Role of chemotherapy in the management of advanced thymic tumors.
Chemotherapy has an important role in the treatment of advanced thymic tumors. Early stage tumors are successfully treated with surgery. Locally advanced tumors (Masaoka stage III and IVA) are often treated with combined modality treatment including surgery, radiation, and chemotherapy. For patients with curable thymic tumors, the ability to attain a complete resection is a critical prognostic factor. Locally advanced tumors have a relatively high risk of recurrence and decreased rates of long-term survival. A multimodality approach including induction chemotherapy and postoperative radiation therapy can improve complete resection rates and long-term outcomes. Thymic tumors are chemoresponsive with optimal responses achieved with cisplatin-based combination chemotherapy. Chemotherapy with radiation can result in long-term progression-free survival for patients with locally advanced disease who remain inoperable following induction therapy. Patients with disseminated (stage IVB) thymic tumors can also have significant disease response and palliation of symptoms when treated with chemotherapy. Octreotide and corticosteroids also have shown efficacy. For best results, it is important that thoracic surgeons, radiation oncologists, and medical oncologists work together to obtain the best local control of tumor and optimal treatment of metastases.
Evans
Tracey L
TL
University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania-Presbyterian, 103 Medical Arts Building, 39th and Market Streets, Philadelphia, PA 19104, USA. tracey.evans@uphs.upenn.edu
Lynch
Thomas J
TJ
D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D018570:Risk Assessment; D015996:Survival Rate; D013934:Thymectomy / Q000379:methods; D013945:Thymoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D013953:Thymus Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome