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{{Meningitis}}
{{thymoma}}
{{CMG}}; {{AE}} {{CZ}}, {{SS}}


==Overview==


* If the suspected patient complaints with fever, headache, altered level of consciousness, signs of meningeal irritationthe, blood culture or CSF should be obtained urgently, then CT. But DO NOT wait for the results of the CT scan and the lumbar puncture; empiric treatment should be started as soon as possible.
==Thymic Tumor, Resectable <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''NCCN Guidelines: Thymomas and Thymic Carcinomas''<ref>{{Cite web  | last =  | first =  | title = https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf | url = https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf | publisher =  | date =  | accessdate = }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==


* Blood cultures should be drawn before starting the [[antibiotic]] therapy, and then the antibiotic treatment should be changed once the blood culture results are out.
<B>
{{familytree/start}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | | | | | | | | | | | A00 | |
A00=<div style="float: center; text-align: center; line-height: 42px; height: 84px; width: 84px; padding: 1px; font-size: 90%"><u>RESECTABLE</u> Thymic Tumor</div>}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | | | | | | | | | | | |!| | | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | |,|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|.| | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | B01 | | | | | | | | B02 | | | | | | | | B03 | | |
B01=<div style="float: center; text-align: center; line-height: 42px; height: 84px; width: 84px; padding: 1px; font-size: 80%"> <u>NO</u> <BR> Residual Tumor</div>|
B02=<div style="float: center; text-align: center; line-height: 42px; height: 84px; width: 84px; padding: 1px; font-size: 80%"><u>MICROSCOPIC</u> <BR> Residual Tumor</div>|
B03=<div style="float: center; text-align: center; line-height: 42px; height: 84px; width: 84px; padding: 1px; font-size: 80%"><u>MACROSCOPIC</u> <BR> Residual Tumor</div>}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |,|-|^|-|.| | | | | |,|-|^|-|.| | | | | |,|-|^|-|.| | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | D01 | | D02 | | | | D03 | | D04 | | | | D05 | | D06 | |
D01=<div style="float: center; text-align: center; line-height: 84px; height: 84px; width: 84px; padding: 1px; font-size: 90%">Stage I</div>|
D02=<div style="float: center; text-align: center; line-height: 84px; height: 84px; width: 84px; padding: 1px; font-size: 90%">Stages II-IV</div>|
D03=<div style="float: center; text-align: center; line-height: 84px; height: 84px; width: 84px; padding: 1px; font-size: 90%">Thymoma</div>|
D04=<div style="float: center; text-align: center; line-height: 42px; height: 84px; width: 84px; padding: 1px; font-size: 90%">Thymic Carcinoma</div>|
D05=<div style="float: center; text-align: center; line-height: 84px; height: 84px; width: 84px; padding: 1px; font-size: 90%">Thymoma</div>|
D06=<div style="float: center; text-align: center; line-height: 42px; height: 84px; width: 84px; padding: 1px; font-size: 90%">Thymic Carcinoma</div>}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |!| | | |!| | | | | |!| | | |!| | | | | |!| | | |!| | | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |!| | | E02 | | | | E03 | | E04 | | | | E05 | | E06 | | | |
E02=<div style="float: center; text-align: center; line-height: 84px; height: 84px; width: 84px; padding: 1px; font-size: 90%">[[Thymoma treatment#Radiation Dose|RT]]</div>|
E03=<div style="float: center; text-align: center; line-height: 84px; height: 84px; width: 84px; padding: 1px; font-size: 90%">[[Thymoma treatment#Radiation Dose|RT]]</div>|
E04=<div style="float: center; text-align: center; line-height: 28px; height: 84px; width: 84px; padding: 1px; font-size: 90%">[[Thymoma treatment#Radiation Dose|RT]] <BR> + <BR> [[Thymoma treatment#Chemotherapy Regimens|Chemotherapy]]</div>|
E05=<div style="float: center; text-align: center; line-height: 28px; height: 84px; width: 84px; padding: 1px; font-size: 90%">[[Thymoma treatment#Radiation Dose|RT]] <BR> ± <BR> [[Thymoma treatment#Chemotherapy Regimens|Chemotherapy]]</div>|
E06=<div style="float: center; text-align: center; line-height: 28px; height: 84px; width: 84px; padding: 1px; font-size: 90%">[[Thymoma treatment#Radiation Dose|RT]] <BR> + <BR> [[Thymoma treatment#Chemotherapy Regimens|Chemotherapy]]</div>}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |!| | | |!| | | | | |!| | | |!| | | | | |!| | | |!| | | |}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |`|-|-|-|^|-|-|-|-|-|^|-|v|-|^|-|-|-|-|-|^|-|-|-|'| | | |}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | | | | | | | | | | | F01 | | | | | | | | | | | | | |
F01=<div style="float: center; text-align: center; line-height: 84px; height: 84px; width: 84px; padding: 1px; font-size: 90%">Surveillance<sup>†</sup></div>}}
{{familytree/end}}
</B>


