Mediastinum (Hong Kong, China)最新文献

{"title":"Multimodality imaging of mediastinal masses and mimics.","authors":"John Matthew Archer,&nbsp;Jitesh Ahuja,&nbsp;Chad D Strange,&nbsp;Girish S Shroff,&nbsp;Gregory W Gladish,&nbsp;Bradley S Sabloff,&nbsp;Mylene T Truong","doi":"10.21037/med-22-53","DOIUrl":"https://doi.org/10.21037/med-22-53","url":null,"abstract":"<p><p>A wide variety of neoplastic and nonneoplastic conditions occur in the mediastinum. Imaging plays a central role in the evaluation of mediastinal pathologies and their mimics. Localization of a mediastinal lesion to a compartment and characterization of morphology, density/signal intensity, enhancement, and mass effect on neighboring structures can help narrow the differentials. The International Thymic Malignancy Interest Group (ITMIG) established a cross-sectional imaging-derived and anatomy-based classification system for mediastinal compartments, comprising the prevascular (anterior), visceral (middle), and paravertebral (posterior) compartments. Cross-sectional imaging is integral in the evaluation of mediastinal lesions. Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to characterize mediastinal lesions detected on radiography. Advantages of CT include its widespread availability, fast acquisition time, relatively low cost, and ability to detect calcium. Advantages of MRI include the lack of radiation exposure, superior soft tissue contrast resolution to detect invasion of the mass across tissue planes, including the chest wall and diaphragm, involvement of neurovascular structures, and the potential for dynamic sequences during free-breathing or cinematic cardiac gating to assess motion of the mass relative to adjacent structures. MRI is superior to CT in the differentiation of cystic from solid lesions and in the detection of fat to differentiate thymic hyperplasia from thymic malignancy.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"7 ","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/f0/med-07-27.PMC10493620.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The European Reference Network: the keystone for the management of rare thoracic cancers.","authors":"Rocco Morra,&nbsp;Antonio D'Ambrosio,&nbsp;Erica Pietroluongo,&nbsp;Pietro De Placido,&nbsp;Liliana Montella,&nbsp;Vitoantonio Del Deo,&nbsp;Marianna Tortora,&nbsp;Sabino De Placido,&nbsp;Giovannella Palmieri,&nbsp;Mario Giuliano","doi":"10.21037/med-22-10","DOIUrl":"https://doi.org/10.21037/med-22-10","url":null,"abstract":"© Mediastinum. All rights reserved. Mediastinum 2023;7:7 | https://dx.doi.org/10.21037/med-22-10 Rare tumors are a heterogeneous group of malignancies, which show an incidence rate of <6 per 100,000 people per year, according to the definition of Surveillance of Rare Cancers in Europe (RARECARE) (1). Overall, the estimated incidence of all rare tumors in Europe accounts for 24% of all cancers, with 5-year relative survival for all rare cancers of 48.5% (2). Indeed, rare thoracic tumors include many entities: epithelial tumors of the trachea, rare epithelial tumors of the lung, epithelial tumors of the thymus, malignant pleural and pericardial mesothelioma, mediastinal germ cell tumors and mesenchymal tumors (Table 1) (1,3-5). The incidence of these tumors in Europe is the highest in patients aged 65 years and older, with a crude rate of 1.4 per million per year for the epithelial tumor of the trachea, 1.7 per million per year for thymic epithelial tumors, among which malignant thymomas are the most common, and 16 per million per year for the malignant mesothelioma of pleura and pericardium. The 5-years relative survival rate is 14% for the epithelial tumors of the trachea, 65.6% for thymic epithelial tumors, and 5.4% for malignant mesothelioma (5). Detailed data on incidence, prevalence and survival of several types of rare thoracic tumors included in Table 1 were reported in a study of the RARECARE working group, using a large patient database (5). These malignancies present an intrinsic complexity in clinical management, both in the initial diagnostic phase, as well as in the treatment choice, due to scarcity of clinical practice guidelines and also to the lack of randomized clinical trials, which substantially limit treatment options. Moreover, to reduce the diagnostic delay and to improve the appropriateness of treatment choice, clinical centers with adequate patient volumes and expertise should be homogeneously accessible in different geographical areas, also to reduce healthcare migration (3,6,7). Notably, the clinical complexity of rare thoracic tumors systematically requires multidisciplinary team discussion to reach the correct diagnosis and offer