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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Re-evaluate
for surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Resectable
 
Unresectable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surgery ±
Postoperative RT
 
 


















































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.


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