Thymic Epithelial Tumor Management Clinical Practice Guidelines (GOECP/SEOR, 2021)

Oncological Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

June 01, 2021

Clinical guidelines on the management of thymic epithelial tumors, including the following recommendations for thymic carcinoma based on Masaoka-Koga stage classification, were published in April 2021 by the Oncological Group for the Study of Lung Cancer(GOECP)/Spanish Society of Radiation Oncology (SEOR) in the World Journal of Clinical Oncology.[1]

Stage I

Surgical resection is the treatment of choice. If complete resection has been achieved, additional treatment is not needed. If resection is incomplete, with microscopic residual tumor remaining, postoperative radiotherapy (50-54 Gy) should be administered.

Stage II

Surgical resection is the treatment of choice.

If complete resection is achieved, postoperative radiotherapy (45-50 Gy) should still be considered, particularly for patients with stage IIB carcinoma.

If resection is incomplete, with microscopic residual tumor remaining, administer postoperative radiotherapy (50-54 Gy) and consider postoperative chemotherapy.

Stage III-IVA

If the tumor is resectable, surgical resection should be performed, with postoperative radiotherapy subsequently administered. If complete resection has been achieved, the recommended postoperative radiotherapy dose is 45-50 Gy. If microscopic residual tumor remains, the dose should be 54 Gy, while if macroscopic residual tumor is left, 60-70 Gy should be administered.

Postoperative chemotherapy is optional if complete resection has been achieved but is recommended if microscopic or macroscopic residual tumor remains.

If the tumor is unresectable, biopsy should be used to confirm the presence of thymic carcinoma. It is recommended that 2-4 cycles of induction chemotherapy be performed, followed by reassessment of tumor resectability via imaging studies. Various chemotherapy options based on cisplatin combined with such agents as etoposide, doxorubicin, or cyclophosphamide can be employed.

If chemotherapy renders the tumor resectable, surgery is performed, followed by postoperative radiotherapy, with 45-50 Gy administered in complete resection, and 54 Gy provided when microscopic residual tumor remains. Postoperative chemotherapy should be considered.

If chemotherapy does not render the tumor resectable or if resection leaves macroscopic residual tumor, radiotherapy (60-70 Gy), with or without concomitant chemotherapy, is indicated.

Stage IVB

Cisplatin-based chemotherapy is the treatment of choice. If the carcinoma is refractory to chemotherapy, the targeted agent imatinib may be a suitable treatment, although the drug is not recommended in the absence of a KIT mutation. Sunitinib may also provide a therapeutic option in patients with refractory tumors, regardless of KIT status. Everolimus is another agent that may be effective in refractory cases.

For more information, please go to Thymic Tumors.

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