Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: A phase II, multi- institutional clinical trial Robert J. Korst, MD, Andrea Bezjak,

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Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: A phase II, multi- institutional clinical trial Robert J. Korst, MD, Andrea Bezjak, MD, Shanda Blackmon, MD, Noah Choi, MD, Panos Fidias, MD, Geoffrey Liu, MD, Alexander Marx, MD, Cameron Wright, MD, Susan Mock, RN, John R. Rutledge, MAS, Shaf Keshavjee, MD The Journal of Thoracic and Cardiovascular Surgery Volume 147, Issue 1, Pages 36-46.e1 (January 2014) DOI: 10.1016/j.jtcvs.2013.08.061 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Study schema. CT, Computed tomography; PET, positron emission tomography; IMRT, intensity-modulated radiotherapy; 3D, 3-dimensional; M, Monday; F, Friday; WHO, World Health Organization. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 36-46.e1DOI: (10.1016/j.jtcvs.2013.08.061) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Pretreatment maximum standard uptake value (SUV) from 21 patients with thymic epithelial tumors and its relationship to the World Health Organization histologic type. Each data point represents an individual patient, and the horizontal bars represent the median values. Two patients with carcinoma did not have a maximum standard uptake value reported. P = .14, carcinoma versus B3; P = .005, carcinoma versus other; P = .008, B3 versus other. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 36-46.e1DOI: (10.1016/j.jtcvs.2013.08.061) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Consolidated Standards of Reporting Trials diagram showing the flow of patients through the protocol. Postop, Postoperative; chemoRT, chemoradiotherapy; chemo, chemotherapy. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 36-46.e1DOI: (10.1016/j.jtcvs.2013.08.061) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 The relationship between the World Health Organization histologic type and response to induction therapy. “Other” refers to type A, AB, B1, B2, and metaplastic thymoma. A, Box and whisker plot of the magnitude of response to induction chemoradiotherapy measured by the tumor size on the computed tomography scan. The upper and lower ends of each box represent the upper and lower quartiles, the thick horizontal bar represents the median, and the extreme horizontal bars represent the maximum and minimum values. P = .09, carcinoma versus other; P = .67, carcinoma versus B3; P = .56, B3 versus other. B, Pathologic response to induction chemoradiotherapy reported as the percentage of viable tumor in the surgical specimens as estimated by the institutional pathologists. Each data point represents an individual patient and the horizontal bars represent the median values. The solid points represent patients with a near complete pathologic response. One patient with a B3 thymoma did not have an estimate of the percentage of viable tumor reported. P = .14, carcinoma versus B3; P = .07, carcinoma versus other; P = .94, B3 versus other. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 36-46.e1DOI: (10.1016/j.jtcvs.2013.08.061) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Freedom from progression and actuarial overall survival after multimodality treatment of locally advanced thymoma and thymic carcinoma. The vertical bars indicate 95% confidence intervals. A, Freedom from progression. B, Overall survival. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 36-46.e1DOI: (10.1016/j.jtcvs.2013.08.061) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions