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Catherine Mercado, MD Department of Radiation Oncology University of Florida College of Medicine

Proton Therapy for Thymic Malignancies: Multi-institutional Patterns-of-Care and Early Clinical Outcomes from the Proton Collaborative Group Registry & UF. Catherine Mercado, MD Department of Radiation Oncology University of Florida College of Medicine October 23rd, 2017. Disclosures.

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Catherine Mercado, MD Department of Radiation Oncology University of Florida College of Medicine

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  1. Proton Therapy for Thymic Malignancies: Multi-institutional Patterns-of-Care and Early Clinical Outcomes from the Proton Collaborative Group Registry & UF Catherine Mercado, MD Department of Radiation Oncology University of Florida College of Medicine October 23rd, 2017

  2. Disclosures None of the authors have conflicts of interest

  3. Background • Thymoma and thymic carcinoma are rare malignancies arising in the anterior mediastinum from the thymus. • Median age of diagnosis: 40-60 years old • Treatment: • Surgery +/- RT, chemo • If unresectable, chemoRT

  4. Background • Long term survivorship common, causing concerns for radiotherapy related late side effects (i.e. cardiac disease or secondary malignancies) OS (RT vs. no-RT) 5yr: 95% vs. 90% 10yr: 86% vs. 79 % Rimner et al. J Thorac Oncol. 2016

  5. Background • NCCN Guidelines RT Techniques for TM: • “...Since these patients are younger and mostly long-term survivors, the mean dose to the total heart should be as low as reasonably achievable.” • Proton therapy (PT) reduces the radiation dose to organs at risk, potentially improving disease control and decreasing long-term toxicity

  6. Background Photon vs. Proton: Dosimetry demonstrates reduced RT dose to the OARs with PT Colorwash isodose distribution for IMRT (left) and PT (right).  DVH representing the percentage of each organ irradiated at each RT dose level with IMRT or PT. Figura et al., J Thorac Oncol. 2013 May;8(5):e38-40.

  7. Background • Vogel et al. assessed risk of predicted secondary malignancies (SMNs) following adjuvant proton vs. photon therapy in thymoma patients • Results: 5 excess SMNs per 100 patients can potentially be avoided using protons vs. photons • Parikh et al. demonstrated significant reductions in heart, lung, and esophagus dose in PT plan compared to analogous IMRT plan Parikh et al., ClinLung Cancer. 2016 Vogel et al., Int J Radiation Oncol Biol Phys, Vol. 99, 2017

  8. Objective • This study reports on the patterns-of-care and early clinical outcomes of patients treated with PT for thymoma and thymic carcinoma.

  9. Methods From January 2008 to March 2017 30 patients received post-operative or definitive proton therapy for thymoma or thymic carcinoma All patients were treated on the institutional review board-approved University of Florida outcomes tracking protocol or PCG registry Clinical outcomes, pathology, treatment dose, acute toxicities, and follow-up information were analyzed.

  10. Patient Characteristics Thymoma Thymic Carcinoma

  11. Clinical Outcomes • Median follow-up: 22 months (range, 3-60 months) • Local recurrence: 2 thymoma and 1 thymic carcinoma patient • Median time from completion of PT to local recurrence: 13 months (range, 2-26) • Patient deaths: 3 • 1 patient died who also had locally recurrent thymic carcinoma • 1 patient died due to metastatic disease • 1 patient died due to intercurrent disease • No patient experienced grade ≥3 toxicities after PT

  12. Clinical Outcomes • 1 patient in cohort had oligometastatic disease prior to PT, at last follow-up patient died with distant metastasis

  13. Discussion • Single institution, 27 patients • Median follow-up: 2 years • No patient experienced grade ≥3 toxicities • At 3 years: Regional control 96%, Distant control 74%, Overall Survival 94% Vogel et al., Radiotherapy and Oncology 118 (2016) 504–509

  14. Discussion • Comparable Results: Vogel et al., Radiotherapy and Oncology 118 (2016) 504–509

  15. Conclusions • Adjuvant and definitive PT is being used in the treatment of thymic malignancies. • Early results demonstrate an acceptable rate of recurrence with a tolerable toxicity profile. • Longer follow-up and a larger patient cohort are needed to confirm these findings.

  16. Acknowledgements Bradford Hoppe, MD Randal Henderson, MD Amanda Price PCG Collaborators: • Henry Tsai, MD (NJ Procure Proton Therapy Center) • Carlos Vargas, MD (Mayo Clinic Arizona) • George E. Laramore, MD, PhD (University of Washington) • Shahed Badiyan, MD (University of Maryland) • William Hartsell, MD (Northwestern Chicago Proton Center) • Gary Larson, MD (Oklahoma City Procure Proton Therapy Center) Questions

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