the best treatment. In 2008, the European Commission launched the RARECARE project. This is a population-based cancer registry aiming at defining incidence, prevalence and long-term outcome of rare cancers. This project allows to study the epidemiology of these cancers in a large and heterogeneous population (8,9). The results of RARECARE registry led to a second project (RARECAREnet), which updated and enlarged the available information on rare cancers in Europe (10). In addition, the Joint Action on Rare Cancers (JARC) launched in 2016, is another major European initiative, in which 34 partners from different countries belonging to the European Community are involved. This project, coordinated by the National Cancer Institute of Milan (INT), seeks to improve the epidemiological knowledge of r","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"7 ","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/36/be/med-07-7.PMC10011864.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9138172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal duplication cysts: a clinical practice review.","authors":"Jessica E Wahi,&nbsp;Fernando M Safdie","doi":"10.21037/med-22-33","DOIUrl":"https://doi.org/10.21037/med-22-33","url":null,"abstract":"<p><p>Esophageal duplication represents one of the most common types of bronchopulmonary foregut malformations. These rare congenital anomalies occur secondary to embryological aberrations between the 4th and 8th weeks of gestation. In order to be classified as an esophageal cyst a mediastinal cyst must have a close proximity with the esophagus, be lined by alimentary (squamous epithelium) or tracheobronchial mucosa and covered by two smooth muscle layers. These rare anomalies are often asymptomatic during adulthood. However, they can cause symptoms in early childhood, generally during the first 2 years of life. Variations in location, size, presence or absence of heterotopic mucosa, will dictate the clinical presentation. Dysphagia, food impaction, persistent cough and chest pain are common clinical presentations. Imaging studies including esophagram, computed tomography (CT) and magnetic resonance imaging (MRI) can provide key findings to reach the diagnosis. Nonetheless, endoscopic evaluation, particularly endoscopic ultrasound (EUS) is the most valuable tool to determine whether this lesion is cystic versus solid and or if there are abnormal mucosal findings. Needle biopsies are controversial but can help with drainage and to rule out malignant transformation. Therapeutic options include endoluminal drainage. However, more definitive therapies include surgical excision. Open and minimally invasive (laparoscopic and thoracoscopic) techniques have been demonstrated to be safe and effective at completely removing these lesions. Recently, robotic-assisted resections have gained more attention with case reports and series reporting excellent outcomes.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"7 ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/6a/med-07-1.PMC10011867.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intralesional microbleeding in resected thymic cysts indeterminate on imaging.","authors":"Julian A Villalba,&nbsp;Adina Haramati,&nbsp;Michelle Garlin,&nbsp;Fabiola Reyes,&nbsp;Cameron D Wright,&nbsp;Abner Louissaint,&nbsp;Jeanne B Ackman","doi":"10.21037/med-22-42","DOIUrl":"https://doi.org/10.21037/med-22-42","url":null,"abstract":"<p><strong>Background: </strong>The propensity of thymic cysts to mimic solid thymic epithelial tumors (TETs) on computed tomography (CT), on account of attenuation values greater than water and thickened or calcified walls, can lead to non-therapeutic thymectomy. These lesions can fluctuate in volume, CT attenuation, and magnetic resonance imaging (MRI) signal over time. We hypothesized that spontaneous hemorrhage and resorption may contribute to their variable appearance over time.</p><p><strong>Methods: </strong>Completely excised thymic cysts were identified retrospectively over a 20-year period by their pathologic diagnosis. Cysts were excluded if they did not have available presurgical imaging, were not prevascular, were located within or contained an enhancing mass by imaging, or were of non-thymic origin upon microscopic review. Histopathological analysis of all available resected thymic cyst material and radiologic analysis of the cysts on pre-operative imaging were performed.