Thymoma treatment

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2]

Approach to Thymoma and Thymic Carcinoma

Thymic Tumor

  ▸  Resectable

  ▸  Unresectable

Pathology Evaluation

R0 Resection

R1 Resection

R2 Resection

Thymoma, no capsular invasion or thymic carcinoma, stage I

Thymoma or thymic carcinoma, capsular invasion present, stages II-IV

Thymoma

Thymic carcinoma

Thymoma

Thymic carcinoma

Postoperative RT

Postoperative RT

Postoperative RT + Chemotherapy

RT ± Chemotherapy

RT + Chemotherapy

Surveillance for recurrence with CT every 6 month for 2 y, then annually every 5 y for thymic carcinoma and 10 y for thymoma

Thymoma or Thymic Carcinoma

Locally Advanced

Solitary Metastasis

Distant metastasis

Chemotherapy

Chemotherapy

Surgery

Chemotherapy

Re-evaluate for surgery

Chemotherapy or RT

Resectable

Unresectable

Surgery ± Postoperative RT

RT ± Chemotherapy

Chemotherapy Regimens

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FIRST-LINE COMBINATION CHEMOTHERAPY REGIMENS		SECOND-LINE CHEMOTHERAPY
CAP (preferred for thymoma) * Cisplatin 50 mg/m² IV day 1 * Doxorubicin 50 mg/m² IV day 1 * Cyclophosphamide 500 mg/m² IV day 1 Administered every 3 weeks	PE * Cisplatin 60 mg/m² IV day 1 * Etoposide 120 mg/m²/d IV days 1 -3 Administered every 3 weeks	Etoposide Ifosfamide Pemetrexed Octreotide (including LAR) + prednisone 5-FU and leucovirin Gemcitabine Paclitaxel
CAP with Prednisone * Cisplatin 30 mg/m² IV days 1-3 * Doxorubicin 20 mg/m²/d IV continuous infusion on days 1 to 3 * Cyclophosphamide 500 mg/m² IV on day 1 * Prednisone 100 mg/day on days 1-5 Administered every 3 weeks	VIP * Etoposide 75 mg/m² on days 1-4 * Ifosfamide 1.2 g/m² on days 1-4 * Cisplatin 20 mg/m² on days 1-4 Administered every 3 weeks
ADOC * Cisplatin 50 mg/m² IV day 1 * Doxorubicin 40 mg/m² IV day 1 * Vincristine 0.6 mg/m² IV day 3 * Cyclophosphamide 700 mg/m² IV day 4 Administered every 3 weeks	Carboplatin/Paclitaxel (preferred for Thymic Carcinoma) * Carboplatin AUC 6 * Paclitaxel 225 mg/m² Administered every 3 weeks

Radiation Dose

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• A dose of 60-70 Gy should be given to patients with unresectable disease.

• For adjuvant treatment, the radiation dose consists of 45-50 Gy for clear/close margins and 54 Gy for microscopically positive resection margins. A total dose of 60 Gy and above should be given to patients with gross residual disease (similar to patients with unresectable disease), when conventional fractionation (1.8 to 2.0 Gy per daily fraction) is applied.

References

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