A single institutional experience of thymic epithelial tumours over 11 years: clinical features and outcome and implications for future management

Lee, H. S.; Kim, S. T.; Lee, J.; Choi, Yong Soo; Han, Joung Ho; Ahn, Yong Chan; Lee, Kyung Shik; Ahn, Jin Seok; Ahn, Myung Ju; Kim, Kwhanmien; Shim, Young Mog; Kim, J.; Park, K.

doi:10.1038/sj.bjc.6603833

Cited by 24 publications

(27 citation statements)

References 27 publications

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“…Recently, the WHO Consensus Committee recommended that epithelial tumors of thymus be classified as thymoma, including type A, AB, B1, B2, and B3 thymoma and thymic carcinoma (29). Most of the WHO type A, AB, B1, and B2 thymomas are benign; however, types B3 and C have malignant potential (30). Our study (24) demonstrated that 16 of 140 thymomas patients experienced recurrences.…”

Section: Pathologic Classificationmentioning

confidence: 58%

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma

Odaka¹,

Tsukamoto²,

Shibasaki³

et al. 2017

J. Vis. Surg.

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type classification are valuable predictors of the prognosis of thymoma; hence, the optimal treatment for thymoma should be performed according to these two. TT is less invasive, with equivalent oncological outcomes, when compared with the OT. Minimally invasive surgery including TT for stage I-II thymomas is becoming the mainstay of therapy. (16,(20)(21)(22)(23). In our previous study (24), Masaoka stage III-IV thymoma patients experienced more recurrences than those with stage I-II patients. The 5-year disease-free survival (DFS) for stage III-IV thymomas was significantly poorer than those for stage I and II thymoma (47% vs. 97.5% and 94.1%, respectively). Hence, the Masaoka stage was a valuable predictor of the prognosis of thymoma. Keywords Pathologic classificationThe pathologic classification of thymoma has remained controversial for many years (25). The World Health Organization (WHO) has developed the most widely adopted pathologic classification for epithelial tumor of thymus by taking into consideration both histological and morphological features (26). There are two staging systems for epithelial tumor of thymus (27). Most widely used clinical stage was first described by Masaoka et al. in 1981, and it is a clinical staging system describing thymomas in terms of local extension or invasion of the tumor (6). The TNM staging follows the pattern of T for tumor descriptor, N for nodal spread, and M for distance metastasis. In 1999, the WHO Consensus Committee published a histologic typing system for neoplasms of the thymus (28). Thymomas are classified into types A, AB, B1, B2, B3, and C based on the morphology of epithelial cells and ratio of lymphocyteto-epithelial cells. Recently, the WHO Consensus Committee recommended that epithelial tumors of thymus be classified as thymoma, including type A, AB, B1, B2, and B3 thymoma and thymic carcinoma (29). Most of the WHO type A, AB, B1, and B2 thymomas are benign; however, types B3 and C have malignant potential (30). Our study (24) demonstrated that 16 of 140 thymomas patients experienced recurrences. Of those 16 patients, 12 patients had WHO type B3 or C thymomas. Thus, pathological aggressiveness seems to strongly influence recurrence. Several reports have indicated the impact of the WHO type on the decisionmaking during clinical treatments (26). Surgical treatmentMost patients having Masaoka stage I-II thymoma receive surgical treatment. Recently, TT has been attempted as a surgical treatment for thymoma. TT for thymoma consists of extended thymectomy (ET), total thymectomy, subtotal thymectomy (STT), and partial thymectomy according to the classification of the extent of the thymus resected. In this review, a few authors classified thymectomy by total and partial thymectomy, while some authors do not describe the resected extent of thymus clearly. Total thymectomy was defined as the resection of the entire thymus, and ET was defined as the resection with the thymus and surrounding fat tissues together. ET was usually performed in patients who had MG. F...

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Section: Pathologic Classificationmentioning

confidence: 58%

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma

Odaka¹,

Tsukamoto²,

Shibasaki³

et al. 2017

J. Vis. Surg.

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“…[7,12] İlk nüks yeri plevra/perikard, akciğer olup yüksek riskli ve ileri evrede adjuvan tedavi ile nüksün önlenebileceği bildirilmektedir. [3,7] EIII-IV olgularda TE sonrası adjuvan RT önerilirken, EII olup TE timomalı olgularda adjuvan tedavi kararı-nın kötü risk faktörleri varlığında verilmesi gerektiği vurgulanmaktadır. [13][14][15][16] Sağkalım açısından invazivlik, rezeksiyon tipi, MG varlığı, ileri yaş, tümör çapı, hücre siklus protein ekspresyonu gibi birçok PF ortaya konmasına rağmen genel olarak Masaoka ve DSÖ sınıflaması en iyi ve geçerli prediktörler olarak kabul edilmekte ve adjuvan tedavi kararının PF'ye göre verilmesi gerektiği bildirilmektedir.…”

