Sandbox/ttt1
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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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Chemotherapy Regimens
| 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
- 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.