Optimal management of thymic malignancies: current perspectives

Gabrielle Drevet, Stéphane Collaud, François Tronc, Nicolas Girard, Jean-Michel Maury, Gabrielle Drevet, Stéphane Collaud, François Tronc, Nicolas Girard, Jean-Michel Maury

Abstract

Thymic epithelial tumors (TETs) belong to orphan oncology. The incidence of TETs is about 1.3-3.2 cases per million worldwide. Following pathology, evolution and prognosis are variable. The World Health Organization classification distinguishes thymomas and thymic carcinomas. TETs are composed of thymic epithelial tumoral cells and normal lymphocytes. The mean age at diagnosis is 50-60 years-old. There are no identified risk factors. TETs are frequently associated with paraneoplastic syndromes as myasthenia gravis. The complete R0 surgical resection is the most significant prognosis factor on survival. In 2010, the French National Institute of Cancer labeled the RYTHMIC network as a specific tumor board including thoracic surgeons, oncologist, and radiation therapist to define standard of care for the management of TETs. The aim of the review was to update knowledge to optimize the standard of care.

Keywords: chemotherapy; radiation; surgery; thymic carcinomas; thymic epithelial tumors; thymomas.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 3
Figure 3
RYTHMIC recommendation for initially unresectable thymic tumors from the RYTHMIC network, TNM IIIa–IIIb and IVa, Masaoka-Koga III–IVa.
Figure 1
Figure 1
HES (Hematoxillin-Eosin-Safran) colorations of different subsets of thymic epithelial tumors, classified according to the World Health Organization classification.
Figure 2
Figure 2
RYTHMIC recommendation for resectable thymic tumors from the RYTHMIC network, TNM I–II, Masaoka-Koga I–III.
Figure 4
Figure 4
RYTHMIC recommendation for metastatic disease TNM IVb and Masaoka-Koga IVb.
Figure 5
Figure 5
Operating views of thymic surgery: (A) enlarged thymectomy for B2 thymoma, the black arrow indicates the tumor developed in the left side of the thymus with mediastinal pleural involvement. (B) Right pleura after cytoreductive pleural surgery during ITCH procedure. The white arrow indicates pleural node of a A thymoma R0 resected two years before.
Figure 6
Figure 6
Chemotherapy and other treatments delivered in patients prospectively included in the French RYTHMIC registry. Abbreviations: CAP, Cyclophosphamid-Adriblastin-Cisplatin; TKI, Tyrosin Kinase Inhibitors.

References

    1. de Jong WK, Blaauwgeers JL, Schaapveld M, Timens W, Klinkenberg TJ, Groen HJ. Thymic epithelial tumours: a population-based study of the incidence, diagnostic procedures and therapy. Eur J Cancer. 2008;44(1):123–130. doi:10.1016/j.ejca.2007.11.004
    1. Siesling S, van der Zwan JM, Izarzugaza I, et al. Rare thoracic cancers, including peritoneum mesothelioma. Eur J Cancer. 2012;48(7):949–960. doi:10.1016/j.ejca.2012.02.047