</p><p><strong>Results: </strong>Upon application of exclusion criteria, we identified 18 thymic cysts from the initial 85 mediastinal cystic specimens. Most cysts were unilocular (11/15, 73%), showed turbid-to-semisolid, hemorrhagic fluid (10/12, 83%) and showed histopathological findings suggestive of intralesional microbleeding (14/18, 78%), remodeling (8/18, 44%), pathological wound healing/scarring of the capsule (16/18, 89%), and fat necrosis in the surrounding thymic tissue (12/18, 67%). On CT, 6/17 (35%) cysts demonstrated wall calcification. Sixty-five percent (11/17) had attenuation values ≥20 Hounsfield units (HU). Two of the 4 cysts imaged by MRI were T1-isointense, one was mixed hyper- and isointense, and one T1-hypointense to muscle, with iso- and hyperintensity indicating hemorrhagic or proteinaceous content. Twenty-five percent (1/4) of cyst walls imaged by MRI were T1/T2-hypointense, indicating presence of calcification, hemosiderin, and/or fibrosis.</p><p><strong>Conclusions: </strong>Resected thymic cysts in this cohort often showed features suggestive of intralesional microbleeding, inflammation, and fibrosis, which may explain their appearance and behavior over time on CT and MRI.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"7 ","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/01/fd/med-07-13.PMC10226889.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9620835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative complications of mediastinal cyst resection and their management.","authors":"Hana Ajouz,&nbsp;Nestor Villamizar","doi":"10.21037/med-22-30","DOIUrl":"https://doi.org/10.21037/med-22-30","url":null,"abstract":"© Mediastinum. All rights reserved. Mediastinum 2023;7:20 | https://dx.doi.org/10.21037/med-22-30 The incidence of complications after resection of mediastinal cysts is not well described in the literature. The incidence of complications after resection of mediastinal cysts reported in few case reports and small case series vary between 2–7% (1-4). Most complications that occur after resection of mediastinal cysts are similar to those that occur after any thoracic procedure (2,3) (Table 1,2). Sound knowledge of the possible postoperative complications allow the surgical team to anticipate postoperative complications and thus reduce this morbidity.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"7 ","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bc/aa/med-07-20.PMC10226888.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9620838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant middle mediastinal lesions: when tumor size correlates with mesenchymal origin-a retrospective single-center analysis.","authors":"Stéphane Collaud,&nbsp;Theresa Stork,&nbsp;Hafsa Kaman,&nbsp;Sebastian Bauer,&nbsp;Christoph Pöttgen,&nbsp;Hans-Ulrich Schildhaus,&nbsp;Bastian Schmack,&nbsp;Clemens Aigner","doi":"10.21037/med-22-49","DOIUrl":"https://doi.org/10.21037/med-22-49","url":null,"abstract":"<p><strong>Background: </strong>The International Thymic Malignancy Interest Group (ITMIG) proposed an internationally accepted division of the mediastinum into three compartments based on computed tomography (CT): anterior (prevascular), middle (visceral) and posterior (paravertebral) compartment. There is no generally accepted definition for the term \"giant\" when applied to middle mediastinal lesions. We defined the term \"giant\" and described our surgical experience in treating patients with giant lesions of the middle mediastinum.</p><p><strong>Methods: </strong>CT imaging of patients operated in our center from January 2016 to August 2021 for mediastinal lesions was reviewed. Lesions were categorized to one of the ITMIG-defined compartments. Lesion size at diagnosis was measured at its largest diameter on axial CT imaging. Giant middle mediastinal lesions were defined as lesions having a size ≥90^th percentile of our middle mediastinal lesion cohort. Patients with giant middle mediastinal lesions were further analyzed.</p><p><strong>Results: </strong>Thirty-six patients (23%) had lesions located in the middle mediastinal compartment. Most common diagnoses were mediastinal cysts (n=10, 28%), metastatic lesions (n=6, 17%), lymphomas (n=5, 14%), and sarcomas (n=3, 8%). Ninetieth percentile lesion size was 73 mm. As per definition, four patients had giant middle mediastinal lesions. All these four lesions were of mesenchymal origin including oesophageal leiomyoma, synovial sarcoma, leiomyosarcoma and undifferentiated round cell sarcoma. Resection was performed through posterolateral thoracotomy or sternotomy, with or without cardiopulmonary bypass.</p><p><strong>Conclusions: </strong>The term \"giant\" could be defined as a mass larger or equal to 73 mm. This definition selected specifically lesions with mesenchymal origin and may therefore guide diagnostic algorithm and patient management.