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V. Ulrych
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P3.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 226)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.08-034 - Chemotherapy and Radiotherapy in the Treatment of Malignant Thymomas after Subtotal Resection - Escalation of Toxicity (ID 601)
09:30 - 09:30 | Author(s): V. Ulrych
- Abstract
Background:
Malignant thymomas are rare tumours. The optimal therapy after subtotal resection is still controversial. Patients with locally advanced stages and postoperative residual tumours have a high risk of tumor recurrence. Adjuvant therapy using chemotherapy and/or radiotherapy brings contradictory results and this treatment can be limited by escalation of toxicity.
Methods:
Between 1994 and 2012 we assessed and retrospectively analysed a total of 36 patients. All patients underwent subtotal resection to various extent. Sixteen patients (44%) were treated with the standard adjuvant radiotherapy (RT) only (group A). In group B, twenty patients (56%) were treated with the sequence of chemotherapy (CT) and conformal radiotherapy (3D-CRT). The CT regimens consisted of doxorubicin + cisplatin + cyclophosphamide ± vincristine). The planned doses of 3D-CRT ranged from 50 to 60 Gy. Both of them, acute toxicities (acute eosophagitis-AE, radiation pneumonitis-RP) and late toxicities (lung fibrosis-LF, heart failure-HF), were classified according to CTC v 3.0. The manifestations of RP were softened by oxygenotherapy, antibiotics, corticoids and pentoxifylline (PTX). Pentoxifylline (400 mg) was administered orally tid in patients with severe manifestation of RP grade 3/4.
Results:
The median age at the time of diagnosis was 56 (range, 38 – 75 years). By Masaoka staging system, 8 patients were stage II (24%) and 28 stage III (76%). The number of applied CT regimens ranged from 4 to 8 cycles. The median 3D-CRT dose was 55.8 Gy (range, 43.2 – 66.6 Gy). Thirty-eight percent of all patients (14/36) had myastenia gravis. AE of grade 1/2 was observed in 1 (6%) and 2 (10%) patients and grade 3/4 in 2 (13%) and 3 (15%) patients in groups A vs B. RP of grade 1/2 was observed in 5 (31%) and 10 (50%) patients in groups A and B, respectively. RP of grade 3/4 was observed in 2 (13%) and 9 (45%) patients in groups A vs B. Median time to recover RP grade 3/4 was 4.7 months in patients without PTX vs 2.6 months in patients using PTX. Radiographic changes of partial LF was observed in 3 (19%) and 8 (40%) patients in groups A and B, respectively. HF was diagnosed only in one of twenty patients (5%) in group B. In this patient degenerative and fibrosis changes of the heart were observed, which resulted in non-congenital aortic valvular stenosis 31 months after 3D-CRT and CT. The patient is still alive with OOS 77 months since the time of the diagnosis. A better local control of the disease was observed in group B where the median time to tumor progression was 49 months in comparison with 21 months in group A (p=0.0001). Five-year survival rates were 43.7% (7/16) and 85% (17/20) in group A vs group B, respectively (p=0.0001).
Conclusion:
Intensive postoperative treatment leads to an improvement of the local control of this disease. The escalated acute toxicity, especially radiation pneumonitis, was not too serious and could be reduced with the benefit by application of pentoxifylline. Manifestation of late toxicities, predominantly lung fibrosis and heart failure, was acceptable.
