Sandbox/thy10

Thymoma
or
Thymic Carcinoma

Locally Advanced

Solitary Metastasis

Distant metastasis

Chemotherapy

Surgery

Chemotherapy

Re-evaluate
for surgery

Chemotherapy or RT

Resectable

Unresectable

Surgery ±
Postoperative RT

RT ± Chemotherapy

FIRST-LINE COMBINATION CHEMOTHERAPY REGIMENS		SECOND-LINE CHEMOTHERAPY
CAP (preferred for thymoma) * Cisplatin 50 mg/m² IV day 1 * Doxorubicin 50 mg/m² IV day 1 * Cyclophosphamide 500 mg/m² IV day 1 Administered every 3 weeks	PE * Cisplatin 60 mg/m² IV day 1 *Etoposide 120 mg/m²/d IV days 1 -3 Administered every 3 weeks	Etoposide Ifosfamide Pemetrexed Octreotide (including LAR) + prednisone 5-FU and leucovirin Gemcitabine Paclitaxel
CAP with Prednisone * Cisplatin 30 mg/m² IV days 1-3 * Doxorubicin 20 mg/m²/d IV continuous infusion on days 1 to 3 * Cyclophosphamide 500 mg/m² IV on day 1 * Prednisone 100 mg/day on days 1-5 Administered every 3 weeks	VIP * Etoposide 75 mg/m² on days 1-4 * Ifosfamide 1.2 g/m² on days 1-4 * Cisplatin 20 mg/m² on days 1-4 Administered every 3 weeks
ADOC * Cisplatin 50 mg/m² IV day 1 * Doxorubicin 40 mg/m² IV day 1 * Vincristine 0.6 mg/m² IV day 3 * Cyclophosphamide 700 mg/m² IV day 4 Administered every 3 weeks	Carboplatin/Paclitaxel (preferred for Thymic Carcinoma) * Carboplatin AUC 6 * Paclitaxel 225 mg/m² Administered every 3 weeks

For adjuvant treatment, the radiation dose consists of 45-50 Gy for clear/close margins and 54 Gy for microscopically positive resection margins. A total dose of 60 Gy and above should be given to patients with gross residual disease (similar to patients with unresectable disease), when conventional fractionation (1.8 to 2.0 Gy per daily fraction) is applied.

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