    1. Girard N, Merveilleux du Vignaux C, Molina T, Besse B, Rythmic R. Thymic tumors. Rev Prat. 2017;67(4):430–434.
    1. Galateau-Salle F, Churg A, Roggli V, Travis WD, World Health Organization Committee for Tumors of the P. The 2015 World Health Organization Classification of Tumors of the Pleura: advances since the 2004 Classification. J Thorac Oncol. 2016;11(2):142–154. doi:10.1016/j.jtho.2015.11.005
    1. Marx A, Strobel P, Badve SS, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol. 2014;9(5):596–611. doi:10.1097/JTO.0000000000000154
    1. Detterbeck FC, Asamura H, Crowley J, et al. The IASLC/ITMIG thymic malignancies staging project: development of a stage classification for thymic malignancies. J Thorac Oncol. 2013;8(12):1467–1473. doi:10.1097/JTO.0000000000000017
    1. Ruffini E, Detterbeck F, Van Raemdonck D, et al; European Association of Thoracic Surgeons Thymic Working G. Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg. 2014;46(3):361–368. doi:10.1093/ejcts/ezt649
    1. Safieddine N, Liu G, Cuningham K, et al. Prognostic factors for cure, recurrence and long-term survival after surgical resection of thymoma. J Thorac Oncol. 2014;9(7):1018–1022. doi:10.1097/JTO.0000000000000215
    1. Ruffini E, Van Raemdonck D, Detterbeck F, Rocco G, Thomas P, Venuta F, European Society of Thoracic Surgeons Thymic Questionnaire Working G. Management of thymic tumors: a survey of current practice among members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2011;6(3):614–623. doi:10.1097/JTO.0b013e318207cd74
    1. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48(11):2485–2492. doi:10.1002/1097-0142(19811201)48:11<2485::aid-cncr2820481123>;2-r
    1. Meurgey A, Girard N, Merveilleux du Vignaux C, et al. Assessment of the ITMIG Statement on the WHO Histological Classification and of the Eighth TNM staging of thymic epithelial tumors of a series of 188 thymic epithelial tumors. J Thorac Oncol. 2017;12(10):1571–1581. doi:10.1016/j.jtho.2017.06.072
    1. Davis RD Jr., Oldham HN Jr., Sabiston DC Jr.. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg. 1987;44(3):229–237.
    1. Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer. 2003;105(4):546–551. doi:10.1002/ijc.11099
    1. Kojima Y, Ito H, Hasegawa S, Sasaki T, Inui K. Resected invasive thymoma with multiple endocrine neoplasia type 1. Jpn J Thorac Cardiovasc Surg. 2006;54(4):171–173. doi:10.1007/BF02662474
    1. Kisand K, Boe Wolff AS, Podkrajsek KT, et al. Chronic mucocutaneous candidiasis in APECED or thymoma patients correlates with autoimmunity to Th17-associated cytokines. J Exp Med. 2010;207(2):299–308. doi:10.1084/jem.20091669
    1. Girard N, Mornex F, Van Houtte P, Cordier JF, van Schil P. Thymoma: a focus on current therapeutic management. J Thorac Oncol. 2009;4(1):119–126. doi:10.1097/JTO.0b013e31818e105c
    1. Chiche P, Benaim R, Samama M, Maury J. [Thrombolytic agents and acute pulmonary emboli. Study of 28 cases treated by streptokinase or urokinase-heparin]. Coeur Med Interne. 1978;17(1):59–66.
    1. Bernard C, Frih H, Pasquet F, et al. Thymoma associated with autoimmune diseases: 85 cases and literature review. Autoimmun Rev. 2016;15(1):82–92. doi:10.1016/j.autrev.2015.09.005
    1. Lee JH, Park CM, Park SJ, Bae JS, Lee SM, Goo JM. Value of computerized 3D shape analysis in differentiating encapsulated from invasive thymomas. PLoS One. 2015;10(5):e0126175. doi:10.1371/journal.pone.0126175
    1. Marom EM, Rosado-de-Christenson ML, Bruzzi JF, Hara M, Sonett JR, Ketai L. Standard report terms for chest computed tomography reports of anterior mediastinal masses suspicious for thymoma. J Thorac Oncol. 2011;6(7 Suppl 3):S1717–S1723. doi:10.1097/JTO.0b013e31821e8cd6
    1. Sato Y, Yanagawa M, Hata A, et al. Volumetric analysis of the thymic epithelial tumors: correlation of tumor volume with the WHO classification and Masaoka staging. J Thorac Dis. 2018;10(10):5822–5832. doi:10.21037/jtd.2018.09.133