Section: Discussionunclassified

“…[13][14][15][16] Sağkalım açısından invazivlik, rezeksiyon tipi, MG varlığı, ileri yaş, tümör çapı, hücre siklus protein ekspresyonu gibi birçok PF ortaya konmasına rağmen genel olarak Masaoka ve DSÖ sınıflaması en iyi ve geçerli prediktörler olarak kabul edilmekte ve adjuvan tedavi kararının PF'ye göre verilmesi gerektiği bildirilmektedir. [1,3,[17][18][19][20] Masaoka evresine göre beş yıllık GSK EI-III timoma için %85, EIV için %65 bildirilmektedir.…”

Section: Discussionunclassified

“…[1] Görülme sıklığı Masaoka EI-II-III-IV için sırasıyla %40, %19.5, %21, %19.5 bildirilmekte olup beş yıllık GSK; EI-III için %70, EIV için %50'dir. [3] DSÖ alt tip görülme sıklığı tip A-AB-B-C için sırasıyla; %4.6, %18.9, %60, %16.4 bildirilmektedir. [3] Ancak DSÖ sınıflama-sı alt tipleri için fikir birliği güç olup prognostik önemi rezeksiyon tipine göre daha azdır.…”

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“…[3] DSÖ alt tip görülme sıklığı tip A-AB-B-C için sırasıyla; %4.6, %18.9, %60, %16.4 bildirilmektedir. [3] Ancak DSÖ sınıflama-sı alt tipleri için fikir birliği güç olup prognostik önemi rezeksiyon tipine göre daha azdır. [2,4] D'Angelillo ve ark.nın çalışmasında; Masaoka evre ve DSÖ sınıflaması temel alınarak iyi-ortakötü risk grupları oluşturulmuş ve gruplar arasında sağkalım farkı gösterilmiştir (10 yıl GSK, sırasıy-la; %95 -%90 -%50).…”

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Thymic tumors and outcomes after radiotherapy

Sarıhan¹

2013

TJ Oncol

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OBJECTIVESWe evaluated the results of treatment in patients with thymic tumors treated with postoperative adjuvant radiotherapy. METHODSEighteen patients were treated median 5400 cGy radiotherapy between 1995-2010. Diagnosis of patients were thymoma (n=10), thymic carcinoma (n=7), thymic neuroendocrin carcinoma (n=1). R0 resection was made on 12 of them. According to prognostic stratification with Masaoka stage and WHO classification, there were 5 good, 7 moderate, and 6 poor risk patients. Survival was calculated from diagnosis. RESULTSA total of 33% patients were recurred median 29.5 months with 34 months follow-up. Local control, median overall and disease-free survival for all patients were 77%, 113 months, and 105 months. Local control for good, moderate, poor risk groups were found 100%, 71%, 50%. There were significant differences survival rates for Masaoka stage, R0 resection, and prognostic groups. CONCLUSIONPrognostic risk classification was found to be better predictive in terms of local control and survival.Key words: Thymic tumor; adjuvant radiotherapy; local control; prognostic group; survival. AMAÇCerrahi sonrası adjuvan radyoterapi uygulanan timik tümörlü olgularda tedavi sonuçları değerlendirildi. GEREÇ VE YÖNTEMOn sekiz olgu 1995-2010 arasında ortanca 5400 cGy radyoterapi ile tedavi edildi. Tanı; timoma (n=10), timik karsinom (n=7), timik nöroendokrin karsinom (n=1) olarak sıralanıyor-du. Olguların 12'sine R0 rezeksiyon yapılmıştı. Masaoka evre ve Dünya Sağlık Örgütü sınıflamasını içeren prognostik risk sınıflamasına göre; 5 iyi, 7 orta ve 6 kötü riskli hasta vardı. Sağkalım tanıdan itibaren hesaplandı. BULGULAROtuz dört aylık izlem süresi içinde olguların %33'ünde ortanca 29.5 ayda nüks görüldü. Lokal kontrol, ortanca genel ve hastalıksız sağkalım tüm olgular için; %77, 113 ay, 105 ay bulundu. İyi-orta-kötü prognostik gruplar için lokal kontrol %100, %71, %50 oldu. Masaoka evre, R0 rezeksiyon, prognostik risk grupları için sağkalım oranlarında anlamlı fark vardı. SONUÇPrognostik risk sınıflamasının lokal kontrol ve sağkalım açı-sından daha iyi prediktör olduğu görüldü.

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American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma

et al. 2023

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ImportanceThymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management.ObjectiveTo develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma.Evidence ReviewCase variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. Variants and procedures were evaluated by the panel using modified Delphi methodology. Agreement/consensus was defined as less than or equal to 3 rating points from median. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures.FindingsThe ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs.Conclusions and RelevanceThe ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.

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A single institutional experience of thymic epithelial tumours over 11 years: clinical features and outcome and implications for future management

Cited by 24 publications

References 27 publications

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma

Thymic tumors and outcomes after radiotherapy

American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma

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