Thymoma medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(4 intermediate revisions by 2 users not shown)
Line 4: Line 4:


==Overview==
==Overview==
* Chemotherapy and radiotherapy are used as [[adjuvant therapy|adjuvant]] or [[neoadjuvant therapy|neoadjuvant therapies]].  
[[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.
* Neoadjuvant therpy may be administered prior to surgery to make the tumor resectable.


==Medical Therapy==
==Medical Therapy==
Line 35: Line 34:


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


====Corticosteroids====
====Corticosteroids====
*Corticosteroids may be used in unresectable 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>
*[[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 decrease corticomedullary differentiation.  
*Similar to the effects of [[Ageing|aging]] and [[Stress (medicine)|stress]], [[Steroid|steroids]] increase [[Thymus|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.<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==
==References==

Latest revision as of 16:33, 15 August 2019

Thymoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Thymoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Thymoma medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Thymoma medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Thymoma medical therapy

CDC on Thymoma medical therapy

Thymoma medical therapy in the news

Blogs on Thymoma medical therapy

Directions to Hospitals Treating Thymoma

Risk calculators and risk factors for Thymoma medical therapy

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

Corticosteroids

Radiotherapy

References

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