The Management of Thymoma - A Review of the Status Quo with Practical Treatment Recommendations

Conrad      B. Falkson

Abstract

Thymic tumors are rare. The management remains controversial. The spectrum of behaviour ranges from benign indolent thymomas to highly aggressive and rapidly fatal undifferentiated thymic carcinomas. There remains inconsistency and controversy in histological classification. There appears to be some correlation between histological type and stage. Surgery is recognized as the mainstay of treatment. The goal of surgery is complete resection (RO) and this appears to be adequate for early stage disease. These tumors appear to be both radiation and chemotherapy responsive. There is controversy as to when adjuvant radiation is appropriate, but generally accepted as part of the treatment algorithm for invasive disease or incompletely resected disease. Induction therapy with chemotherapy alone or with radiation and or targeted therapies have been used to try and improve the RO resection rate. Systemic therapy with a cisplatin and anthracyclin containing regimen is often used for unresectable and metastatic disease, again with or without radiation and targeted agents. There is no good evidence to favour either concurrent or sequential therapies. The Thymoma Working Group of the NCIC has devised a treatment algorithm in an attempt to standardize treatment in Canada. In order to address the problems associated with this rare and varied tumor group the International Thymic Malignancies Interest Group (ITMIG) has been formed. It is only through worldwide collaboration through such a group that any real progress in the management of thymic tumors can be made.

Keywords: Thymic carcinoma, thymoma, chemotherapy, radiation therapy, targeted therapy, Systemic Chemotherapy, EPIDEMIOLOGY

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