Survival impact of adjuvant radiotherapy in Masaoka stage II-IV thymomas – A systematic review and meta-analysis

Publication date: Available online 14 January 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Yu Jin Lim, Eunji Kim, Hak Jae Kim, Hong-Gyun Wu, Jinchun Yan, Qin Liu, Shilpen Patel
PurposeDue to the lack of randomized evidence, no conclusion has been made concerning the role of postoperative radiotherapy (PORT) in thymomas. This systematic review and meta-analysis evaluated the survival impact of PORT in stage II-IV thymomas.Methods and MaterialsA 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.ResultsSeven retrospective series with a total of 1,724 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-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-IV (HR 0.63, 95% CI 0.40‒0.99). Significant heterogeneity and publication bias were not found in the analyses.ConclusionsFrom the present meta-analysis of the 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.

Teaser

This study showed survival impact of postoperative radiotherapy (PORT) in thymomas based on the pooled analyses of time-to-event overall survival data of existing observational studies. Although there was no significant difference with and without PORT in Masaoka stage II, improved survival was observed in stage III-IV thymomas. We could suggest clinical benefit of PORT in the locally advanced tumors. Further large-scale analyses are needed to verify the present results.


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