The role of surgery in the management of locally advanced and metastatic thymoma: a narrative review

Abstract

Thymic epithelial tumors (TETs) are rare neoplasms. While treatment guidelines for early stage TETs are well established, treatment for advanced and locally invasive and metastatic TETs (Masaoka stage IVa/IVb) is varied. Many studies examining outcomes in this patient population are single institution, retrospective studies with small sample sizes. Further complicating study of advanced TETs is that Masaoka stage IVa/IVb describes a wide variety of disease heterogeneity, and includes both thymoma and thymic carcinoma. Thus, recommendations for treatment strategies vary widely. Surgical resection with an R0 resection is a key component of treatment for early stage TETs, however the utility of surgery and appropriate surgical approach for patients with locally invasive disease is debated and ranges from local metastasectomy to extrapleural pneumonectomy (EPP). The use of multimodal therapies, including adjuvant and neoadjuvant radiation and chemoradiation, are important for patients with locally advanced disease, however identifying patients who would most benefit from each strategy has been challenging. In this review we examined the literature to provide treatment strategies for advanced TETs. Surgery with an R0 resection should be attempted in all risk appropriate patients. Multimodal therapies are likely beneficial to patients particularly with locally advanced disease, and neoadjuvant therapies may increase likelihood of R0 resection. Further investigation is necessary to identify optimal treatment strategies for patients with locally advanced TETs.

The role of surgery in advanced thymic tumors: A retrospective cohort study

“…There is no definitive and detailed treatment guideline for advanced TETs however, thus when lymph node and other organ metastasis are present the clinical guidelines recommend chemotherapy-based multidisciplinary treatment ( 7 , 8 ). Previous studies indicate that surgery is beneficial for advanced TETs ( 9 – 11 ), but due to few cases of advanced TETs and the scarcity of reports, the role of surgery is still unknown ( 12 , 13 ). The present study aimed to systematically analyze the role of surgery in advanced thymic tumors based on the Surveillance, Epidemiology, and End Results (SEER) database with a sufficient number of cases.…”

Intuitive evaluation of contemporary management strategies in thymoma — the largest Indian experience

“…Surgery has been the mainstay of treatment, in both early and locally advanced thymomas, with adjuvant radiation and chemotherapy being recommended for invasive thymic malignancies [ 5 ]. For unresectable thymic malignancies, chemotherapy and radiotherapy, either in sequential or concurrent manner have been given with durable responses reported across literature [ 6 ].…”