Aggressive treatment of intrathoracic recurrences of thymoma.
Between 1974 and 1988, 21 patients with intrathoracic recurrences of thymoma received radiotherapy with radical intent; surgery was always attempted when considered feasible: 11 patients were partially (6 cases) or totally (5 cases) resected before irradiation, while in the other 10 radiotherapy was the only treatment. In 7 cases the recurrence was confined to the anterior mediastinum, 9 had pleural nodules without mediastinal lesions and 5 had both mediastinal and pleural lesions. Mediastinal recurrences were treated by opposed parallel mediastinal fields with 2/3 of the dose delivered through the anterior port: doses ranged between 38 and 44 Gy; a boost of 10-16 Gy was given in patients not radically resected. Pleural nodules were treated with a variety of techniques according to the extent of the lesions. The 7-year survival of the whole group was 70%; 5 patients died: 4 with intrathoracic progression and one with distant metastases. The survival was 74% in the 11 patients having received surgery, either radical or subtotal, and 65% in the 10 patients treated with radiotherapy alone: the difference is not significant. Patients with Karnofsky index greater than 70 had a significantly better survival (100%, versus 28%, p = 0.0015). This is a selected series of patients presenting recurrences still amenable to a radical treatment either by surgery and radiotherapy or by radiotherapy alone: the results confirm that an aggressive approach is warranted in patients in good general conditions with recurrences confined to the mediastinum and/or 1 hemithorax.
Urgesi
A
A
Department of Radiation Therapy, University of Torino, Italy.
Monetti
U
U
Rossi
G
G
Ricardi
U
U
Maggi
G
G
Sannazzari
G L
GL
D000328:Adult; D000368:Aged; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery*; D010997:Pleural Neoplasms / Q000532:radiotherapy / Q000601:surgery; D011882:Radiotherapy, High-Energy; D015996:Survival Rate; D013945:Thymoma / Q000532:radiotherapy* / Q000601:surgery*; D013953:Thymus Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome
D003037:Cobalt Radioisotopes