Thymoma medical therapy

Revision as of 17:15, 27 November 2017 by Mmir (talk | contribs) (Mahshid)
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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 therpy may be administered prior to surgery to make the tumor resectable.

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 any chemotherapy is administered.
  • 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 ageing and stress, steroids increase thymic fat and connective tissue and decrease corticomedullary differentiation.
  • Therefore in WHO subtypes A and B thymomas, corticosteroids cause tumor size reduction mainly through lymphocyte depletion.[3]

References

  1. "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)
  2. "http://www.cancernet.nci.nih.gov/cancertopics/types/thymoma". External link in |title= (help)
  3. "Octreotide alone or with prednisone in patients... [J Clin Oncol. 2004] - PubMed - NCBI".