 patients were eligible for inclusion, 2001 of whom (49{\%}) received PORT. On multivariate analysis of OS in the thymoma cohort adjusted for age, WHO histologic subtype, Masaoka-Koga stage group, surgical margins, and chemotherapy administration, PORT was associated with superior OS (hazard ratio [HR] = 0.72, p = 0.001). Propensity score–matched analyses confirmed the survival advantage associated with PORT. Subset analysis indicated longer OS in association with PORT for patients with stage IIB thymoma (HR = 0.61, p = 0.035), stage III (HR = 0.69, p = 0.020), and positive margins (HR = 0.53, p < 0.001). The impact of PORT for stage I to IIA disease did not reach significance (HR = 0.76, p = 0.156). Conclusions In this large database analysis of PORT for thymic tumors, PORT was associated with longer OS, with the greatest relative benefits observed for stage IIB to III disease and positive margins. In the absence of randomized studies assessing the value of PORT, these data may inform clinical practice.",
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AU - Camidge, D. Ross

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AU - Robin, Tyler P.

AU - Sher, David J.

AU - Koshy, Matthew

AU - Kavanagh, Brian D.

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N2 - Introduction The optimal role for postoperative radiotherapy (PORT) for thymoma and thymic carcinoma remains controversial. We used the National Cancer Data Base to investigate the impact of PORT on overall survival (OS). Methods Patients who underwent an operation for thymoma or thymic carcinoma were categorized into Masaoka-Koga stage groups I to IIA, IIB, III, and IV. Patients who did not undergo an operation or those who received preoperative radiation were excluded. Kaplan-Meier estimates of OS and univariate and multivariate Cox proportional hazards regression analyses were performed. Propensity score–matched analyses were performed to further control for baseline confounders. Results From 2004 to 2012, 4056 patients were eligible for inclusion, 2001 of whom (49%) received PORT. On multivariate analysis of OS in the thymoma cohort adjusted for age, WHO histologic subtype, Masaoka-Koga stage group, surgical margins, and chemotherapy administration, PORT was associated with superior OS (hazard ratio [HR] = 0.72, p = 0.001). Propensity score–matched analyses confirmed the survival advantage associated with PORT. Subset analysis indicated longer OS in association with PORT for patients with stage IIB thymoma (HR = 0.61, p = 0.035), stage III (HR = 0.69, p = 0.020), and positive margins (HR = 0.53, p < 0.001). The impact of PORT for stage I to IIA disease did not reach significance (HR = 0.76, p = 0.156). Conclusions In this large database analysis of PORT for thymic tumors, PORT was associated with longer OS, with the greatest relative benefits observed for stage IIB to III disease and positive margins. In the absence of randomized studies assessing the value of PORT, these data may inform clinical practice.

AB - Introduction The optimal role for postoperative radiotherapy (PORT) for thymoma and thymic carcinoma remains controversial. We used the National Cancer Data Base to investigate the impact of PORT on overall survival (OS). Methods Patients who underwent an operation for thymoma or thymic carcinoma were categorized into Masaoka-Koga stage groups I to IIA, IIB, III, and IV. Patients who did not undergo an operation or those who received preoperative radiation were excluded. Kaplan-Meier estimates of OS and univariate and multivariate Cox proportional hazards regression analyses were performed. Propensity score–matched analyses were performed to further control for baseline confounders. Results From 2004 to 2012, 4056 patients were eligible for inclusion, 2001 of whom (49%) received PORT. On multivariate analysis of OS in the thymoma cohort adjusted for age, WHO histologic subtype, Masaoka-Koga stage group, surgical margins, and chemotherapy administration, PORT was associated with superior OS (hazard ratio [HR] = 0.72, p = 0.001). Propensity score–matched analyses confirmed the survival advantage associated with PORT. Subset analysis indicated longer OS in association with PORT for patients with stage IIB thymoma (HR = 0.61, p = 0.035), stage III (HR = 0.69, p = 0.020), and positive margins (HR = 0.53, p < 0.001). The impact of PORT for stage I to IIA disease did not reach significance (HR = 0.76, p = 0.156). Conclusions In this large database analysis of PORT for thymic tumors, PORT was associated with longer OS, with the greatest relative benefits observed for stage IIB to III disease and positive margins. In the absence of randomized studies assessing the value of PORT, these data may inform clinical practice.

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