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Therapie von Thymomen und Thymuskarzinomen

Therapy of thymoma and thymic carcinoma

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best practice onkologie Aims and scope

Zusammenfassung

Hintergrund

Thymome und Thymuskarzinome (TK) zählen zu den häufigsten primären malignen Raumforderungen im vorderen Mediastinum.

Ziel der Arbeit

In diesem Übersichtsartikel sollen insbesondere diagnostische Verfahren und multimodale Therapiekonzepte dargestellt werden.

Material und Methode

Selektive Literaturrecherche über Medline (Schlüsselwörter: thymoma, thymic carcinoma, advanced thymoma) und interdisziplinäre, klinische Erfahrungen.

Ergebnisse

Die therapeutisch und prognostisch relevante Beschreibung der Ausbreitung (Staging) von Thymomen und TK erfolgt aktuell zweigleisig nach der Masaoka-Koga- und der neuen TNM-Klassifikation, die histologische Einteilung nach der WHO-Klassifikation. Die komplette chirurgische Tumorresektion (R0) inklusive Thymus (Thymom‑/Thymektomie) ist die Standardtherapie bei primär resektablen Tumoren und der entscheidende prognostische Faktor. Bei fortgeschrittenen bzw. primär nichtresektablen Tumoren wird ein multimodales Therapiekonzept bestehend aus Chemotherapie, Operation und Strahlentherapie empfohlen. Bei Patienten mit refraktären Thymomen und TK werden Immun-Checkpoint-Inhibitoren aktuell klinisch getestet.

Diskussion

Die präoperative Diagnostik bei Mediastinaltumoren umfasst die Computer- und Magnetresonanztomographie sowie die histologische Untersuchung von Stanzbiopsien, falls insbesondere Lymphome differenzialdiagnostisch in Betracht kommen. Die komplette Tumorresektion bildet bei Thymomen und TK weiterhin die Therapie der ersten Wahl. Eine interdisziplinäre Indikationsstellung und eine multimodale Behandlung in einem erfahrenen Zentrum können sowohl bei Patienten mit lokal oder pleural fortgeschrittenen Thymomen bzw. TK als auch bei Patienten mit Tumorrezidiven die Prognose verbessern.

Abstract

Background

Thymoma and thymic carcinoma (TC) are the most common primary malignancies in the anterior mediastinum.

Objectives

In this review article, modern diagnostic tools and innovative treatments are described.

Materials and methods

Selective literature research in Medline (key words: thymoma, thymic carcinoma, advanced thymoma) and interdisciplinary, clinical experience.

Results

Treatment decisions and the prognosis of thymomas and TCs depend on tumor stage (currently described in parallel by the Masaoka-Koga and the new TNM system), histological subtype (according to the World Health Organization [WHO] classification) and resection status. R0 resection (that traditionally includes thymectomy) counts among the most important prognostic factors and is the standard therapeutic approach for resectable tumors. A multimodality treatment regime consisting of chemotherapy, surgical resection and in some cases radiotherapy is recommended for advanced or primarily unresectable tumors. Clinical trials evaluating immune checkpoint inhibitors in refractory thymomas and TCs are underway.

Discussion

Modern diagnostics comprise computertomography scans, magnetic resonance imaging and precise histological investigation. An interdisciplinary evaluation and a multimodal treatment regime might improve the prognosis of locoregional and pleural advanced thymoma and thymic carcinoma as well as the prognosis of recurrent thymoma.

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Author information

Authors and Affiliations

  1. Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    Michael Ried & Hans-Stefan Hofmann

  2. Klinik und Poliklinik für Innere Medizin III, Hämatologie und Onkologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland

    Michael Rechenmacher

  3. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland

    Barbara Dietl

  4. Pathologisches Institut, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    Alexander Marx

  5. Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland

    Okka W. Hamer

  6. Klinik und Poliklinik für Neurologie, Universität Regensburg am Bezirksklinikum Regensburg, Universitätsstraße 84, 93053, Regensburg, Deutschland

    Berthold Schalke & Lukas Kirzinger

  7. Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, Regensburg, Deutschland

    Hans-Stefan Hofmann

Authors
  1. Michael Ried
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  2. Michael Rechenmacher
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  3. Barbara Dietl
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  4. Alexander Marx
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  6. Berthold Schalke
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  7. Lukas Kirzinger
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  8. Hans-Stefan Hofmann
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Correspondence to Michael Ried.

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Ried, M., Rechenmacher, M., Dietl, B. et al. Therapie von Thymomen und Thymuskarzinomen. best practice onkologie 12, 206–214 (2017). https://doi.org/10.1007/s11654-017-0037-7

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  • DOI: https://doi.org/10.1007/s11654-017-0037-7

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