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{{thymoma}}




{{familytree/start |Resectable}}
{{familytree/start |Resectable}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | | | | | | | | | | | A01 | | | |A01=<div style="float: left; text-align: center; height: 1.5em; width: 12em; padding: 1em; font-size: 100%">Pathology evaluation</div>}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | | | | | | | | | | | A01 | | | |A01=<div style="float: left; text-align: center; height: 2.5em; width: em; padding: 1em; font-size: 100%">Pathology Evaluation</div>}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | |,|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|.| | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | |,|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|.| | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | B01 | | | | | | | | B03 | | | | | | | | B02 | | |B01=R0 Resection|B02=R2 Resection|B03=R1 Resection}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | B01 | | | | | | | | B03 | | | | | | | | B02 | | |B01=R0 Resection|B02=R2 Resection|B03=R1 Resection}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |,|-|^|-|.| | | | | |,|-|^|-|.| | | | |,|-|^|-|.| | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |,|-|^|-|.| | | | | |,|-|^|-|.| | | | | |,|-|^|-|.| | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | D01 | | D02 | | | | | D03 | | D04 | | | D05 | | D06 | |D01=Thymoma, no capsular invasion or thymic carcinoma,stage I|D02=Thymoma or thymic carcinoma, capsular invasion presents stages II-IV|D03=Thymoma|D04=Thymic carcinoma|D05=Thymoma|D06=Thymic carcinoma}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | D01 | | D02 | | | | D03 | | D04 | | | | D05 | | D06 | |D01=Thymoma, no capsular invasion or thymic carcinoma, stage I|D02=Thymoma or thymic carcinoma, capsular invasion present, stages II-IV|D03=Thymoma|D04=Thymic carcinoma|D05=Thymoma|D06=Thymic carcinoma}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |!| | | |!| | | | | |!| | | |!| | | | | |!| | | |!| | | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |!| | | |!| | | | | |!| | | |!| | | | | |!| | | |!| | | }}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | E01 | | E02 | | | | E03 | | E04 | | | | E05 | | E06 | | | |E01=Surveillance for recurrence with CT every 6 month for 2 y, then annually every 5 y for thymic carcinoma and 10 y for thymoma|E02=Consider postoperative RT|E03=Postoperative RT|E04=Postoperative RT+chemotherapy|E05=RT +/- chemotherapy|E06=RT + Chemotherapy}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |!| | | E02 | | | | E03 | | E04 | | | | E05 | | E06 | | | |E02=Postoperative '''[[Thymoma treatment#Radiation Dose|RT]]'''|E03=Postoperative '''[[Thymoma treatment#Radiation Dose|RT]]'''|E04=Postoperative '''[[Thymoma treatment#Radiation Dose|RT]]''' + '''[[Thymoma treatment#Chemotherapy Regimens|Chemotherapy]]'''|E05='''[[Thymoma treatment#Radiation Dose|RT]]''' ± '''[[Thymoma treatment#Chemotherapy Regimens|Chemotherapy]]'''|E06='''[[Thymoma treatment#Radiation Dose|RT]]''' + '''[[Thymoma treatment#Chemotherapy Regimens|Chemotherapy]]'''}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |!| | | |!| | | | | |!| | | |!| | | | | |!| | | |!| | | |}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | |!| | | |!| | | | | |!| | | |!| | | | | |!| | | |!| | | |}}
{{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; | | | | | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | | | | | | | | | | | | | F01 | | | | | | | | | | | | | |F01=G01=Surveillance for recurrence with CT every 6 month for 2 y, then annually every 5 y for thymic carcinoma and 10 y for thymoma}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke; | | | | | | | | | | | | | F01 | | | | | | | | | | | | | |F01=Surveillance for recurrence with CT <BR> every 6 month for 2 y, then annually every 5 y for thymic carcinoma <BR> and 10 y for thymoma}}
{{familytree/end}}
{{familytree/end}}
====Chemotherapy Regimens====
<B><small>[[Thymoma treatment#Approach to Thymoma and Thymic Carcinoma|Return to top]]</small></B>
{| {{table}}
| align="center" style="background:#f0f0f0;" colspan=2|'''FIRST-LINE COMBINATION CHEMOTHERAPY REGIMENS'''
| align="center" style="background:#f0f0f0;"|'''SECOND-LINE CHEMOTHERAPY'''
|-
| '''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
|-
| '''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
|-
| '''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
|-
|}
====Radiation Dose====
<B><small>[[Thymoma treatment#Approach to Thymoma and Thymic Carcinoma|Return to top]]</small></B>
* 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.

Latest revision as of 21:16, 27 February 2014


 
 
 
 
 
 
 
 
 
 
 
 
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

Return to top

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

Return to top

  • 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.