    1. Benveniste MF, Moran CA, Mawlawi O, et al. FDG PET-CT aids in the preoperative assessment of patients with newly diagnosed thymic epithelial malignancies. J Thorac Oncol. 2013;8(4):502–510. doi:10.1097/JTO.0b013e3182835549
    1. Fukumoto K, Taniguchi T, Ishikawa Y, et al. The utility of [18F]-fluorodeoxyglucose positron emission tomography-computed tomography in thymic epithelial tumours. Eur J Cardiothorac Surg. 2012;42(6):e152–e156. doi:10.1093/ejcts/ezs527
    1. Scagliori E, Evangelista L, Panunzio A, et al. Conflicting or complementary role of computed tomography (CT) and positron emission tomography (PET)/CT in the assessment of thymic cancer and thymoma: our experience and literature review. Thorac Cancer. 2015;6(4):433–442. doi:10.1111/1759-7714.12197
    1. Priola AM, Priola SM. Imaging of thymus in myasthenia gravis: from thymic hyperplasia to thymic tumor. Clin Radiol. 2014;69(5):e230–e245. doi:10.1016/j.crad.2014.01.005
    1. Detterbeck F, Youssef S, Ruffini E, Okumura M. A review of prognostic factors in thymic malignancies. J Thorac Oncol. 2011;6(7 Suppl 3)):S1698–S1704. doi:10.1097/JTO.0b013e31821e7b12
    1. Girard N, Ruffini E, Marx A, Faivre-Finn C, Peters S, Committee EG. Thymic epithelial tumours: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26 Suppl 5:v40–v55. doi:10.1093/annonc/mdv277
    1. Friedant AJ, Handorf EA, Su S, Scott WJ. Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis. J Thorac Oncol. 2016;11(1):30–38. doi:10.1016/j.jtho.2015.08.004
    1. Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg. 2017;104(3):1047–1053. doi:10.1016/j.athoracsur.2017.03.054
    1. Hess NR, Sarkaria IS, Pennathur A, Levy RM, Christie NA, Luketich JD. Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes. Ann Thorac Surg. 2016;5(1):1–9. doi:10.3978/j.issn.2225-319X.2016.01.01
    1. Wang H, Gu Z, Ding J, et al. Perioperative outcomes and long-term survival in clinically early-stage thymic malignancies: video-assisted thoracoscopic thymectomy versus open approaches. J Thorac Dis. 2016;8(4):673–679. doi:10.21037/jtd.2016.03.05
    1. Buentzel J, Heinz J, Hinterthaner M, et al. Robotic versus thoracoscopic thymectomy: the current evidence. Int J Med Robot. 2017;13(4).
    1. Buentzel J, Straube C, Heinz J, et al. Thymectomy via open surgery or robotic video assisted thoracic surgery: can a recommendation already be made? Medicine. 2017;96(24):e7161. doi:10.1097/MD.0000000000007161
    1. Casiraghi M, Galetta D, Borri A, et al. Robotic-assisted thymectomy for early-stage thymoma: a propensity-score matched analysis. J Robot Surg. 2018;12(4):719–724. doi:10.1007/s11701-018-0816-3
    1. Fok M, Bashir M, Harky A, et al. Video-assisted thoracoscopic versus robotic-assisted thoracoscopic thymectomy: systematic review and meta-analysis. Innovations. 2017;12(4):259–264. doi:10.1097/IMI.0000000000000382
    1. Nakagawa K, Asamura H, Sakurai H, Watanabe S, Tsuta K. Does the mode of surgical resection affect the prognosis/recurrence in patients with thymoma? J Surg Oncol. 2014;109(3):179–183. doi:10.1002/jso.23499
    1. Nakagawa K, Yokoi K, Nakajima J, et al. Is thymomectomy alone appropriate for stage I (T1N0M0) thymoma? Results of a propensity-score analysis. Ann Thorac Surg. 2016;101(2):520–526. doi:10.1016/j.athoracsur.2015.07.084
    1. Yano M, Fujii Y, Yoshida J, et al. A phase II study of partial and subtotal thymectomy for thymoma (JART02). World J Surg. 2017;41(8):2033–2038. doi:10.1007/s00268-017-3990-y
    1. Narm KS, Lee CY, Do YW, et al. Limited thymectomy as a potential alternative treatment option for early-stage thymoma: a multi-institutional propensity-matched study. Lung Cancer. 2016;101:22–27. doi:10.1016/j.lungcan.2016.06.021
