Recommendations for Post-Operative RadioTherapy After Complete Resection of Thymoma-a French DELPHI Consensus Initiative

Clémence Basse; Jonathan Khalifa; François Thillays; Cécile Le Pechoux; Jean-Michel Maury; Pierre-Emmanuel Bonte; Alexandre Coutte; Nicolas Pourel; Vincent Bourbonne; Olivier Pradier; Aurélie Belliere; Florence Le Tinier; Mélanie Deberne; Ronan Tanguy; Fabrice Denis; Laetitia Padovani; Audrey Zaccariotto; Thierry Molina; Lara Chalabreysse; Geoffrey Brioude; Bertrand Delatour; Jean-Christophe Faivre; Kim Cao; Philippe Giraud; François-Georges Riet; Sébastien Thureau; Delphine Antoni; Carole Massabeau; Audrey Keller; Emilie Bonnet; Delphine Lerouge; Etienne Martin; Nicolas Girard; Angela Botticella

doi:10.1016/j.jtho.2024.04.003

Recommendations for Post-Operative RadioTherapy After Complete Resection of Thymoma-a French DELPHI Consensus Initiative

J Thorac Oncol. 2024 Apr 10:S1556-0864(24)00161-8. doi: 10.1016/j.jtho.2024.04.003. Online ahead of print.

Authors

Clémence Basse¹, Jonathan Khalifa², François Thillays³, Cécile Le Pechoux⁴, Jean-Michel Maury⁵, Pierre-Emmanuel Bonte⁶, Alexandre Coutte⁷, Nicolas Pourel⁸, Vincent Bourbonne⁹, Olivier Pradier⁹, Aurélie Belliere¹⁰, Florence Le Tinier¹¹, Mélanie Deberne¹², Ronan Tanguy¹², Fabrice Denis¹³, Laetitia Padovani¹⁴, Audrey Zaccariotto¹⁴, Thierry Molina¹⁵, Lara Chalabreysse¹⁶, Geoffrey Brioude¹⁷, Bertrand Delatour¹⁸, Jean-Christophe Faivre¹⁹, Kim Cao²⁰, Philippe Giraud²¹, François-Georges Riet²², Sébastien Thureau²³, Delphine Antoni²⁴, Carole Massabeau²⁵, Audrey Keller²⁵, Emilie Bonnet²⁶, Delphine Lerouge²⁷, Etienne Martin²⁸, Nicolas Girard²⁹, Angela Botticella⁴

Affiliations

¹ Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; Paris Saclay Campus, Versailles Saint Quentin University, Versailles, France.
² Department of Radiotherapy, Institut Claudius Rigaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France.
³ Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Nantes, France.
⁴ Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
⁵ 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.
⁶ Biostatistics Department, Research Center, Institut Curie, Paris, France.
⁷ Department of Radiotherapy, Amiens Hospital, Amiens, France.
⁸ Radiation Department, Institut Sainte Catherine, Avignon, France.
⁹ Department of Radiotherapy, University Hospital of Brest, Brest, France.
¹⁰ Department of Radiotherapy, Centre Jean Perrin, Clermont-Ferrand, France.
¹¹ Department of Radiotherapy, Centre Oscar Lambret, Lille, France.
¹² Department of Radiotherapy, Hospices Civils Lyonnais, Lyon, France.
¹³ Department of Radiotherapy, Centre de Cancérologie de la Sarthe, ELSAN, Le Mans, France.
¹⁴ Department of Radiotherapy, Assistance Publique Hôpitaux de Marseille, Marseille, France.
¹⁵ Pathology Department, Necker Enfants Malades Hospital, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
¹⁶ Department of Pathology, Groupement Hospitalier Est, Bron Cedex Lyon, France.
¹⁷ Department of Thoracic Surgery, Disease of the Oesophagus and Lung Transplantations, Hôpital Nord, Aix-Marseille University, Marseille, France.
¹⁸ Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France.
¹⁹ Department of Radiotherapy, Institut de Cancérologie de Lorraine, Nancy, France.
²⁰ Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France.
²¹ Paris City University, Department of Radiation Oncology, Hopital Européen Georges Pompidou, Paris, France.
²² Department of Radiotherapy, Centre Hospitalier Privé Saint Grégoire, Rennes, France.
²³ Department of Radiotherapy, Centre Henri Becquerel, Rouen, France.
²⁴ Department of Radiotherapy, ICANS, Institut de Cancérologie de Strasbourg, Strasbourg, France.
²⁵ Department of Radiotherapy, Institut Claudius Rigaud, Toulouse, France.
²⁶ Department of Radiotherapy, IMR de Valence, Valence, France.
²⁷ Department of Radiation Oncology, Centre Baclesse, Caen, France.
²⁸ Department of Radiotherapy, Centre Georges-François-Leclerc, Dijon, France.
²⁹ Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; Paris Saclay Campus, Versailles Saint Quentin University, Versailles, France. Electronic address: nicolas.girard2@curie.fr.

PMID: 38608932
DOI: 10.1016/j.jtho.2024.04.003

Abstract

Introduction: 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 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.

Results: 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.

Conclusion: This is the first consensus for PORT in thymoma. Implementation will help to harmonize practices.

Keywords: DELPHI; Intensity-Modulated Radiation Therapy (IMRT); Post-Operative Radiotherapy; Recommendations; Thymoma.