Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; Paris Saclay Campus, Versailles Saint Quentin University, Versailles, France.
Department of Radiotherapy, Institut Claudius Rigaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France.
J Thorac Oncol. 2024 Jul;19(7):1095-1107. doi: 10.1016/j.jtho.2024.04.003. Epub 2024 Apr 10.
Thymomas are rare intrathoracic malignancies that can relapse after surgery. Whether or not Post-Operative RadioTherapy (PORT) should be delivered after surgery remains a major issue. RADIORYTHMIC is an ongoing, multicenter, randomized phase 3 trial addressing this question in patients with completely R0 resected Masaoka-Koga stage IIb/III thymoma. Experts in the field met to develop recommendations for PORT.
A scientific committee from the RYTHMIC network identified key issues regarding the modalities of PORT in completely resected thymoma. A DELPHI method was used to question 24 national experts, with 115 questions regarding the following: (1) imaging techniques, (2) clinical target volume (CTV) and margins, (3) dose constraints to organs at risk, (4) dose and fractionation, and (5) follow-up and records. Consensus was defined when opinions reached more than or equal to 80% agreement.
We established the following recommendations: preoperative contrast-enhanced computed tomography (CT) scan is recommended (94% agreement); optimization of radiation delivery includes either a four-dimensional CT-based planning (82% agreement), a breath-holding inspiration breath-hold-based planning, or daily control CT imaging (81% agreement); imaging fusion based on cardiovascular structures of preoperative and planning CT scan is recommended (82% agreement); right coronary and left anterior descending coronary arteries should be delineated as cardiac substructures (88% agreement); rotational RCMI/volumetric modulated arc therapy is recommended (88% agreement); total dose is 50 Gy (81% agreement) with 1.8 to 2 Gy per fraction (94% agreement); cardiac evaluation and follow-up for patients with history of cardiovascular disease are recommended (88% agreement) with electrocardiogram and evaluation of left ventricular ejection fraction at 5 years and 10 years.
This is the first consensus for PORT in thymoma. Implementation will help to harmonize practices.
胸腺瘤是一种罕见的胸腔内恶性肿瘤，手术后可能会复发。手术后是否应进行术后放射治疗（PORT）仍然是一个主要问题。RADIORYTHMIC 是一项正在进行的、多中心、随机 3 期临床试验，旨在解决完全 R0 切除的 Masaoka-Koga 分期 IIb/III 胸腺瘤患者的这一问题。该领域的专家开会制定了 PORT 的推荐意见。
RYTHMIC 网络的一个科学委员会确定了完全切除胸腺瘤 PORT 方式的关键问题。采用 DELPHI 方法对 24 名国家专家提出了 115 个问题，涉及以下方面：（1）成像技术，（2）临床靶区（CTV）和边界，（3）危及器官的剂量限制，（4）剂量和分割，（5）随访和记录。当意见达到 80%以上的一致时，即达成共识。
我们提出了以下建议：推荐使用术前增强 CT 扫描（94%的意见一致）；优化放射治疗的方法包括基于 4D-CT 的计划（82%的意见一致）、屏气吸气屏气计划或每日 CT 影像控制（81%的意见一致）；建议基于术前和计划 CT 扫描的心血管结构进行成像融合（82%的意见一致）；建议勾画右冠状动脉和左前降支冠状动脉作为心脏亚结构（88%的意见一致）；推荐使用旋转 RCMI/容积调强弧形治疗（88%的意见一致）；总剂量为 50Gy（81%的意见一致），分割剂量为 1.8-2Gy（94%的意见一致）；建议对有心血管病史的患者进行心脏评估和随访（88%的意见一致），并在 5 年和 10 年时进行心电图和左心室射血分数评估。
这是胸腺瘤 PORT 的首个共识。实施后将有助于协调实践。
