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MINI 25 - Trials, Radiation and Other (ID 142)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
MINI25.06 - Appropriate Time of Adjuvantr Adiotherapy for Thymoma with MG After Thymectomy (ID 358)
16:45 - 18:15 | Author(s): S. Ma
Controversy over adjuvant radiation of thymoma has raged on among experts for decades. 20-30% thymoma patients present with myasthenia gravis (MG). The co-existence of MG and thymoma makes the surgical treatment and adjuvant radiation more complicated. The aim of this article is to investigate whether patients with MG and thymoma should receive mediastinal radiation therapy and when after extended thymectomy.
Between 2002 and 2012, 159 patients with MG and thymoma underwent extended thymectomy. These patients were subdivided into 3 groups: Group 1 (n=89), patients having mediastinal radiotherapy within one month after surgery; Group 2, having mediastinal radiotherapy over three month after surgery (n = 49); and Group 3, without adjuvant radiation (n = 21).
152 patients underwent extended thymectomy by VATS, and 7 undergoing the trans-sternal approach due to thymoma invading great vessels. The resection was extended to the pericardium in 23 patients, the lung in 17 patients, and the innominate vein in 11 patients. There were no inoperable cases. The proportions of type A, AB, B1, B2, B3, and thymic carcinoma in this data were 0.6%, 19.5%, 25.8%, 32.7%,21.4%, and 0%, respectively. 146 patients were followed for 15 months to 12 years: 82 in Group 1, 45 in Group 2, and 19 in Group 3. Postoperative myasthenic crisis occurred in 38 cases: 16 cases in Group 1, 14 in Group 2, and 8 in Group 3. There was a significant difference in occurrence of postoperative myasthenic crisis between Group 1 and Group 3 (P=0.045). The rates of reaching CSR were 31.7% in Group 1, 22.2% in Group 2, and 21.1% in Group 3, respectively. The overall survival of Group 1, Group 2, and Group 3 were 90.2%, 86.7%, and 78.9%, respectively. 6 patients in Group 1 recurred, while 4 patients in Group 2 and 4 in Group 3 recurred. There was no lymph node metastasis detected. Kaplan-Meier survival curves demonstrate that there is no significant difference in overall survival among 3 groups. However, Cox regression analysis made by entering some factors including sex, age, and adjuvant radiation, revealed that adjuvant radiation might have significant influence in prognosis in thymoma patients ( P = 0.047). Figure 1
Adjuvant radiation within one month after extended thymectomy may help decrease possibility of postoperative myasthenic crisis, raise the cumulative probabilities of reaching CSR, and might have significant influence in prognosis in thymoma patients with MG. In recurrence cases, no lymph node metastasis was detected
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