title: State of the art: diagnostic tools and innovative therapies for treatment of advanced thymoma and thymic carcinoma.
abstract: In this review article, state-of-the-art diagnostic tools and innovative treatments of thymoma and thymic carcinoma (TC) are described with special respect to advanced tumour stages. Complete surgical resection (R0) remains the standard therapeutic approach for almost all a priori resectable mediastinal tumours as defined by preoperative standard computed tomography (CT). If lymphoma or germ-cell tumours are differential diagnostic considerations, biopsy may be indicated. Resection status is the most important prognostic factor in thymoma and TC, followed by tumour stage. Advanced (Masaoka-Koga stage III and IVa) tumours require interdisciplinary therapy decisions based on distinctive findings of preoperative CT scan and ancillary investigations [magnetic resonance imaging (MRI)] to select cases for primary surgery or neoadjuvant strategies with optional secondary resection. In neoadjuvant settings, octreotide scans and histological evaluation of pretherapeutic needle biopsies may help to choose between somatostatin agonist/prednisolone regimens and neoadjuvant chemotherapy as first-line treatment. Finally, a multimodality treatment regime is recommended for advanced and unresectable thymic tumours. In conclusion, advanced stage thymoma and TC should preferably be treated in experienced centres in order to provide all modern diagnostic tools (imaging, histology) and innovative therapy techniques. Systemic and local (hyperthermic intrathoracic chemotherapy) medical treatments together with extended surgical resections have increased the therapeutic options in patients with advanced or recurrent thymoma and TC.
authors.affiliation: Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany micha.ried@t-online.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Ried
authors.affiliation: Institute for Pathology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Marx
authors.affiliation: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Götz
authors.affiliation: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Okka
authors.initials: O
authors.lastname: Hamer
authors.affiliation: Department of Neurology, University Regensburg at the District Medical Center, Regensburg, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Schalke
authors.affiliation: Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Hans-Stefan
authors.initials: HS
authors.lastname: Hofmann
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D009367:Neoplasm Staging; D013934:Thymectomy; D013945:Thymoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D013953:Thymus Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D014057:Tomography, X-Ray Computed
keywords: Hyperthermic intrathoracic chemotherapy; Multimodality therapy; Thymic carcinoma; Thymoma