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"7 ","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/90/med-07-24.PMC10493615.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging evaluation of thymic tumors.","authors":"Chad D Strange,&nbsp;Mylene T Truong,&nbsp;Jitesh Ahuja,&nbsp;Taylor A Strange,&nbsp;Smita Patel,&nbsp;Edith M Marom","doi":"10.21037/med-22-58","DOIUrl":"https://doi.org/10.21037/med-22-58","url":null,"abstract":"<p><p>An integral part of managing patients with thymoma and thymic carcinoma is imaging. At diagnosis and staging, imaging helps demonstrate the extent of local invasion and distant metastases which allows the proper stratification of patients for therapy. For decades, the predominant staging system for thymic tumors was the Masaoka-Koga staging system. More recently, however, the International Association for the Study of Lung Cancer, the International Thymic Malignancies Interest Group (ITMIG), the European Society of Thoracic Surgeons, the Chinese Alliance for Research on Thymomas, and the Japanese Association of Research on Thymus partnered together to develop a tumor-node-metastasis (TNM) staging system specifically for thymic tumors based on a retrospective database of nearly 10,000 patients. The TNM 8^th edition defines specific criteria for thymic tumors. Imaging also serves to assess treatment response and detect recurrent disease after various treatment modalities. The Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 is currently used to assess response to treatment. ITMIG recommends certain modifications to RECIST version 1.1, however, in thymic tumors due to unique patterns of spread. While there is often overlap, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) characteristics can help differentiate thymoma and thymic carcinoma, with newer CT and MRI techniques under evaluation showing encouraging potential.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"7 ","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e3/ac/med-07-28.PMC10493619.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging modalities (MRI, CT, PET/CT), indications, differential diagnosis and imaging characteristics of cystic mediastinal masses: a review.","authors":"Amar Shah,&nbsp;Carlos A Rojas","doi":"10.21037/med-22-31","DOIUrl":"https://doi.org/10.21037/med-22-31","url":null,"abstract":"<p><p>Cystic mediastinal masses have traditionally represented a diagnostic dilemma with differentiation of malignant masses a particular area of concern. Each imaging modality has strengths and weaknesses in mediastinal imaging-computed tomography (CT) offers increased spatial resolution at the cost of poorer soft tissue differentiation and requiring ionizing radiation, while magnetic resonance imaging (MRI) offers superior soft tissue contrast/characterization at significantly greater cost. Ultrasound offers real-time visualization but is operator and tissue dependent. [18F]fluoro-D-glucose (F-18 FDG) positron emission tomography (F-18 FDG PET) CT provides functional information, but poorer spatial resolution. Recent advances have focused upon the use of magnetic resonance imaging to aid in characterization of cystic mediastinal lesions, particularly in the context of indeterminate CT findings. The mediastinum may be divided into three anatomic compartments: prevascular, visceral, and paravertebral. All three compartments extend superiorly from the thoracic inlet and inferiorly to the diaphragm. These compartments provide a useful framework for categorizing normal and pathologic mediastinal processes. In this article, we will review the imaging characteristics of mediastinal cystic lesions via a case-based review divided by anatomical mediastinal compartments. Characteristic imaging features and troubleshooting are particular areas of focus. Normal variants that may mimic cystic pathology are discussed. The roles of CT and MRI will be emphasized. Cases from our institution are presented as illustrative examples.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"7 ","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b9/7e/med-07-3.PMC10011868.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9138167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AB004. Radiotherapy for thymic epithelial tumors: what is the optimal dose?