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Radiotherapy for thymic epithelial tumours: a review
Krisztian Süveg1, Paul Martin Putora1,2, Markus Joerger3
1Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Translational Lung Cancer Research
|May 20, 2021
Summary
Optimal treatment for rare thymic epithelial tumours (TETs) is debated. Surgery is primary, but postoperative radiotherapy (PORT) use varies by stage and histology, especially for thymomas and thymic carcinomas. Multidisciplinary discussion is key.
Area of Science:
- Oncology
- Thoracic Surgery
- Radiation Oncology
Background:
- Thymic epithelial tumours (TETs) are rare but are the most common anterior mediastinal neoplasms.
- Limited evidence exists for optimal TET treatment due to their rarity.
- Surgery is the primary treatment, but the role of postoperative radiotherapy (PORT) is debated.
Purpose of the Study:
- To review the current evidence and guidelines for the use of postoperative radiotherapy (PORT) in thymic epithelial tumours (TETs).
- To clarify the indications for PORT in different stages and subtypes of thymomas and thymic carcinomas.
- To highlight the importance of a multidisciplinary approach in managing TETs.
Main Methods:
- Review of existing literature and clinical guidelines regarding the management of thymic epithelial tumours.
- Analysis of treatment outcomes based on tumour stage, histological subtype (WHO classification), and extent of resection.
- Consideration of radiotherapy's role in both resectable and unresectable locally advanced and metastatic disease.
Main Results:
- PORT is debated for completely resected stage II thymomas, particularly those with less aggressive features.
- PORT may benefit stage II thymomas with aggressive histology (B2, B3) or extensive invasion (Masaoka-Koga IIB).
- PORT is suggested for stage III thymomas after complete resection, and recommended for incompletely resected thymomas (stage II+) and thymic carcinomas with positive margins.
- Radiotherapy is crucial for unresectable locally advanced TETs, and induction therapy may precede surgery.
- Chemotherapy is used palliatively for metastatic disease; checkpoint inhibitors show promise for refractory cases.
Conclusions:
- The decision to use postoperative radiotherapy (PORT) for thymic epithelial tumours (TETs) should be individualized based on stage, histology, and resection margins.
- PORT plays a significant role in managing unresectable and advanced TETs.
- A multidisciplinary team approach is essential for optimal treatment planning and patient care in TET management.
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