    1. Gu Z, Fu J, Shen Y, et al. Thymectomy versus tumor resection for early-stage thymic malignancies: a Chinese Alliance for Research in Thymomas retrospective database analysis. J Thorac Dis. 2016;8(4):680–686. doi:10.21037/jtd.2016.03.16
    1. Fang W, Yao X, Antonicelli A, et al. Comparison of surgical approach and extent of resection for Masaoka-Koga Stage I and II thymic tumours in Europe, North America and Asia: an International Thymic Malignancy Interest Group retrospective database analysis. Eur J Cardiothorac Surg. 2017;52(1):26–32. doi:10.1093/ejcts/ezx042
    1. Mori T, Nomori H, Ikeda K, et al. Three cases of multiple thymoma with a review of the literature. Jpn J Clin Oncol. 2007;37(2):146–149. doi:10.1093/jjco/hyl147
    1. Suzuki H, Yoshida S, Hiroshima K, Nakatani Y, Yoshino I. Synchronous multiple thymoma: report of three cases. Surg Today. 2010;40(5):456–459. doi:10.1007/s00595-009-4080-z
    1. Hwang Y, Park IK, Park S, Kim ER, Kang CH, Kim YT. Lymph node dissection in thymic malignancies: implication of the ITMIG lymph node map, TNM stage classification, and recommendations. J Thorac Oncol. 2016;11(1):108–114. doi:10.1016/j.jtho.2015.09.001
    1. Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;76(3):878–884; discussion 884–875.
    1. Bhora FY, Chen DJ, Detterbeck FC, et al. The ITMIG/IASLC thymic epithelial tumors staging project: a proposed lymph node map for thymic epithelial tumors in the forthcoming 8th edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9(9 Suppl 2):S88–S96. doi:10.1097/JTO.0000000000000293
    1. Carter BW, Benveniste MF, Madan R, et al. IASLC/ITMIG staging system and lymph node map for thymic epithelial neoplasms. Radiographics. 2017;37(3):758–776. doi:10.1148/rg.2017160096
    1. Cheufou DH, Valdivia D, Puhlvers S, et al. Lymph node involvement and the surgical treatment of thymic epithelial and neuroendocrine carcinoma. Ann Thorac Surg. 2019;107:1632–1638. doi:10.1016/j.athoracsur.2019.01.006
    1. Lin CS, Kuo KT, Hsu WH, et al. Managements of locally advanced unresectable thymic epithelial tumors. J Chin Med Assoc. 2004;67(4):172–178.
    1. Liu HC, Chen YJ, Tzen CY, Huang CJ, Chang CC, Huang WC. Debulking surgery for advanced thymoma. Eur J Surg Oncol. 2006;32(9):1000–1005. doi:10.1016/j.ejso.2006.03.049
    1. Attaran S, Acharya M, Anderson JR, Punjabi PP. Does surgical debulking for advanced stages of thymoma improve survival? Interact Cardiovasc Thorac Surg. 2012;15(3):494–497. doi:10.1093/icvts/ivs263
    1. Hamaji M, Ali SO, Burt BM. A meta-analysis of surgical versus nonsurgical management of recurrent thymoma. Ann Thorac Surg. 2014;98(2):748–755. doi:10.1016/j.athoracsur.2014.04.028
    1. Kondo K. Therapy for thymic epithelial tumors. Gen Thorac Cardiovasc Surg. 2014;62(8):468–474. doi:10.1007/s11748-014-0420-z
    1. Cohen DJ, Ronnigen LD, Graeber GM, et al. Management of patients with malignant thymoma. J Thorac Cardiovasc Surg. 1984;87(2):301–307.
    1. Moser B, Fadel E, Fabre D, et al. Surgical therapy of thymic tumours with pleural involvement: an ESTS Thymic Working Group Project. Eur J Cardiothorac Surg. 2017;52:346–355. doi:10.1093/ejcts/ezx090
    1. Lucchi M, Davini F, Ricciardi R, et al. Management of pleural recurrence after curative resection of thymoma. J Thorac Cardiovasc Surg. 2009;137(5):1185–1189. doi:10.1016/j.jtcvs.2008.09.033
    1. Yano M, Sasaki H, Yukiue H, et al. Thymoma with dissemination: efficacy of macroscopic total resection of disseminated nodules. World J Surg. 2009;33(7):1425–1431. doi:10.1007/s00268-009-0069-4
    1. Okuda K, Yano M, Yoshino I, et al. Thymoma patients with pleural dissemination: nationwide retrospective study of 136 cases in Japan. Ann Thorac Surg. 2014;97(5):1743–1748. doi:10.1016/j.athoracsur.2014.01.042
    1. Hamaji M, Kojima F, Omasa M, et al. A meta-analysis of debulking surgery versus surgical biopsy for unresectable thymoma. Eur J Cardiothorac Surg. 2015;47(4):602–607.