—a systematic review","authors":"A. Angrisani, R. Houben, F. Marcuse, M. Hochstenbag, J. Maessen, D. de Ruysscher, S. Peeters","doi":"10.21037/med-22-ab004","DOIUrl":"https://doi.org/10.21037/med-22-ab004","url":null,"abstract":"Background Thymic epithelial tumors (TETs) are rare thoracic tumors, often requiring multimodal approaches. Surgery represents the first step of the treatment, possibly followed by adjuvant radiotherapy (RT) and, less frequently, chemotherapy. For unresectable tumors, a combination of chemotherapy and RT is often used. Currently, the optimal dose for patients undergoing radiation is not clearly defined. The available guidelines’ recommendations on RT are based on studies with a low level of evidence, where two-dimensional (2D)-RT was widely used. Methods A systematic review of the recent literature regarding the optimal radiation dose for patients with TETs undergoing RT was carried out. It included reports using modern RT techniques such as 3D-CRT, intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT), or proton therapy. A comprehensive literature search of four databases was conducted following the PRISMA guidelines. Two investigators independently screened and reviewed the retrieved references. Reports with <20 patients, 2D-RT use only, median follow-up time 3 years, three additional studies could be evaluated. A total of 193 patients were analyzed, stratified for prognostic factors (histology, stage, and completeness of resection), and synthesized according to the SWIM method. The paucity and heterogeneity of eligible studies led to controversial results. Overall, a dose escalation for post-operative RT beyond 50 Gy is not recommended for totally resected tumors, platinum-based chemo plus concurrent RT >54 Gy is recommended for unresectable TETs, while a dose below 52 Gy has been defined as \"palliative\" for recurrent TETs. Conclusions The optimal RT dose for postoperative or primary RT in the era of modern RT did not univocally emerge. Current recommendations remain valid. Doses of 54 Gy or higher can be recommended for definitive RT only. Conversely, this overview can spark new evidence to define the optimal RT dose for each TETs category.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43862237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AB001. Surgical resection followed by entire hemithorax irradiation in patients with stage IVa thymoma: preliminary result of a prospective phase II study","authors":"Changlu Wang, Qin Zhang, Xiao-long Fu, Z. Gu, T. Mao, W. Fang","doi":"10.21037/med-22-ab001","DOIUrl":"https://doi.org/10.21037/med-22-ab001","url":null,"abstract":"Background The aim of this study is to evaluate the safety and tumor-control effect of macroscopically surgical resection plus low-dose hemithorax irradiation in this group of patients. Methods This clinical trial was registered in April 2020 (ChiCTR2000035540). Patients enrolled in this study meet the following criteria: (I) pathologically confirmed thymoma, (II) with pleural dissemination (de-novo or recurrence), (III) removal of all visible lesions by surgical resection, (IV) age between 18 and 75 years. Radiotherapy was carried out 4–6 weeks after surgery via intensity modulated radiotherapy (IMRT) technique. The clinical target volume (CTV) covered the entire ipsilateral pleura and lung structure. A 4–6 mm margin was added beyond CTV to form the planning target volume (PTV). The radiation dose was 14 Gy in 14 fractions. A boost radiation (30 Gy/15 fraction) will be delivered to mediastinal tumor bed if the T stage is beyond T2. Progression-free survival (PFS) and toxicity were recorded as main end-points. Results From April 2020 to July 2021, a total of 65 patients have been enrolled in this trial. There were 29 male and 36 female patients with the age ranging between 27 and 75 years. The pathological subtypes were A (n=2), AB (n=2), B1 (n=11), B2 (n=23) and B3 (n=27), respectively. Thirty-five patients received previous surgery and developed pleural recurrence before this study, and 27 of them also underwent mediastinal tumor bed radiotherapy (≤50 Gy). The other 30 patients were diagnosed as primary thymoma with pleural dissemination. After surgery, 61 patients completed the hemithorax radiotherapy without severe side effects. The most common adverse events were fatigue, appetite loss and vomiting, and most of them were mild. Two patients suspended treatment at 6 Gy due to fatigue and resumed the therapy after 1–2 weeks of rest. One patient discontinued treatment due to grade 3 thrombocytopenia at 6 Gy, another patient discontinued treatment due to weakness at 8 Gy. After a median follow-up of 18 (10–25) months, 5 (7.7%) patients developed pleural recurrence. By the cut-off time, the disease control rate is 92.3%. Conclusions Prophylactic entire hemithorax radiotherapy after surgical resection is a safe and effective treatment modality for patients with stage IVa thymoma.","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43423868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}