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.

The comparison of predictive factors regarding prognoses and invasion of thymic neuroendocrine tumors preoperatively and postoperatively

“…As our unpublished study concerning thymus tumors revealed that, with increasing tumor size, patients' survival decreased significantly (detailed information is not shown). Besides, previous studies reported that complete resection significantly improved OS postoperatively (6,10,18,19), consistent with previous studies based on SEER (2,3). Information of resected marginal status could not be obtained from the SEER, posing an additional limitation in the present study as well.…”

Gene-Specific Methylation Analysis in Thymomas of Patients with Myasthenia Gravis

“…On the basis of the morphology of epithelial cells and the lymphocyte to epithelial cell ratio, they are classified into five histological types, A, AB, B1, B2, and B3 [1]. The most widely used system for staging thymomas is the Masaoka–Koga staging system; according to this, thymomas are classified in stage I comprising encapsulated tumors, stages II and III showing direct local invasion, and stage IV showing metastatic spread [2]. Thymomas are associated with a wide variety of autoimmune diseases, and among these about 30%–40% of thymomas are associated with myasthenia gravis (MG), an autoimmune disease characterized by autoantibodies directed to different targets at the neuromuscular junction, such as acetylcholine receptor (AChR), muscle specific kinase (MuSK), and agrin-receptor low-density lipoprotein receptor related-protein 4 (LRP4) [3].…”

Analysis of giant thoracic neoplasms: Correlations between imaging, pathology and surgical management

“…For giant soft tissue sarcoma, advanced thymic carcinoma, or malignant germ cell tumor, (especially an aggressive tumor with an abundant blood supply strongly suspected to be unresectable based on preoperative imaging manifestation), direct surgical treatment means a high possibility of conversion to debulking surgery or exploratory thoracotomy, increasing complication morbidity and poor prognosis. Therefore, neoadjuvant or even radical radiochemotherapy should be recommended for these selected patients prior to surgery …”