    1. Fabre D, Fadel E, Mussot S, et al. Long-term outcome of pleuropneumonectomy for Masaoka stage IVa thymoma. Eur J Cardiothorac Surg. 2011;39(5):e133–e138. doi:10.1016/j.ejcts.2010.12.064
    1. Ishikawa Y, Matsuguma H, Nakahara R, et al. Multimodality therapy for patients with invasive thymoma disseminated into the pleural cavity: the potential role of extrapleural pneumonectomy. Ann Thorac Surg. 2009;88(3):952–957. doi:10.1016/j.athoracsur.2009.05.019
    1. Wright CD. Pleuropneumonectomy for the treatment of Masaoka stage IVA thymoma. Ann Thorac Surg. 2006;82(4):1234–1239. doi:10.1016/j.athoracsur.2006.05.028
    1. Wright CD. Stage IVA thymoma: patterns of spread and surgical management. Thorac Surg Clin. 2011;21(1):93–97, vii. doi:10.1016/j.thorsurg.2010.08.007
    1. Maury JM, Drevet G, Collaud S, et al. Cytoreductive pleurectomy and intrathoracic chemohyperthermia for pleural relapse of thymomas. Ann Thorac Surg. 2019;107(2):e157–e160. doi:10.1016/j.athoracsur.2018.07.058
    1. Ambrogi MC, Korasidis S, Lucchi M, et al. Pleural recurrence of thymoma: surgical resection followed by hyperthermic intrathoracic perfusion chemotherapydagger. Eur J Cardiothorac Surg. 2016;49(1):321–326. doi:10.1093/ejcts/ezv039
    1. Maury JM, Girard N, Tabutin M, et al. Intra-thoracic chemo-hyperthermia for pleural recurrence of thymoma. Lung Cancer. 2017;108:1–6. doi:10.1016/j.lungcan.2017.02.014
    1. Refaely Y, Simansky DA, Paley M, Gottfried M, Yellin A. Resection and perfusion thermochemotherapy: a new approach for the treatment of thymic malignancies with pleural spread. Ann Thorac Surg. 2001;72(2):366–370.
    1. Ried M, Potzger T, Sziklavari Z, et al. Extended surgical resections of advanced thymoma Masaoka stages III and IVa facilitate outcome. Thorac Cardiovasc Surg. 2014;62(2):161–168. doi:10.1055/s-0033-1345303
    1. Girard N, Lal R, Wakelee H, Riely GJ, Loehrer PJ. Chemotherapy definitions and policies for thymic malignancies. J Thorac Oncol. 2011;6(7 Suppl 3):S1749–S1755. doi:10.1097/JTO.0b013e31821ea5f7
    1. Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG thymic epithelial tumors staging project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9(9 Suppl 2):S65–S72. doi:10.1097/JTO.0000000000000290
    1. Merveilleux du Vignaux C, Dansin E, Mhanna L, et al. Systemic therapy in advanced thymic epithelial tumors: insights from the RYTHMIC prospective cohort. J Thorac Oncol. 2018;13(11):1762–1770. doi:10.1016/j.jtho.2018.08.005
