Thymoma medical therapy: Difference between revisions

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VisualWikitext

Latest revision as of 16:33, 15 August 2019

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

Overview

Chemotherapy and radiotherapy are used as adjuvant or neoadjuvant therapies. Neoadjuvant therapy may be administered prior to surgery to make the tumor resectable. Radiotherapy is used in the treatment of unresectable thymoma. Radiotherapy may be used to decrease the size of the tumor and improve resectability, before surgery is attempted.

Medical Therapy

Resectable

Resection of primary tumor & isolated metastasis

Consider postoperative radiotherapy

Locally advanced

Chemotherapy

Re-evaluate for surgery

Unresectable

Radiotherapy +/- chemotherapy

Chemotherapy

Thymoma

Isolated solitary metastasis

Surgery

Consider chemotherapy or radiotherapy

Evidence of distant metastasis

Chemotherapy

Adopted from the NCCN treatment algorithm^[1]

Chemotherapy

Chemotherapy is used in locally advanced thymomas, after which patients are re-evaluated for resectability.
In cases of isolated solitary metastasis, surgery may be attempted before chemotherapy administration.
Chemotherapy is also used if there is evidence of distant metastasis.
Most of the chemotherapy regimens used are based on cisplatin and anthracyclines.

Corticosteroids

Corticosteroids may be used in unresectable tumors that are refractory to radiation therapy, leading to transient partial responses.^[2]
Similar to the effects of aging and stress, steroids increase thymic fat and connective tissue and decrease corticomedullary differentiation.
Therefore in WHO sub-types A and B thymomas, corticosteroids cause tumor size reduction mainly through lymphocyte depletion.^[3]

Radiotherapy

Radiotherapy is used in unresectable thymoma or incompletely resected invasive thymoma.
The dose and fraction schemes of radiotherapy depend on the indication of the radiation and the completeness of surgical resection.^[4]

References

↑ "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)
↑ "http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma". External link in |title= (help)
↑ "Octreotide alone or with prednisone in patients... [J Clin Oncol. 2004] - PubMed - NCBI".
↑ "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)

[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)

[www.cancernet.nci.nih.gov-2] "http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma". External link in |title= (help)

[www.ncbi.nlm.nih.gov-3] "Octreotide alone or with prednisone in patients... [J Clin Oncol. 2004] - PubMed - NCBI".

[4] "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)

[1]

[2]

[3]

[4]

