title: Adjuvant treatment in patients at high risk of recurrence of thymoma: efficacy and safety of a three-dimensional conformal radiation therapy regimen.
abstract: BACKGROUND
  The clinical benefits of postoperative radiation therapy (PORT) for patients with thymoma are still controversial. In the absence of defined guidelines, prognostic factors such as stage, status of surgical margins, and histology are often considered to guide the choice of adjuvant treatment (radiotherapy and/or chemotherapy). In this study, we describe our single-institution experience of three-dimensional conformal PORT administered as adjuvant treatment to patients with thymoma.
  
  
  METHODS
  Twenty-two consecutive thymoma patients (eleven male and eleven female) with a median age of 52 years and treated at our institution by PORT were analyzed. The patients were considered at high risk of recurrence, having at least one of the following features: stage IIB or III, involved resection margins, or thymic carcinoma histology. Three-dimensional conformal PORT with a median total dose on clinical target volume of 50 (range 44-60) Gy was delivered to the tumor bed by 6-20 MV X-ray of the linear accelerator. Follow-up after radiotherapy was done by computed tomography scan every 6 months for 2 years and yearly thereafter.
  
  
  RESULTS
  Two of the 22 patients developed local recurrence and four developed distant metastases. Median overall survival was 100 months, and the 3-year and 5-year survival rates were 83% and 74%, respectively. Median disease-free survival was 90 months, and the 5-year recurrence rate was 32%. On univariate analysis, pathologic stage III and presence of positive surgical margins had a significant impact on patient prognosis. Radiation toxicity was mild in most patients and no severe toxicity was registered.
  
  
  CONCLUSIONS
  Adjuvant radiotherapy achieved good local control and showed an acceptable toxicity profile in patients with high-risk thymoma.
authors.affiliation: Medical Oncology Unit, POC S Annunziata, Taranto, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perri
authors.affiliation: Medical Oncology Unit, POC S Annunziata, Taranto, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pisconti
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Conson
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pacelli
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Della Vittoria Scarpati
authors.affiliation: Medical Oncology Unit, POC S Annunziata, Taranto, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gnoni
authors.affiliation: Medical Oncology Unit, POC S Annunziata, Taranto, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: D'Aniello
authors.affiliation: Medical Oncology Unit, POC S Annunziata, Taranto, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Cavaliere
authors.affiliation: Medical Oncology Unit, POC S Annunziata, Taranto, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Licchetta
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cella
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy ; Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Giuliano
authors.affiliation: Department of Radiotherapy, Istituto Nazionale per la Cura dei Tumori-Fondazione G. Pascale. IRCCS di Napoli, Naples, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Schiavone
authors.affiliation: Department of Radiotherapy, Istituto Nazionale per la Cura dei Tumori-Fondazione G. Pascale. IRCCS di Napoli, Naples, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Falivene
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
authors.affiliation: Division of Oncology, Centro di riferimento Oncologico di Basilicata, IRCCS Rionero in Vulture, Potenza, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Buonerba
authors.affiliation: Department of Radiotherapy, Istituto Nazionale per la Cura dei Tumori-Fondazione G. Pascale. IRCCS di Napoli, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ravo
authors.affiliation: Department of Radiotherapy, Istituto Nazionale per la Cura dei Tumori-Fondazione G. Pascale. IRCCS di Napoli, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Muto
keywords: adjuvant treatment; local control; three-dimensional conformal radiotherapy; thymoma; toxicity