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Master Thesis

Radiothérapie post-opératoire pour les tumeurs épithéliales thymiques : données RYTHMIC

Abstract : Thymic Epithelial Tumors (TETs) are rare intrathoracic malignancies for which surgery represents the mainstay of the treatment strategy. Postoperative radiotherapy (PORT) to the anterior mediastinal postoperative bed has been historically a standard of care. Through the prospective RYTHMIC cohort of patients, we previously assessed whether PORT decisions were in accordance with ESMO/RYTHMIC guidelines, and ultimately implemented in a cohort of 274 patients; we also verified how ITMIG definitions and recommendations for dose-volume constraints were actually followed in a real practice setting. METHODS Through a more prolonged follow-up, we further analysed the outcomes of those patients. RESULTS From a total of 274 patients enrolled in the cohort analysed for PORT decision-making, 187 were analysed with available data (84 lost of follow-up, 3 wit exclusion criteria). After a median follow-up of 5.1 years, 39 (21%) patients had presented TET recurrence: 27 (32%) in the PORT group, and 12 (12%) in the no-PORT group (p=0.001). Median recurrence-free survival (RFS) was 41.1 (95% CI: 29.2-53.0) months. The most frequent site of relapses among the PORT group was pleura (44%), versus the mediastinum in the no-PORT group (67%). RFS and OS were significantly superior in case of complete resection (p=0.04, and p=0,002). Only 12 patients had died. CONCLUSIONS Our data highlight the low - 21% - risk of TET recurrence after a follow-up of 5 years, and the excellent outcome of patients in terms of OS. A longer follow-up is needed in order to highlight differences in OS between groups. Our data show the limited value of stage and histology to predict recurrences, while completion of surgical resection remains the most significant prognostic and predictive factor for recurrences. Ultimately, we did not identify PORT as being significantly associated with RFS and OS. However, the lack of difference in RFS and OS between groups can be explain by a reduced risk of relapse in the PORT group. Further studies are needed to help identify subgroups of population who can beneficiate from PORT. The higher rate of extra-mediastinal relapses in the no-PORT group encourage us to implement a more frequent control of the disease after surgery.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02735324
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Clémence Basse. Radiothérapie post-opératoire pour les tumeurs épithéliales thymiques : données RYTHMIC. Médecine humaine et pathologie. 2019. ⟨dumas-02735324⟩

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