* Empiric antibiotic treatment should be started within 30 minutes after the patient presentation.


* In case of high suspicion of pneumococcal meningitis in adult patients, 0.15 mg/kg IV Q6H dexomethasone should be administered for 2 to 4 days.
''<SMALL><sup>†</sup> CT scan every 6 months for 2 years, then annually every 5 years for thymic carcinoma and every 10 years for thymoma.</SMALL>''


:* The first dose of dexomethasone is given along with or 20 minutes prior to starting the antibiotics treatment.<ref name="pmid16394301">van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16394301 Community-acquired bacterial meningitis in adults.] ''N Engl J Med'' 354 (1):44-53. [http://dx.doi.org/10.1056/NEJMra052116 DOI:10.1056/NEJMra052116] PMID: [http://pubmed.gov/16394301 16394301]</ref><ref name="pmid20417414">Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20417414 Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis.] ''Lancet Infect Dis'' 10 (5):317-28. [http://dx.doi.org/10.1016/S1473-3099(10)70048-7 DOI:10.1016/S1473-3099(10)70048-7] PMID: [http://pubmed.gov/20417414 20417414]</ref><ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref>


==Empiric Therapy==
====Chemotherapy Regimens====


<div style="float: left;">
<B><small>[[Thymoma treatment#Approach to Thymoma and Thymic Carcinoma|Return to top]]</small></B>


<div class="mw-collapsible mw-collapsed">
{| {{table}}
 
| align="center" style="background:#f0f0f0;" colspan=2|'''FIRST-LINE COMBINATION CHEMOTHERAPY REGIMENS'''
=====Community-Acquired Meningitis=====
| align="center" style="background:#f0f0f0;"|'''SECOND-LINE CHEMOTHERAPY'''
 
<div class="mw-collapsible-content">
 
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:32em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Newborn, Age <1 Week}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 100—150 mg/kg/day IV q8—12h'''''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q12h'''''
|-
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Newborn, Age 1—4 Weeks}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 150—200 mg/kg/day IV q6—8h'''''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h'''''
| '''CAP''' (preferred for thymoma) <BR> * Cisplatin 50 mg/m² IV day 1  <BR> * Doxorubicin 50 mg/m² IV day 1 <BR>  * Cyclophosphamide 500 mg/m² IV day 1 <BR>  Administered every 3 weeks|| '''PE''' <BR> * Cisplatin 60 mg/m² IV day 1 <BR> *Etoposide 120 mg/m²/d IV days 1  -3 <BR> Administered every 3 weeks||rowspan=3 valign=top|Etoposide <BR> Ifosfamide <BR> Pemetrexed <BR> Octreotide (including LAR) + prednisone <BR> 5-FU and leucovirin <BR> Gemcitabine    <BR> Paclitaxel
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
| '''CAP with Prednisone'''  <BR>  * Cisplatin 30 mg/m² IV days 1-3 <BR> * Doxorubicin 20 mg/m²/d <BR> IV continuous infusion on days 1 to 3 <BR> * Cyclophosphamide 500 mg/m² IV on day 1 <BR> * Prednisone 100 mg/day on days 1-5 <BR> Administered every 3 weeks||'''VIP''' <BR> * Etoposide 75 mg/m² on days 1-4 <BR>* Ifosfamide 1.2 g/m² on days 1-4  <BR> * Cisplatin 20 mg/m² on days 1-4 <BR> Administered every 3  weeks
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸'''''[[Tobramycin]]2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸ '''''[[Amikacin]] 10 mg/kg IV q8h'''''
| '''ADOC''' <BR> * Cisplatin 50 mg/m² IV day 1 <BR> * Doxorubicin 40 mg/m² IV day 1  <BR> * Vincristine 0.6 mg/m² IV day 3  <BR> * Cyclophosphamide 700 mg/m² IV day 4 <BR> Administered every 3 weeks || '''Carboplatin/Paclitaxel''' (preferred for Thymic Carcinoma) <BR>* Carboplatin AUC 6 <BR> *  Paclitaxel 225 mg/m² <BR> Administered every 3 weeks
|-
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Infant and Children}}''<sup>†</sup>
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <BR> to achieve serum trough concentrations of 15–20 μg/mL
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 225—300 mg/kg/day IV q6–8h''''' <BR>''OR''<BR>▸'''''[[Ceftriaxone]] 80—100 mg/kg/day IV q12–24h''''' <BR> <BR> <BR> <BR>
|-
|-
|}
|}
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:32em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age <50 Years}}<sup>†</sup>''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h''''' <BR> to achieve serum trough concentrations of 15–20 μg/mL
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age >50 Years}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Immunocompromised}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h''''' <BR> ''OR'' <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Recurrent}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]]  8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|}
|}
<sup>†</sup>Add '''''[[Ampicillin]] 2 g IV q4h''''' ('''''50 mg/kg IV q6h''''' for children) if meningitis caused by ''[[Listeria monocytogenes]]'' is also suspected.
</div></div>
<div class="mw-collapsible mw-collapsed">
=====Healthcare-Associated Meningitis=====
<div class="mw-collapsible-content">
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:32em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Basilar Skull Fracture}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]]  8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR> ▸'''''[[Ceftriaxone]] 2 g IV q12h'''''<BR><BR><BR>
|}
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:32em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Head Trauma; Post-Neurosurgery}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]]  2 g IV q8 h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h'''''
|}
|}
<SMALL>Adapted from ''Advances in treatment of bacterial meningitis. Lancet. 2012;380(9854):1693-702.''</SMALL><ref name="van de Beek-2012">{{Cite journal  | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref>


</div></div>


</div>
====Radiation Dose====


<div style="text-align: left;">
<B><small>[[Thymoma treatment#Approach to Thymoma and Thymic Carcinoma|Return to top]]</small></B>
<div style="margin: auto; clear: both;">
</div>
</div>


==References==
* A dose of 60-70 Gy should be given to patients with unresectable disease.
{{Reflist|2}}


[[Category:Primary care]]
* 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.
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Diseases involving the fasciae]]
[[Category:Inflammations]]
[[Category:Neurological disorders]]

Latest revision as of 03:34, 28 February 2014

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Thymic Tumor, Resectable Adapted from NCCN Guidelines: Thymomas and Thymic Carcinomas[1]

 
 
 
 
 
 
 
 
 
 
 
 
RESECTABLE Thymic Tumor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NO
Residual Tumor
 
 
 
 
 
 
 
MICROSCOPIC
Residual Tumor
 
 
 
 
 
 
 
MACROSCOPIC
Residual Tumor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage I
 
Stages II-IV
 
 
 
Thymoma
 
Thymic Carcinoma
 
 
 
Thymoma
 
Thymic Carcinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surveillance†
 
 
 
 
 
 
 
 
 
 
 
 
 


† CT scan every 6 months for 2 years, then annually every 5 years for thymic carcinoma and every 10 years for thymoma.


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.
  1. ↑ "https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf" (PDF). External link in |title= (help)
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