@@ Line 1: / Line 1: @@
-Medi__NOTOC__
+__NOTOC__
 {{Thymoma}}
-{{CMG}} {{AE}} {{AM}}
+{{CMG}}; {{AE}} {{AM}}
-Please help WikiDoc by adding more content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
+==Overview==
+[[Chemotherapy]] and [[radiotherapy]] are used as [[adjuvant therapy|adjuvant]] or [[neoadjuvant therapy|neoadjuvant therapies]]. [[Neoadjuvant therapy]] may be administered prior to [[surgery]] to make the [[tumor]] [[Resection|resectable]]. [[Radiotherapy]] is used in the treatment of unresectable thymoma. [[Radiation therapy|Radiotherapy]] may be used to decrease the size of the [[tumor]] and improve [[Resection|resectability]], before [[surgery]] is attempted.
-==Overview==
-Surgery is the main stay of therapy. Chemo and radio therapy are used as adjuvant ot neoadjuvant therapies. Sometimes they are used prior to surgery to make the tumor resectable.
-Signs and symptoms of [[myasthenia gravis]] should be evaluated before surgery and medically controlled.
 ==Medical Therapy==
-{|
+<small>
-| [[File:nccn.png|800px|thumb]]
+{{familytree/start |summary=Treatment of Thymoma.}}
-|}<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>
+{{familytree | | | | | | | | | | | | | | | | | | |,|-| G01 |-| G02 |-| G03 | | | |G01=Resectable |G02=Resection of primary tumor & isolated metastasis |G03=Consider postoperative radiotherapy }}
+{{familytree | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
+{{familytree | | | | | | |,|-| A01 |-| A02 |-| A03 | | | |A01=Locally advanced |A02=Chemotherapy |A03=Re-evaluate for surgery }}
+{{familytree | | | | | | |!| | | | | | | | | | |!|!| | | | | | | | | | | | | | | | | | }}
+{{familytree | | | | | | |!| | | | | | | | | | |!|`|-| F01 |-| F02 | | | |F01=Unresectable |F02=Radiotherapy +/- chemotherapy }}
-====Radiotherapy====
+{{familytree | | | | | | |!| | | | | | | | | | |!| | | | | | | }}
-Radiotherapy is used in unresectable thymoma or incompletely resected invasive thymoma.
+{{familytree | | | | | | |!| | | | | | | | | | |!| | | | | | | }}
-The dose and fractionation schemes of RT depend on the indication of the radiation and the completeness of surgical resection.<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>
+{{familytree | | | | | | |!| | | | | | | | | | |!| | | | | | | }}
+{{familytree | | | | | | |!| | | |,|-| I01 |-|-|'| | |I01=Chemotherapy }}
+{{familytree | | | | | | |!| | | |!| | | | | | | | | | | | | | | | | | }}
+{{familytree | | | Thymoma |-|+|-| C02 | | | |Thymoma=Thymoma |C02=Isolated solitary metastasis }}
+{{familytree | | | | | | |!| | | |!| | | | | | | | | | | | | | | | | | }}
+{{familytree | | | | | | |!| | | |`|-| H01 |-| H02 | | | |H01=Surgery |H02=Consider chemotherapy or radiotherapy }}
+{{familytree | | | | | | |!| | | | | | | | | | | | | | | | | | }}
+{{familytree | | | | | | |!| | | | | | | | | | | | | | | | | | }}
+{{familytree | | | | | | |!| | | | | | | | | | | | | | | | | | }}
+{{familytree | | | | | | |`|-| E01 |-| E02 | | | |E01=Evidence of distant metastasis |E02=Chemotherapy }}
+{{familytree/end}}
+</small>
+Adopted from the NCCN treatment algorithm<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>
 ====Chemotherapy====
-It is used in '''locally advanced''' thymomas then re-evaluated for resectability. In cases of '''isolated solitary metastasis''', we either start with chemo then re-evaluate for surgery or start by surgery.
+*[[Chemotherapy]] is used in locally advanced thymomas, after which [[Patient|patients]] are re-evaluated for [[Resection|resectability]].
-It is also used if there is evidence of '''distant metastasis'''.
+*In cases of isolated [[solitary]] [[metastasis]], [[surgery]] may be attempted before [[chemotherapy]] administration.
+*[[Chemotherapy]] is also used if there is evidence of distant [[metastasis]].
+*Most of the [[Chemotherapy regimen|chemotherapy regimens]] used are based on [[cisplatin]] and [[anthracyclines]].
 ====Corticosteroids====
-Corticosteroids may be used in unresectable tumors that have been refractory to radiation therapy leading to transient partial responses.<ref name="www.cancernet.nci.nih.gov">{{Cite web  | last =  | first =  | title = http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma | url = http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma | publisher =  | date =  | accessdate = }}</ref>
+*[[Corticosteroid|Corticosteroids]] may be used in unresectable [[Tumor|tumors]] that are refractory to [[radiation therapy]], leading to [[transient]] partial responses.<ref name="www.cancernet.nci.nih.gov">{{Cite web  | last =  | first =  | title = http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma | url = http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma | publisher =  | date =  | accessdate = }}</ref>
-Similar to the effects of ageing and stress, steroids increase thymic fat and connective tissue and
+*Similar to the effects of [[Ageing|aging]] and [[Stress (medicine)|stress]], [[Steroid|steroids]] increase [[Thymus|thymic]] [[fat]] and [[connective tissue]] and decrease corticomedullary differentiation.
-decrease corticomedullar differentiation. Therefore in WHO subtypes A and B thymoma, corticosteroids produce tumour size reduction due to lymphocyte depletion.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Octreotide alone or with prednisone in patients... [J Clin Oncol. 2004] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/14722038 | publisher =  | date =  | accessdate = }}</ref>
+*Therefore in [[World Health Organization|WHO]] sub-types A and B thymomas, [[Corticosteroid|corticosteroids]] cause [[tumor]] size reduction mainly through [[lymphocyte]] depletion.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Octreotide alone or with prednisone in patients... [J Clin Oncol. 2004] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/14722038 | publisher =  | date =  | accessdate = }}</ref>
+====Radiotherapy====
+*[[Radiation therapy|Radiotherapy]] is used in unresectable thymoma or incompletely [[Resection|resected]] [[invasive]] thymoma.
+* The [[dose]] and fraction schemes of [[Radiation therapy|radiotherapy]] depend on the [[Indication (medicine)|indication]] of the [[radiation]] and the completeness of [[surgical resection]].<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>
 ==References==
 {{Reflist|2}}
-[[Category:Oncology]]
 [[Category:Types of cancer]]
 [[Category:Rare diseases]]
 [[Category:Disease]]
-[[Category:Needs content]]
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Hematology]]
+[[Category:Immunology]]
+[[Category:Surgery]]

Thymoma medical therapy: Difference between revisions

Latest revision as of 16:33, 15 August 2019

Overview

Medical Therapy

Chemotherapy

Corticosteroids

Radiotherapy

References

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