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Eur J Cardiothorac Surg 2007;31:109-113. doi:10.1016/j.ejcts.2006.10.022
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Does adjuvant radiation therapy improve disease-free survival in completely resected Masaoka stage II thymoma?

^a Thoracic Surgery Department, University of Eastern Piedmont ‘A. Avogadro’, Novara, Italy
^b Thoracic Surgery Department, University of Torino, Italy
^c Pathology Department, University of Torino, Italy

Received 24 August 2006; received in revised form 27 September 2006; accepted 3 October 2006.

^_* Corresponding author. Address: Thoracic Surgery Department, University of Eastern Piedmont, ‘Maggiore della Carità’ General Hospital, Novara, Via Frasconi 14, 28100 Novara, Italy. Tel.: +39 0321 3733076; fax: +39 0321 3733578. (Email: ottaviorena{at}libero.it).

Objective: To determine whether or not patients with completely resected Masaoka stage II thymoma benefit from postoperative radiotherapy (RT). Methods: We retrospectively review the case records and compared the long-term outcomes of patients affected by Masaoka stage II thymoma treated by resection alone with same stage thymoma patients submitted to resection and RT. Surgical specimens were reviewed to confirm pathological stage, negative resection margins and histological subtype. Results: Between 1988 and 2000, we performed 197 resections for thymoma; 58 patients resulted to be affected by completely resected tumours with microscopic transcapsular invasion (stage IIA, n = 25) or macroscopic invasion into the surrounding fatty tissue with or without adhesion to the mediastinal pleura (stage IIB, n = 33). Thirty-two patients underwent only complete surgical resection (14 stage IIA and 18 stage IIB); 26 patients underwent complete resection and subsequent mediastinal RT (11 stage IIA and 15 stage IIB). RT dosages were 45–54 grays (Gy), in 25–30 fractions. Histological subtypes were similarly represented in both groups. Median follow-up was 91 months (range 9–170). Five intrathoracic recurrences occurred: three radiated patients (2 stage IIB – 1 AB and 1 B2 thymoma; 1 stage IIA B1 thymoma) and two not-radiated patients (1 stage IIA AB thymoma and 1 stage IIB B1 thymoma). Disease-free survival rate at 5- and 10-year were 94% and 87%, respectively. Log-rank test showed no difference in Kaplan–Meier survival curves (p = 0.432) between radiated and not-radiated patients. Conclusions: These data support the concept that radical surgical resection alone should be considered a sufficient treatment for stage II thymoma.

Key Words: Thymoma • Surgery • Radiotherapy • Survival