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Abstract

PURPOSE:

To evaluate the survival impact of postoperative radiation therapy (PORT) in stage II to IV thymomas, using systematic review and meta-analysis.

METHODS AND MATERIALS:

A database search was conducted with EMBASE, PubMed, Web of Science, Cochrane Library, and Ovid from inception to August 2015. Thymic carcinomas were excluded, and studies comparing overall survival (OS) with and without PORT in thymomas were included. The hazard ratios (HRs) of OS were extracted, and a random-effects model was used in the pooled analysis.

RESULTS:

Seven retrospective series with a total of 1724 patients were included and analyzed. Almost all of the patients underwent macroscopically complete resection, and thymoma histology was confirmed by the World Health Organization criteria. In the overall analysis of stage II to IV thymomas, OS was not altered with the receipt of PORT (HR 0.79, 95% confidence interval [CI] 0.58-1.08). Although PORT was not associated with survival difference in Masaoka stage II disease (HR 1.45, 95% CI 0.83-2.55), improved OS was observed with the addition of PORT in the discrete pooled analysis of stage III to IV (HR 0.63, 95% CI 0.40-0.99). Significant heterogeneity and publication bias were not found in the analyses.

CONCLUSIONS:

From the present meta-analysis of sole primary thymomas, we suggest the potential OS benefit of PORT in locally advanced tumors with macroscopically complete resection, but not in stage II disease. Further investigations with sufficient survival data are needed to establish detailed treatment indications. 

Author information

Lim YJ1, Kim E1, Kim HJ2, Wu HG3, Yan J4, Liu Q5, Patel S6.​

1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.

2Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: khjae@snu.ac.kr.

3Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.

4Department of Radiation Oncology, Dalian Medical University, Liaoning, China; Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai, China.

5The Wistar Institute, Philadelphia, Pennsylvania.

6Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington.