The Management of Thymoma: A Systematic Review and Practice Guideline

Abstract

Introduction: Thymoma is a rare tumor for which there is little randomized evidence to guide treatment. Because of the lack of high-quality evidence, a formal consensus-based approach was used to develop recommendations on treatment. Methods: A systematic refview of the literature was performed. Recommendations were formed from available evidence and developed through a two-round modified Delphi consensus approach. Results: The treatment recommendations are summarized as follows: Stage I-complete resection of the entire thymus without neoadjuvant or adjuvant therapy. Stage II-complete resection of the entire thymus with consideration of adjuvant radiation for high-risk tumors. Stage IIIA-surgery either initially or after neoadjuvant therapy, or surgery followed by adjuvant therapy. Stage IIIB-treatment may include a combination of chemotherapy, radiation, and/or surgery, or if technically possible, surgery in combination with chemoradiotherapy (concurrent cisplatin based). For bulky tumors, consideration should be given to sequential chemotherapy followed by radiation. Stage IVA-as per stage III, with surgery only if metastases can be resected. Stage IVB-treatment on an individual case basis (no generic recommendations). Recurrent disease-consider surgery, radiation, and/or chemoradiation. Chemoradiation should be considered in all medically inoperable and technically inoperable patients. Conclusion: Consensus was achieved on these recommendations, which serve to provide practical guidance to the physician treating this rare disease.

The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice

“…In recent years, Delphi expert panels have been used in medical fields to help develop best practice recommendations when only limited or equivocal evidence is available. [31][32][33] This approach is less commonly applied in critical care, but it could be a pragmatic method to support clinical decision making, particularly related to new advances in critical care interventions. Furthermore, the methodology provides the tools to incorporate clinical expertise in the clinical decision-making process, specifically in grey areas of clinical practice.…”

The Usefulness of Positron-Emission Tomography Findings in the Management of Anterior Mediastinal Tumors

“…19) On the other hand, several recent studies note that thymothymectomy might not always be necessary in non-myasthenic thymoma patients, because there were no differences in the surgical results of patients who underwent thymomectomy with or without extended thymectomy. [20][21][22] Thus, the optimal mode of thymoma resection in non-myasthenic thymoma patients remains controversial, and the oncological indication of limited resection (thymomectomy) is unclear.…”

Prognostic value of immunohistochemical markers in malignant thymic epithelial tumors

“…Due to the rarity of TETs, treatment strategy is not yet standardized and mostly based on retrospective reviews (1)(2)(3). The pathological classification of TETs has been the subject of discussion over many years.…”