Effectiveness of Adjuvant Chemo- and Radiotherapy in Thymic Carcinoma Stage II: A Systematic Review and Meta-Analysis

Overview

Journal Cancer Control

Date 2025 Jan 27

PMID 39865594

Authors

Ahmad Nazzal

Josef Yayan

Christian Biancosino

Seyed Vahid Tabatabaei

Khosro Hekmat

Affiliations

Soon will be listed here.

Abstract

Background: Thymic carcinoma is a rare tumor arising from the epithelial thymic tissue, yet among mediastinal tumors, it is the most common malignant entity. Thymic carcinoma often causes no symptoms and is incidentally discovered. Adjuvant radiotherapy is recommended, particularly in cases of incomplete resection and for stages III and IV, based on current guidelines and existing literature. In stage II (Masaoka-Koga system), the role of chemotherapy remains controversial, particularly in cases of incomplete resection. Therefore, this study aims to assess the effectiveness of adjuvant chemotherapy compared to adjuvant radiotherapy in the treatment of stage II (Masaoka-Koga system) thymic carcinoma after surgery.

Methods: A comprehensive literature search was conducted in the Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE/PubMed databases for relevant studies published through April 30, 2023.

Results: The review identified a total of 101 studies in the Embase, Cochrane Library, and MEDLINE/PubMed databases. Of these, only eight retrospective studies met the inclusion criteria and were included in the meta-analysis. These eight studies encompassed a total of 323 patients with stage II (Masaoka-Koga system) thymic carcinoma, with an average patient age of 53.8 ± 5.0 years. There was no significant difference in the number of R0 resections between patients receiving adjuvant chemotherapy and those receiving adjuvant radiotherapy ( = 0.82). Patients who received adjuvant radiotherapy had a higher rate of recurrence, but this difference was not statistically significant ( = 0.93). The meta-analysis synthesized five-year overall survival data, with a combined hazard ratio (HR) of 0.881 (95% CI: 0.463 to 1.299), indicating no statistically significant difference between the treatment groups.

Conclusions: Although the results were not statistically significant, the findings suggest that adjuvant chemotherapy might be associated with a more favorable outcome for patients with stage II (Masaoka-Koga system) thymic carcinoma compared to adjuvant radiotherapy.

References

Luo T, Zhao H, Zhou X . The clinical features, diagnosis and management of recurrent thymoma. J Cardiothorac Surg. 2016; 11(1):140. PMC: 5007840. DOI: 10.1186/s13019-016-0533-9. View

LOGAN D, Lochrin C, Darling G, Eady A, Newman T, Evans W . Adjuvant radiotherapy and chemotherapy for stage II or IIIA non-small-cell lung cancer after complete resection. Provincial Lung Cancer Disease Site Group. Cancer Prev Control. 1998; 1(5):366-78. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Ruffini E, Venuta F . Management of thymic tumors: a European perspective. J Thorac Dis. 2014; 6 Suppl 2:S228-37. PMC: 4032964. DOI: 10.3978/j.issn.2072-1439.2014.04.19. View

Pettit L, El-Modir A . The role of somatostatin analogues in the treatment of advanced malignant thymomas: case report and review of the literature. Br J Radiol. 2010; 84(997):e7-e10. PMC: 3473811. DOI: 10.1259/bjr/16436465. View

Sioletic S, Lauriola L, Gallo E, Martucci R, Evoli A, Palmieri G . Diagnostic features and subtyping of thymoma lymph node metastases. Biomed Res Int. 2014; 2014:546149. PMC: 4109419. DOI: 10.1155/2014/546149. View

Tayabali K, Pothiwalla H, Thole J, Nguyen B . Rarity among the rare-large and invasive thymoma, a case report and review. J Community Hosp Intern Med Perspect. 2020; 10(3):233-237. PMC: 7426983. DOI: 10.1080/20009666.2020.1766819. View

McErlean A, Huang J, Zabor E, Moskowitz C, Ginsberg M . Distinguishing benign thymic lesions from early-stage thymic malignancies on computed tomography. J Thorac Oncol. 2013; 8(7):967-73. PMC: 3978781. DOI: 10.1097/JTO.0b013e3182904bc2. View

Peliukhovskii S, Mamchich V . [Combined treatment of thymoma: surgery and chemotherapy]. Klin Khir. 2002; (4):40-2. View

10.

Markowiak T, Hofmann H, Ried M . Classification and staging of thymoma. J Thorac Dis. 2021; 12(12):7607-7612. PMC: 7797834. DOI: 10.21037/jtd-2019-thym-01. View

11.

Funaki S, Shintani Y, Fukui E, Kanzaki R, Kanou T, Ose N . Surgical treatment strategies for invasive thymoma. J Thorac Dis. 2021; 12(12):7619-7625. PMC: 7797825. DOI: 10.21037/jtd-19-3045. View

12.

Gao L, Wang C, Liu M, Fang W, Lv C, Fu X . Adjuvant chemotherapy improves survival outcomes after complete resection of thymic squamous cell carcinoma: a retrospective study of 116 patients. Interact Cardiovasc Thorac Surg. 2021; 33(4):550-556. PMC: 8691688. DOI: 10.1093/icvts/ivab146. View

13.

Ruffini E, Detterbeck F, Van Raemdonck D, Rocco G, Thomas P, Weder W . Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg. 2014; 46(3):361-8. PMC: 4155438. DOI: 10.1093/ejcts/ezt649. View

14.

Yan J, Liu Q, Moseley J, Baik C, Chow L, Goulart B . Adjuvant Radiotherapy for Stages II and III Resected Thymoma: A Single-institutional Experience. Am J Clin Oncol. 2014; 39(3):223-7. PMC: 5199721. DOI: 10.1097/COC.0000000000000044. View

15.

Fuller C, Housman D, Thomas C . Radiotherapy for thymoma and thymic carcinoma. Hematol Oncol Clin North Am. 2008; 22(3):489-507. DOI: 10.1016/j.hoc.2008.03.012. View

16.

Shen S, Ai X, Lu S . Long-term survival in thymic epithelial tumors: a single-center experience from China. J Surg Oncol. 2012; 107(2):167-72. DOI: 10.1002/jso.23256. View

17.

Kelly R, Petrini I, Rajan A, Wang Y, Giaccone G . Thymic malignancies: from clinical management to targeted therapies. J Clin Oncol. 2011; 29(36):4820-7. PMC: 3675690. DOI: 10.1200/JCO.2011.36.0487. View

18.

Zhang Y, Li Z, Chen Y, Tan L, Zeng Z, Ding J . Induction Strategy for Locally Advanced Thymoma. Front Oncol. 2021; 11:704220. PMC: 8339962. DOI: 10.3389/fonc.2021.704220. View

19.

Ahmad U, Yao X, Detterbeck F, Huang J, Antonicelli A, Filosso P . Thymic carcinoma outcomes and prognosis: results of an international analysis. J Thorac Cardiovasc Surg. 2014; 149(1):95-100, 101.e1-2. DOI: 10.1016/j.jtcvs.2014.09.124. View

20.

Song Z, Zhang Y . Outcomes after surgical resection of thymic carcinoma: A study from a single tertiary referral centre. Eur J Surg Oncol. 2014; 40(11):1523-7. DOI: 10.1016/j.ejso.2014.05.011. View