Radiation Therapy in the Management of Malignant Thymic Tumors

Arriagada, R.; Gérard-Marchant, R; Tubiana, M; Amiel, J. L.; Hajj, L. El

doi:10.3109/02841868109130192

Cited by 26 publications

(6 citation statements)

References 15 publications

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“…However, up to 40% of the thymic tumours are invasive [79] and, in these cases, complete resection may be hampered either by extended local infiltration or by dissemination outside the mediastinum [80][81][82]. The ability to achieve complete resection is clearly the key factor for cure [6,17] and must be regarded as the gold standard for treatment at any stage; incomplete resection and debulking should be interpreted as a failure, since they offer no advantage over simple biopsy, as mentioned before [6,9,10,17].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Thymoma and thymic carcinoma

Venuta

Anile

Diso

et al. 2010

European Journal of Cardio-Thoracic Surgery

184

152

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Thymoma and thymic carcinoma are an extremely heterogeneous group of neoplastic lesions with an exceedingly wide spectrum of morphologic appearances. They show different presentations with a variable and unpredictable evolution ranging from an indolent non-invasive attitude to a highly infiltrative and metastasising one. Prognosis can be predicted on the basis of a number of variables, mainly staging, the WHO histological pattern and diameter of the tumour. Complete surgical resection is certainly the gold standard to achieve cure. However, especially in patients with lesions at advanced stage, complete resection may be difficult and recurrence often occurs; at these stages, disease-free long-term survival may be difficult to be accomplished. Chemo- and radiotherapy protocols have been designed to complete surgical treatment and improve results in inoperable patients as well, based on the reported sensitivity of thymic tumours to these treatment modalities. The integration of clinical staging and histology, with the new histogenetic morphological classification, has contributed to design multimodality treatment protocols that help to improve prognosis. Induction therapy can now be applied before surgery in patients with tumours considered inoperable, improving resectability and outcome without adding morbidity and mortality to the surgical procedure. This newly developed approach helps to reduce the recurrence rate and to ameliorate disease-free survival. New therapies are now being evaluated as for many other tumours; however, they still need confirmation in prospective randomised studies. In the future, integrated treatment modality should be incorporated in a standardised approach that goes from a careful assessment of histology, staging and lymph node status, and a constructive and non-empirical co-operation between medical and radiation oncologists, pathologists and thoracic surgeons.

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Section: Surgical Treatmentmentioning

confidence: 99%

Thymoma and thymic carcinoma

Venuta

Anile

Diso

et al. 2010

European Journal of Cardio-Thoracic Surgery

184

152

View full text Add to dashboard Cite

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“…There are multiple factors that may render Masaoka stage III locally advanced thymic carcinomas unresectable, such as phrenic nerve involvement, extensive great vessel invasion, and medical comorbidities. In such circumstances where surgery is not possible, there was panel consensus that curative-intent definitive combined modality therapy with chemoradiation should be pursued based on several studies, with roughly a 50% response rate …”

Section: Resultsmentioning

confidence: 99%

“…The panel recommended against the use of elective nodal radiation therapy, as a retrospective analysis did not demonstrate benefit . Although a range of radiation doses are reported in the medical literature, the strongest evidence came from a prospective phase 2 clinical trial for unresectable thymic carcinoma treating patients with concurrent cisplatin and etoposide and 60 Gy using IMRT . There was panel consensus that conventionally fractionated radiation to a dose of 60 to 66 Gy is usually appropriate and that dose escalation beyond 66 Gy is usually not appropriate.…”

Section: Resultsmentioning

confidence: 99%

American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma

et al. 2023

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ImportanceThymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management.ObjectiveTo develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma.Evidence ReviewCase variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. Variants and procedures were evaluated by the panel using modified Delphi methodology. Agreement/consensus was defined as less than or equal to 3 rating points from median. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures.FindingsThe ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs.Conclusions and RelevanceThe ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.

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“…Os pacientes com timoma podem apresentar quadro clínico não muito específico: tosse, dispnéia, dor torácica, perda de peso, queda do estado geral. Porém, alguns pacientes são diagnosticados por radiografias de tórax em exames de rotina -que mostram opacidade homogênea no mediastino ântero-superior -ou por apresentar miastenia gravis associada (2) . Grande parte dos pacientes que apresentam timoma é de portadores de outras doenças auto-imunes ou endócrinas.…”

Section: Objetivounclassified

Timoma: discussão sobre tratamento e prognóstico

Pêgo‐Fernandes¹,

Ebaid²,

Galizia³

et al. 2001

J. Pneumologia

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ObjetivoLocalizado em sua porção anterior, é o tumor mais freqüente desse compartimento, compreendendo aproximadamente de 20 a 30% das massas mediastinais em adultos (1) . Os pacientes com timoma podem apresentar quadro clínico não muito específico: tosse, dispnéia, dor torácica, perda de peso, queda do estado geral. Porém, alguns pacientes são diagnosticados por radiografias de tórax em exames de rotina -que mostram opacidade homogênea no mediastino ântero-superior -ou por apresentar miastenia gravis associada (2) . Grande parte dos pacientes que apresentam timoma é de portadores de outras doenças auto-imunes ou endócrinas. Cerca de 27% dos pacientes com miastenia gravis apresentam timoma -83% dos homens com miastenia gravis entre 50 e 60 anos possuem timoma (3) -e 20-40% dos pacientes com timoma apresentam miastenia gravis. Artrite reumatóide, miosite e aplasia por células vermelhas puras são outras síndromes que podem vir associadas ao timoma (4) . O timoma está mais presente nas 5 a e 6 a décadas de vida, sendo menos freqüente em pacientes abaixo de 40 INTRODUÇÃO Timoma, um tumor infreqüente e de crescimento lento, é usualmente confinado localmente ao mediastino.

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Radiation Therapy in the Management of Malignant Thymic Tumors

Cited by 26 publications

References 15 publications

Thymoma and thymic carcinoma

Thymoma and thymic carcinoma

American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma

Timoma: discussão sobre tratamento e prognóstico

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