Thymoma / Thymic carcinoma 229
46. Thymoma / Thymic carcinoma
46.1 General considerations
Thymomas originate within the epithelial cells of the thymus; They also contain admixtures or (bengin) lymphocytes . Thymic carcinoma is also believed to be a tumor of the thymic epithelium, but it is associated with a paucicity of lymphocytes and often presents with more invasive or metastatic disease.
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Masaoka staging system of thymomas (adapted) |
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Stage Description |
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I Macroscopically completely encapsulated with no microscopic extracapsular invasion |
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IIA Microscopic invasion through the capsule |
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IIB Macroscopic invasion into mediastinal fat or pleura |
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III Macroscopic invasion into adjacent structures (i.e. pericardium, great vessels, or lung) |
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IVA Pleural or pericardial metastases |
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IVB Lymphogenous or hematogenous metastases |
For the majority of patients with localized thymomas surgery is the principal treatment . The rate of failure after complete resection of encapsulated disease is considerably low. Local control and survival seem to be improved by adjuvant radiotherapy in more advanced, but respectable disease. Chemotherapy can be offered to patients with locally advanced, recurrent, or metastatic thymoma, with responses in 50-80 % of patients and prolonged survival .
The optimal coordination of chemotherapy, radiation therapy, and surgery in a multimodality approach has yet to be defined.
Literature: for review e.g.
GIACCONE, Ann. Oncol. 11 (Supple. 3) ( 2000) : 245-246
JOHNSON et al, Oncologist 6(2001): 239- 246
LARA, Cancer Treat. Rev. 26 (2000): 127 – 131
LOEHRER and WICk, Cancer Treat Res, 105 (2001): 277 – 302
MULLER- HERMELINK and MARX, Curr. Opin. Oncol. 12 (2000):
426-433
THOMAS et al, J. Clin. Oncol. 17 (1999) : 2280 – 2289
46.2 thymoma
46.2.1 PAC
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Cisplatin 50mg/m2 i.v.(1 h inf ) d 1 |
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Doxorubicin 50mg/m2 i.v. (bolus) d 1 |
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Cyclophosphamide 500 mg/m2 i.v. (bolus) d 1 |
To be repeated every 3 weeks ( 2-4 cycles, followed by radiotherapy as induction
therapy)
Literature:
LOEHRER et al, J. Clin. Oncol. 15(1997): 3093- 3099
230 Thymoma/ Thymic Carcinoma
46.2.2 ADOC
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Doxorubicin 40mg/m2 i.v. (bolus) d 1 |
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Cisplatin 50mg/m2 i.v. ( 1 h inf) d 1 |
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Vincristine 0.6 mg/m2 i.v. (bolus) d 2 |
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Cyclophosphamide 700 mg/m2 i.v. (bolus) d 4 |
To be repeated every 3 weeks ( 3-6 cycles as induction therapy)
Literature:
BERRUTI et al, Br. J. Cancer 81 (1999) : 841-845
46.2.3. PE
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Cisplatin 60mg/m2 i.v. ( 1 h inf) d 1 |
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Etoposide 120 mg/m2 i.v. (30 min inf) d 1-3 |
To be repeated every 3 weeks
Literature:
GIACCONE et al, J. Clin. Oncol. 14 (1996): 814 – 820
46.2.4 ifosfamide
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Ifosfamide 1500mg/m2 i.v. (30 min inf) d 1-5 With mesna uroprotection |
To be repeated every 3 weeks
Literture:
HIGHLEY et al, J. Clin. Oncol. 17 (1999): 2737 – 2744
46.3. Thymic carcinoma
Treatment can be tried with cisplatin-based regimens used in germ cell tumors (e.g. BEP).
Literature:
WEIDE et al, Cancer 71 (1993): 1219 – 1223