THYMOMA AND THYMIC CARCINOMA- TREATMENT OVERVIEW

Treatment Option Overview for Thymoma and Thymic Carcinoma Treatment

·      Thymoma

Most thymomas are diagnosed and staged at the time of surgical intervention. Surgical resection is the preferred treatment of patients who can tolerate surgery and have a mediastinal mass that is suspected of being a thymoma. A complete, surgical resection is recommended for patients with either stage I or stage II disease. A complete resection of all tumors can be achieved in nearly all stage I and stage II patients and in 27% to 44% of stage III patients. Postoperative radiation therapy (PORT) is generally employed for stage II and stage III patients. Patients with stage IVa disease can only rarely be resected completely and are usually offered debulking surgery and PORT with or without chemotherapy.

Thymic Carcinoma

The optimal treatment of thymic carcinoma remains undefined because of its rarity. Most patients with thymic carcinomas present initially with any of the following:

·         Cough.

·         Chest pain.

·         Phrenic nerve palsy.

·         Superior vena cava syndrome.

Most patients with thymic carcinoma have evidence of invasion of contiguous mediastinal structures at presentation.

Thymic carcinoma can metastasize to the following areas:

·         Regional lymph nodes.

·         Bone.

·         Liver.

·         Lungs.

Treatment options include the following:[1]

·         Surgery.

·         Radiation.

·         Multimodality approach, such as:

o    Surgical resection.

o    Radiation therapy.

o    Cisplatin-based chemotherapy.

For patients with clinically resectable disease, surgical resection is often the initial therapeutic intervention. For clinically borderline or frankly unresectable lesions, neoadjuvant (preoperative) chemotherapy or thoracic radiation therapy, or both, is given.[2] Patients presenting with locally advanced disease should be carefully evaluated and undergo multimodality therapy. Patients with poor performance status and high associated operative risks are generally not considered for these types of aggressive treatments. Patients with metastatic disease may respond to combination chemotherapy.

References

1.     Hsu HC, Huang EY, Wang CJ, et al.: Postoperative radiotherapy in thymic carcinoma: treatment results and prognostic factors. Int J Radiat Oncol Biol Phys 52 (3): 801-5, 2002. [PUBMED Abstract]

2.     Koizumi T, Takabayashi Y, Yamagishi S, et al.: Chemotherapy for advanced thymic carcinoma: clinical response to cisplatin, doxorubicin, vincristine, and cyclophosphamide (ADOC chemotherapy). Am J Clin Oncol 25 (3): 266-8, 2002. [PUBMED Abstract]