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Basse C, Khalifa J, Thillays F, Le Pechoux C, Maury JM, Bonte PE, Coutte A, Pourel N, Bourbonne V, Pradier O, Belliere A, Le Tinier F, Deberne M, Tanguy R, Denis F, Padovani L, Zaccariotto A, Molina T, Chalabreysse L, Brioude G, Delatour B, Faivre JC, Cao K, Giraud P, Riet FG, Thureau S, Antoni D, Massabeau C, Keller A, Bonnet E, Lerouge D, Martin E, Girard N, Botticella A. Recommendations for Post-Operative Radiotherapy after complete resection of Thymoma - a French DELPHI consensus initiative. J Thorac Oncol 2024:S1556-0864(24)00161-8. [PMID: 38608932 DOI: 10.1016/j.jtho.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/29/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND 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. METHODS 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: 1/ Imaging techniques, 2/ Clinical Target Volume (CTV) and margins, 3/ Dose constraints to Organs At Risk, 4/ Dose and fractionation, 5/ Follow-up and records. Consensus was defined when opinions reached ≥ 80% agreement. RESULTS We established the following recommendations: pre-operative contrast-enhanced CT-scan is recommended (94% agreement); optimization of radiation delivery includes either a 4D-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 pre-operative 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/VMAT is recommended (88% agreement); total dose is 50Gy (81% agreement) with 1.8-2Gy per fraction (94% agreement); cardiac evaluation, and follow-up for patients with history of cardiovascular disease is recommended (88% agreement) with EKG and evaluation of LVEF at 5 years and 10 years. CONCLUSION This is the first consensus for PORT in thymoma. Implementation will help to harmonize practices.
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Affiliation(s)
- Clémence Basse
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; Paris Saclay Campus, Versailles Saint Quentin University, Versailles, France
| | - Jonathan Khalifa
- Department of Radiotherapy, Institut Claudius Rigaud, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - François Thillays
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Nantes, France
| | - Cécile Le Pechoux
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; IVPC UMR754 INRA, Univ Lyon, Université Claude Bernard Lyon 1, EPHE, Lyon, France
| | | | | | - Nicolas Pourel
- Radiation department, Institut Sainte Catherine, Avignon, France
| | - Vincent Bourbonne
- Department of Radiotherapy, University Hospital of Brest, Brest, France
| | - Olivier Pradier
- Department of Radiotherapy, University Hospital of Brest, Brest, France
| | - Aurélie Belliere
- Department of Radiotherapy, Centre Jean Perrin, Clermont-Ferrand, France
| | | | - Mélanie Deberne
- Department of Radiotherapy, Hospices Civils Lyonnais, Lyon, France
| | - Ronan Tanguy
- Department of Radiotherapy, Hospices Civils Lyonnais, Lyon, France
| | - Fabrice Denis
- Department of Radiotherapy, Centre de Cancérologie de la Sarthe, ELSAN, Le Mans, France
| | - Laetitia Padovani
- Department of Radiotherapy, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Audrey Zaccariotto
- Department of Radiotherapy, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Thierry Molina
- Pathology Department, Necker Enfants Malades Hospital, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Lara Chalabreysse
- Department of Pathology, Groupement Hospitalier Est, Bron Cedex Lyon, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, Disease of the Oesophagus and Lung Transplantations, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Bertrand Delatour
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, 2 rue Henri le Guilloux, 35000 Rennes, France
| | | | - Kim Cao
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France
| | - Philippe Giraud
- Paris City University, Department of Radiation Oncology, Hopital Européen Georges Pompidou, Paris, France
| | | | | | - Delphine Antoni
- Department of Radiotherapy, ICANS, Institut de Cancérologie de Strasbourg, France
| | - Carole Massabeau
- Department of Radiotherapy, Institut Claudius Rigaud, Toulouse, France
| | - Audrey Keller
- Department of Radiotherapy, Institut Claudius Rigaud, Toulouse, France
| | | | | | - Etienne Martin
- Department of Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Nicolas Girard
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; Paris Saclay Campus, Versailles Saint Quentin University, Versailles, France.
| | - Angela Botticella
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
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