Thymic Carcinoma Management Patterns among International Thymic Malignancy Interest Group (ITMIG) Physicians with Consensus from the Thymic Carcinoma Working Group

Abstract

Introduction Thymic carcinomas are rare epithelial malignancies with limited data to guide management. Methods In order to identify areas of agreement and variability in current clinical practice, a 16-question electronic survey was given to members of the International Thymic Malignancy Interest Group (ITMIG). Areas of controversy were discussed with the Thymic Carcinoma Working Group and consensus was achieved, as described. Results One hundred ITMIG members responded. There was general agreement regarding the role for multimodality therapy with definitive surgical resection in physically fit patients with advanced, but resectable disease. Areas of controversy included the need for histologic confirmation prior to surgery, the role of adjuvant therapy, the optimal first-line chemotherapy regimen, and the recommended treatment course for marginally resectable disease with invasion into the great vessels, pericardium, and lungs. Conclusions The results of the questionnaire provide a description of the management of thymic carcinoma by 100 ITMIG members with a specific interest or expertise in thymic malignancies. Although there was agreement in some areas, clinical practice appears to vary significantly. There is a great need for collaborative research to identify optimal evaluation and treatment strategies. Given the need for multimodality therapy in many cases, a multidisciplinary discussion of the management of patients with thymic carcinoma is critical.

Surgical feasibility and long‐term outcome of superior vena cava replacement for advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy

“…Currently, complete surgical resection is the main treatment for patients with stage I, II and IIIA thymoma, 15,21 but the treatment of patients with advanced thymoma that invades the mediastinal large vessels, pericardium, or pleural dissemination is more complicated, and is still controversial 22 . Some studies have shown that patients with advanced thymoma, in whom preoperative examination confirms that resection of their tumor is not achievable, should be treated with induction chemoradiotherapy to improve the feasibility of complete surgical resection 7,9,14,18,20 .…”

Radiographic Predictors of Resectability in Thymic Carcinoma

“…Thymic carcinoma is a rare aggressive tumor with limited published data regarding optimal disease management. As a result, the treatment pathways are not clearly defined, as shown by a recent survey from the ITMIG (12). It has been shown that a complete resection is the most important predictor of long term survival (4, 7, 8, 10, 13, 14).…”

A Whole-Tumor Histogram Analysis of Apparent Diffusion Coefficient Maps for Differentiating Thymic Carcinoma from Lymphoma

“…The accurate differentiation of these two entities is very important for determining the individual treatment strategy. Surgery combined with chemoradiotherapy is recommended as the first-line treatment for thymic carcinoma; while chemotherapy is more preferred for lymphoma ( 2 3 ). A biopsy is the gold standard, but it is invasive and may be associated with sampling error ( 4 ).…”