Thymoma medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Chemotherapy and radiotherapy are used as [[adjuvant therapy|adjuvant]] or [[neoadjuvant therapy|neoadjuvant therapies]]. Neoadjuvant therapy may be administered prior to surgery to make the tumor resectable. [[Radiotherapy]] is used in the treatment of unresectable thymoma. Radiotherapy may be used to decrease the size and improve resectability, before surgery is attempted. | [[Chemotherapy]] and [[radiotherapy]] are used as [[adjuvant therapy|adjuvant]] or [[neoadjuvant therapy|neoadjuvant therapies]]. [[Neoadjuvant therapy]] may be administered prior to [[surgery]] to make the [[tumor]] [[Resection|resectable]]. [[Radiotherapy]] is used in the treatment of unresectable thymoma. [[Radiation therapy|Radiotherapy]] may be used to decrease the size of the [[tumor]] and improve [[Resection|resectability]], before [[surgery]] is attempted. | ||
==Medical Therapy== | ==Medical Therapy== | ||
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====Chemotherapy==== | ====Chemotherapy==== | ||
*Chemotherapy is used in | *[[Chemotherapy]] is used in locally advanced thymomas, after which [[Patient|patients]] are re-evaluated for [[Resection|resectability]]. | ||
*In cases of | *In cases of isolated [[solitary]] [[metastasis]], [[surgery]] may be attempted before [[chemotherapy]] administration. | ||
*Chemotherapy is also used if there is evidence of | *[[Chemotherapy]] is also used if there is evidence of distant [[metastasis]]. | ||
*Most of the chemotherapy regimens used are based on [[cisplatin]] and [[anthracyclines]]. | *Most of the [[Chemotherapy regimen|chemotherapy regimens]] used are based on [[cisplatin]] and [[anthracyclines]]. | ||
====Corticosteroids==== | ====Corticosteroids==== | ||
*Corticosteroids may be used in unresectable tumors that are refractory to radiation therapy leading to transient partial responses.<ref name="www.cancernet.nci.nih.gov">{{Cite web | last = | first = | title = http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma | url = http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma | publisher = | date = | accessdate = }}</ref> | *[[Corticosteroid|Corticosteroids]] may be used in unresectable [[Tumor|tumors]] that are refractory to [[radiation therapy]], leading to [[transient]] partial responses.<ref name="www.cancernet.nci.nih.gov">{{Cite web | last = | first = | title = http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma | url = http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma | publisher = | date = | accessdate = }}</ref> | ||
*Similar to the effects of aging and stress, steroids increase thymic fat and connective tissue and decrease corticomedullary differentiation. | *Similar to the effects of [[Ageing|aging]] and [[Stress (medicine)|stress]], [[Steroid|steroids]] increase [[Thymus|thymic]] [[fat]] and [[connective tissue]] and decrease corticomedullary differentiation. | ||
*Therefore in WHO | *Therefore in [[World Health Organization|WHO]] sub-types A and B thymomas, [[Corticosteroid|corticosteroids]] cause [[tumor]] size reduction mainly through [[lymphocyte]] depletion.<ref name="www.ncbi.nlm.nih.gov">{{Cite web | last = | first = | title = Octreotide alone or with prednisone in patients... [J Clin Oncol. 2004] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/14722038 | publisher = | date = | accessdate = }}</ref> | ||
===Radiotherapy=== | ====Radiotherapy==== | ||
* Radiotherapy is used in unresectable thymoma or incompletely resected invasive thymoma. | *[[Radiation therapy|Radiotherapy]] is used in unresectable thymoma or incompletely [[Resection|resected]] [[invasive]] thymoma. | ||
* The dose and fraction schemes of radiotherapy depend on the indication of the radiation and the completeness of surgical resection.<ref>{{Cite web | last = | first = | title = https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf | url = https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf | publisher = | date = | accessdate = }}</ref> | * The [[dose]] and fraction schemes of [[Radiation therapy|radiotherapy]] depend on the [[Indication (medicine)|indication]] of the [[radiation]] and the completeness of [[surgical resection]].<ref>{{Cite web | last = | first = | title = https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf | url = https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf | publisher = | date = | accessdate = }}</ref> | ||
==References== | ==References== | ||
Latest revision as of 16:33, 15 August 2019
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Thymoma medical therapy On the Web |
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American Roentgen Ray Society Images of Thymoma medical therapy |
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Risk calculators and risk factors for Thymoma medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2]
Overview
Chemotherapy and radiotherapy are used as adjuvant or neoadjuvant therapies. Neoadjuvant therapy may be administered prior to surgery to make the tumor resectable. Radiotherapy is used in the treatment of unresectable thymoma. Radiotherapy may be used to decrease the size of the tumor and improve resectability, before surgery is attempted.
Medical Therapy
| Resectable | Resection of primary tumor & isolated metastasis | Consider postoperative radiotherapy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Locally advanced | Chemotherapy | Re-evaluate for surgery | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Unresectable | Radiotherapy +/- chemotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Chemotherapy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Thymoma | Isolated solitary metastasis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Surgery | Consider chemotherapy or radiotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Evidence of distant metastasis | Chemotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adopted from the NCCN treatment algorithm[1]
Chemotherapy
- Chemotherapy is used in locally advanced thymomas, after which patients are re-evaluated for resectability.
- In cases of isolated solitary metastasis, surgery may be attempted before chemotherapy administration.
- Chemotherapy is also used if there is evidence of distant metastasis.
- Most of the chemotherapy regimens used are based on cisplatin and anthracyclines.
Corticosteroids
- Corticosteroids may be used in unresectable tumors that are refractory to radiation therapy, leading to transient partial responses.[2]
- Similar to the effects of aging and stress, steroids increase thymic fat and connective tissue and decrease corticomedullary differentiation.
- Therefore in WHO sub-types A and B thymomas, corticosteroids cause tumor size reduction mainly through lymphocyte depletion.[3]
Radiotherapy
- Radiotherapy is used in unresectable thymoma or incompletely resected invasive thymoma.
- The dose and fraction schemes of radiotherapy depend on the indication of the radiation and the completeness of surgical resection.[4]
References
- ↑ "https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf" (PDF). External link in
|title=(help) - ↑ "http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma". External link in
|title=(help) - ↑ "Octreotide alone or with prednisone in patients... [J Clin Oncol. 2004] - PubMed - NCBI".
- ↑ "https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf" (PDF). External link in
|title=(help)