Thymoma medical therapy
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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]
Overview
Chemotherapy and radiotherapy are used as adjuvant or neoadjuvant therapies. Neoadjuvant therpy may be administered prior to surgery to make the tumor resectable.
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 any chemotherapy is administered.
- 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 ageing and stress, steroids increase thymic fat and connective tissue and decrease corticomedullary differentiation.
- Therefore in WHO subtypes A and B thymomas, corticosteroids cause tumor size reduction mainly through lymphocyte depletion.[3]
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".