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D. Dvorakova
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P1.17 - Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies (ID 703)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.17-019b - Acute and Late Toxicities in the Management of Malignant Thymomas After Subtotal Resection, Chemotherapy and Radiotherapy (ID 9496)
09:30 - 09:30 | Author(s): D. Dvorakova
- Abstract
Background:
Malignant thymomas are uncommon tumours. The optimal therapy after subtotal resection is controversial. Adjuvant therapy using chemotherapy and/or radiotherapy brings contradictory results and this treatment can be limited by escalation of acute and late toxicity.
Method:
Between 1994 and 2016 we assessed a total of 39 patients. All patients underwent subtotal resection. Sixteen patients (41%) were treated with the standard adjuvant radiotherapy (RT) only (group A). Twenty-three patients (59%) were treated with the sequence of chemotherapy (CT) and conformal radiotherapy (3D-CRT), (group B). The CT regimens consisted of doxorubicin + cisplatin + cyclophosphamide ± vincristine. The doses of 3D-CRT ranged 50 - 60 Gy. 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, corticosteroids and pentoxifylline (PTX). Pentoxifylline (400 mg) was administered orally tid in patients with severe manifestation of RP grade 3/4.
Result:
The median age at the time of diagnosis was 54 (38–75) years. By Masaoka staging system, 9 patients were stage II (23%) and 30 stage III (77%). The number of CT regimens ranged 4 - 8 cycles. The median 3D-CRT dose was 57.6 Gy (43.2–66.6 Gy). AE grade 1/2 was observed in 1 (6%) and 5 (21%) patients and grade 3/4 in 2 (13%) and 7 (30%) patients in groups A vs B. RP grade 1/2 was observed in 5 (31%) and 11 (48%) patients in groups A and B, respectively. RP of grade 3/4 was observed in 2 (13%) and 10 (43%) patients in groups A vs B. Median time to recover RP grade 3/4 was 4.9 months in patients without PTX vs 2.7 months in patients using PTX. Radiographic changes of partial LF were observed in 3 (19%) and 10 (43%) patients in groups A and B, respectively. HF was diagnosed only in one patient (4%) in group B. The median time to tumor progression was 51 months in group B vs 21 months in group A (p=0.0001). Five-year survival rates were 43.7% (7/16) and 78.2% (18/23) in group A vs group B, respectively (p=0.0001).
Conclusion:
Intensive adjuvant chemotherapy and radioterapy after subtotal resection leads to an improvement of the local control of this disease. Acute eosophagitis and radiation pneumonitis were not too serious. Radiation pneumonitis could be beneficially reduced by application of pentoxifylline. Manifestation of late toxicities, predominantly lung fibrosis and heart failure, was acceptable.