    1. Okuma Y, Saito M, Hosomi Y, Sakuyama T, Okamura T. Key components of chemotherapy for thymic malignancies: a systematic review and pooled analysis for anthracycline-, carboplatin- or cisplatin-based chemotherapy. J Cancer Res Clin Oncol. 2015;141(2):323–331. doi:10.1007/s00432-014-1800-6
    1. Lara PN Jr., Bonomi PD, Faber LP. Retreatment of recurrent invasive thymoma with platinum, doxorubicin, and cyclophosphamide. Chest. 1996;110(4):1115–1117. doi:10.1378/chest.110.4.1115
    1. Liang Y, Padda SK, Riess JW, West RB, Neal JW, Wakelee HA. Pemetrexed in patients with thymic malignancies previously treated with chemotherapy. Lung Cancer. 2015;87(1):34–38. doi:10.1016/j.lungcan.2014.11.006
    1. Bluthgen MV, Boutros C, Fayard F, Remon J, Planchard D, Besse B. Activity and safety of oral etoposide in pretreated patients with metastatic or recurrent thymic epithelial tumors (TET): a single-institution experience. Lung Cancer. 2016;99:111–116. doi:10.1016/j.lungcan.2016.06.020
    1. Loehrer PJ Sr., Wang W, Johnson DH, Aisner SC, Ettinger DS, Eastern Cooperative Oncology Group Phase IIT. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004;22(2):293–299. doi:10.1200/JCO.2004.02.047
    1. Zucali PA, De Pas T, Palmieri G, et al. Phase II study of everolimus in patients with thymoma and thymic carcinoma previously treated with cisplatin-based chemotherapy. J Clin Oncol. 2018;36(4):342–349. doi:10.1200/JCO.2017.74.4078
    1. Girard N, Shen R, Guo T, et al. Comprehensive genomic analysis reveals clinically relevant molecular distinctions between thymic carcinomas and thymomas. Clin Cancer Res. 2009;15(22):6790–6799. doi:10.1158/1078-0432.CCR-09-0644
    1. Merveilleux du Vignaux C, Maury JM, Girard N. Novel agents in the treatment of thymic malignancies. Curr Treat Options Oncol. 2017;18(9):52. doi:10.1007/s11864-017-0495-8
    1. Palmieri G, Marino M, Buonerba C, et al. Imatinib mesylate in thymic epithelial malignancies. Cancer Chemother Pharmacol. 2012;69(2):309–315. doi:10.1007/s00280-011-1690-0
    1. Giaccone G, Rajan A, Ruijter R, Smit E, van Groeningen C, Hogendoorn PC. Imatinib mesylate in patients with WHO B3 thymomas and thymic carcinomas. J Thorac Oncol. 2009;4(10):1270–1273. doi:10.1097/JTO.0b013e3181b6be57
    1. Lattanzio R, La Sorda R, Facciolo F, et al. Thymic epithelial tumors express vascular endothelial growth factors and their receptors as potential targets of antiangiogenic therapy: a tissue micro array-based multicenter study. Lung Cancer. 2014;85(2):191–196.
    1. Tomita M, Matsuzaki Y, Edagawa M, et al. Correlation between tumor angiogenesis and invasiveness in thymic epithelial tumors. J Thorac Cardiovasc Surg. 2002;124(3):493–498.
