Multidisciplinary management of thymic carcinoma.
Thymic carcinomas represent approximately 10% of thymic tumors. In our approach to patients with thymic carcinoma, we emphasize multimodality treatment with close communication between the pathologist, thoracic surgeon, medical oncologist, and radiation oncologist. Given the paucity of high-quality clinical research data, treatment decisions are guided by a small amount of prospective trial data, retrospective reports, and clinical experience. Surgical management of thymic carcinoma must account for the more aggressive biology, higher degree of local invasion of neighboring structures, greater propensity for nodal metastasis, and higher risk of distant metastatic disease. Although surgical resection remains the most important component in the management of localized thymic tumors, radiation therapy (RT) may be used as adjuvant therapy after surgical resection or as the definitive treatment modality in patients who are deemed unresectable because of medical comorbidities or technical reasons. Systemic therapy for thymic carcinoma is used in two clinical scenarios: preoperative treatment and palliative therapy. First-line, platinum-based chemotherapy regimens are associated with response rates between 22% and 75%. Recent data from targeted therapy trials do not reveal a clear role for targeted therapies for patients with thymic carcinoma.
From the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY; Thoracic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center New York, NY; Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
Gregory J
GJ
Riely
From the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY; Thoracic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center New York, NY; Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
James
J
Huang
From the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY; Thoracic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center New York, NY; Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
Andreas
A
Rimner