Management of thymomas

Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Blake 1570, Boston, MA 02114, USA.
Critical Reviews in Oncology/Hematology (Impact Factor: 4.03). 03/2008; 65(2):109-20. DOI: 10.1016/j.critrevonc.2007.04.005
Source: PubMed


Thymoma is a rare neoplasm usually with an indolent growth pattern, however, local invasion and/or metastases may occur. The association with several paraneoplastic syndromes, especially myasthenia gravis, is noteworthy. Surgery has been the standard of care for early stage disease with high cure rates anticipated. The most important prognostic factors after resection are Masaoka stage, World Health Organization (WHO) histology, complete resection status and size. Multimodality therapy can result in long-term disease-free survival for patients presenting with locally advanced disease. Thymomas are sensitive to both chemotherapy and radiation therapy and are utilized with good effects in unresectable patients.

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    • "Distinction between histological subtypes has important clinical implications. Thymomas are low-grade malignant tumours that tend to invade surrounding organs and rarely give distant metastasis [12]. Thymic carcinomas are highly aggressive , may arise from malignant transformation of a pre-existing thymoma [13] and have poor prognosis due to the local invasiveness and the risk of metastasis [14]. "
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    ABSTRACT: Thymomas and thymic carcinomas belong to a group of thymic epithelial tumours arising from the anterior mediastinum and, are extremely rare in children in which no therapeutic guidelines have been established. The aim is to describe paediatric characteristics of these tumours and give some therapeutic indications. Retrospective analysis of clinical data and therapeutic characteristics of paediatric patients less than 18years with thymic tumours treated between 2000 and 2012 registered in the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) database of the cooperating national rare paediatric tumour working groups from France, Italy, Germany and Poland. Sixteen children with thymoma, median age 11years and 20 patients with thymic carcinoma, median age 14years were enrolled into study. At diagnosis complete primary resection was possible in 11 patients with thymoma and one with thymic carcinoma; resection with microscopic residue was performed in three cases and incomplete resection with macroscopic residue in four patients. Chemotherapy with various regimens was administered to 22 children; 17 of them as neoadjuvant chemotherapy. Eight patients with thymic carcinoma received additional radiotherapy. Seventeen children died (15 thymic carcinoma, two thymoma). Five-year overall survival for patients with thymic carcinoma is 21.0±10.0%. This study confirms the possibility to perform European retrospective analysis even in very rare paediatric tumours. Thymic carcinoma is associated with paediatric patients to give a very poor prognosis independently despite multimodal management. Multidisciplinary, multicenter approach and collaboration with adults' physician are necessary in order to propose homogenous guidelines. Copyright © 2015 Elsevier Ltd. All rights reserved.
    European journal of cancer (Oxford, England: 1990) 08/2015; 51(16). DOI:10.1016/j.ejca.2015.06.121 · 5.42 Impact Factor
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    • "First, when limited thymectomy is performed, one issue is how to guarantee a sufficient margin while achieving complete resection. Transcapsular perithymic invasion can be subtle and is often not grossly appreciable by the surgeon peri-operatively [25]. Thus, even when resection is performed to include the surrounding thymus and fatty tissue, it is unclear how much tissue in addition to thymoma should be resected to ensure complete resection. "
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    ABSTRACT: Complete resection of the thymus is considered appropriate for a thymoma resection because any remaining thymic tissue can lead to local recurrence. However, there are few studies concerning the extent of thymus resection. Therefore, we conducted a retrospective study to investigate whether recurrence following thymoma resection correlated to the extent of resection. Between 1986 and 2011, a total of 491 patients underwent resection of thymic epithelial tumors with curative intent. Of those, we excluded patients with an undetermined World Health Organization (WHO) histologic type, patients with type C thymoma, and patients who underwent incomplete resection (n = 21). The remaining 342 patients were reviewed retrospectively and compared recurrence according to the extent of resection. Extended thymectomy was performed in 239 patients (69.9%) and limited thymectomy was performed 103 patients (30.1%). In the extended thymectomy group, 29 recurrences occurred, and in the limited thymectomy group, 10 recurrences occurred.Comparing rates of freedom from recurrence between two groups, there was no significant statistical difference in total recurrence (p =0.472) or local recurrence (p =0.798). After matching patients by stage and tumor size, there was no significant difference in freedom from recurrence between the two groups (p = 0.162). Additionally, after adjusting for histologic type and MG, there was also no significant difference (p = 0.125) between groups. No difference in the rate of recurrence was observed in patients following limited thymectomy compared with extended thymectomy.
    Journal of Cardiothoracic Surgery 03/2014; 9(1):51. DOI:10.1186/1749-8090-9-51 · 1.03 Impact Factor
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    • "Wright12 suggested that a tumor size of 8 cm or larger was an independent risk factor of recurrence, and that large masses in which invasiveness is not clearly observable on CT are likely to be treated as stage III tumors. Our results also showed that a tumor size of 8 cm or larger was significantly associated with recurrence. "
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    ABSTRACT: Purpose Recurrence rate is considered a better measure of clinical outcomes after thymoma resection than overall survival due to the indolent behavior of thymomas. This study was designed to determine predictors of recurrence after thymoma resection. Materials and Methods A single-institution, retrospective study was performed, including 305 patients who had undergone thymoma resection between 1986 and 2009. Results Among 305 patients, recurrence was observed in 41 patients (13.4%). The recurrence rates were 0% (0/19), 6.3% (4/63), 4.2% (2/48), 18.6% (11/59) and 20.7% (24/116) for type A, AB, B1, B2 and B3 tumors, respectively. The recurrence rate according to Masaoka stage was 6.1% (8/132), 11.4% (13/114), 26.8% (11/41) and 50.0% (9/18) for stages I, II, III and IV, respectively. After univariate analysis, completeness of resection (R0 versus R1), World Health Organization (WHO) histologic type (A, AB, B1 versus B2, B3), Masaoka stage, and size of tumor (<8 cm versus ≥8 cm) demonstrated significant differences with freedom from recurrence. Upon multivariate analysis, Masaoka stage was the only independent predictor of recurrence. Conclusion WHO histologic type, Masaoka stage, and size of tumor were associated with recurrence. Particularly, Masaoka stage was the only independent predictor of recurrence after thymoma resection.
    Yonsei medical journal 07/2013; 54(4):875-882. DOI:10.3349/ymj.2013.54.4.875 · 1.29 Impact Factor
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