    1. Remon J, Girard N, Mazieres J, et al. Sunitinib in patients with advanced thymic malignancies: cohort from the French RYTHMIC network. Lung Cancer. 2016;97:99–104. doi:10.1016/j.lungcan.2016.04.024
    1. Palmieri G, Montella L, Martignetti A, et al. Somatostatin analogs and prednisone in advanced refractory thymic tumors. Cancer. 2002;94(5):1414–1420. doi:10.1002/cncr.10374
    1. Arbour KC, Naidoo J, Steele KE, et al. Expression of PD-L1 and other immunotherapeutic targets in thymic epithelial tumors. PLoS One. 2017;12(8):e0182665. doi:10.1371/journal.pone.0182665
    1. Katsuya Y, Horinouchi H, Asao T, et al. Expression of programmed death 1 (PD-1) and its ligand (PD-L1) in thymic epithelial tumors: impact on treatment efficacy and alteration in expression after chemotherapy. Lung Cancer. 2016;99:4–10. doi:10.1016/j.lungcan.2016.05.007
    1. Weissferdt A, Fujimoto J, Kalhor N, et al. Expression of PD-1 and PD-L1 in thymic epithelial neoplasms. Mod Pathol. 2017;30(6):826–833. doi:10.1038/modpathol.2017.6
    1. Giaccone G, Kim C, Thompson J, et al. Pembrolizumab in patients with thymic carcinoma: a single-arm, single-centre, phase 2 study. Lancet Oncol. 2018;19(3):347–355. doi:10.1016/S1470-2045(18)30062-7
    1. Gomez D, Komaki R, Yu J, Ikushima H, Bezjak A. Radiation therapy definitions and reporting guidelines for thymic malignancies. J Thorac Oncol. 2011;6(7 Suppl 3):S1743–S1748. doi:10.1097/JTO.0b013e31821ea60c
    1. Treglia G, Sadeghi R, Giovanella L, Cafarotti S, Filosso P, Lococo F. Is (18)F-FDG PET useful in predicting the WHO grade of malignancy in thymic epithelial tumors? A meta-analysis. Lung Cancer. 2014;86(1):5–13. doi:10.1016/j.lungcan.2014.08.008
    1. Huang J, Detterbeck FC, Wang Z, Loehrer PJ Sr.:. Standard outcome measures for thymic malignancies. J Thorac Oncol. 2010;5(12):2017–2023. doi:10.1097/JTO.0b013e3181f13682
    1. Mornex F, Resbeut M, Richaud P, et al. Radiotherapy and chemotherapy for invasive thymomas: a multicentric retrospective review of 90 cases. The FNCLCC trialists. Federation Nationale des Centres de Lutte Contre le Cancer. Int J Radiat Oncol Biol Phys. 1995;32(3):651–659.
    1. Basse C, Thureau S, Bota S, et al. Multidisciplinary tumor board decision making for postoperative radiotherapy in thymic epithelial tumors: insights from the RYTHMIC prospective cohort. J Thorac Oncol. 2017;12(11):1715–1722. doi:10.1016/j.jtho.2017.07.023
    1. Vogel J, Lin L, Simone CB 2nd, Berman AT. Risk of major cardiac events following adjuvant proton versus photon radiation therapy for patients with thymic malignancies. Acta Oncol. 2017;56(8):1060–1064. doi:10.1080/0284186X.2017.1302097
    1. Jackson MW, Palma DA, Camidge DR, et al. The impact of postoperative radiotherapy for thymoma and thymic carcinoma. J Thorac Oncol. 2017;12(4):734–744. doi:10.1016/j.jtho.2017.01.002
    1. Omasa M, Date H, Sozu T, et al. Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stage II and III thymic epithelial tumors: the Japanese Association for Research on the Thymus Database Study. Cancer. 2015;121(7):1008–1016. doi:10.1002/cncr.29166
    1. Rimner A, Yao X, Huang J, et al. Postoperative radiation therapy is associated with longer overall survival in completely resected stage II and III thymoma – an analysis of the international thymic malignancies interest group retrospective database. J Thorac Oncol. 2016;11(10):1785–1792. doi:10.1016/j.jtho.2016.06.011
    1. Korst RJ, Kansler AL, Christos PJ, Mandal S. Adjuvant radiotherapy for thymic epithelial tumors: a systematic review and meta-analysis. Ann Thorac Surg. 2009;87(5):1641–1647. doi:10.1016/j.athoracsur.2008.11.022
    1. Ahmad U, Yao X, Detterbeck F, et al. Thymic carcinoma outcomes and prognosis: results of an international analysis. J Thorac Cardiovasc Surg. 2015;149(1):95–100, 101 e101–e102. doi:10.1016/j.jtcvs.2014.09.124
    1. Fu H, Gu ZT, Fang WT, et al. Long-term survival after surgical treatment of thymic carcinoma: a retrospective analysis from the Chinese Alliance for Research of Thymoma Database. Ann Surg Oncol. 2016;23(2):619–625. doi:10.1245/s10434-015-4825-4
    1. Urgesi A, Monetti U, Rossi G, Ricardi U, Maggi G, Sannazzari GL. Aggressive treatment of intrathoracic recurrences of thymoma. Radiother Oncol. 1992;24(4):221–225.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir