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Treatment of Early Stage Thymic Tumors: Surgery and Radiation Therapy

  • Thymoma
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Opinion statement

Tumors of the thymus are an uncommon entity, constituting 30% and 15% of anterior mediastinal masses in adults and children, respectively. The majority of these tumors are thymomas, with thymic carcinomas less common, and thymic carcinoids exceedingly rare. Recognition of the distinct clinicopathologic behavior of various thymic neoplasms is crucial to providing optimal treatment. Evidence guiding the treatment of early stage thymic tumors is limited secondary to the low incidence and resulting lack of randomized data. Proper management requires a careful analysis of the available literature with particular attention paid to limitations of the existing studies. This article provides a discussion of the presentation, evaluation, diagnosis, surgical techniques, and treatment outcomes relevant to early stage thymomas, thymic carcinomas, and thymic carcinoid tumors. The role of radiation therapy in the management of early stage thymic tumors remains controversial and is discussed in detail.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Davis RD, Oldham HN, Sabiston DC. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg 1987;44:229.

    PubMed  Google Scholar 

  2. Azarow KS, Pearl RH, Zurcher R, et al. Primary mediastinal masses: a comparison of adult and pediatric populations. J Thorac Cardiovasc Surg 1993;106:67.

    PubMed  CAS  Google Scholar 

  3. Kazemi S, Kress DC, Gal RA, et al. A rare case of intracardiac thymoma. Echocardiography 2006; 24(4):348–349.

    Article  Google Scholar 

  4. Shimosato Y. Controversies surrounding the subclassification of thymoma. Cancer 1994;74:542.

    Article  PubMed  CAS  Google Scholar 

  5. Suster S, Moran CA. Primary thymic epithelial neoplasms: current concepts and controversies. In: Fechner RE, Rosen PP, eds. Anatomic Pathology 1997, vol 2. Chicago: ASCP Press, 1997:1.

    Google Scholar 

  6. Marx A, Muller-Hermelink HK. From basic immunobiology to the upcoming WHO-classification of tumors of the thymus. Pathol Res Pract 1999;195:515.

    PubMed  CAS  Google Scholar 

  7. Rieker RJ, Hoegel J, Morresi-Hauf A, et al.: Histologic classification of thymic epithelial tumors: Comparison of established classification schemes. Int J Cancer 2002; 98:900–906.

    Article  PubMed  CAS  Google Scholar 

  8. Detterbeck FC. Clinical value of the WHO classification system of thymoma. Ann Thorac Surg 2006; 81:2328–2334.

    Article  PubMed  Google Scholar 

  9. Patterson GA. Thymomas. Semin Thorac Cardiovasc Surg 1992;4:39.

    PubMed  CAS  Google Scholar 

  10. Rinadi TP, Batocchi AP, Evoli A, et al. Thymic lesions and myasthenia gravis: diagnosis based on mediastinal imaging and pathological findings. Acta Radiol 2002;43:380.

    Article  Google Scholar 

  11. Berrih-Akin S, Morel E, Raimond F, et al. 1987 The role of the thymus in myasthenia gravis: immunohistological and immunological studies in 115 cases. Ann N Y Acad Sci 505:51.

    Google Scholar 

  12. Blossom GB, Ernstoff RM, Howells GA, Bendick PJ, Glover JL. Thymectomy for myasthenia gravis. Arch Surg 1993;128:855.

    PubMed  CAS  Google Scholar 

  13. Bogot NR, Quint LE: Imaging of thymic disorders. Cancer Imaging 2005; 5:139–149.

    Article  PubMed  Google Scholar 

  14. Tomiyama H, Muller NL, Ellis SJ, et al. 2001 Invasive and noninvasive thymoma: distinctive CT features. J Comput Assist Tomogr 25:388.

    Article  PubMed  CAS  Google Scholar 

  15. Inoue A, Tomiyama N, Fujimoto K, et al.: MR imaging of thymic epithelial tumors: correlation with World Health Organization classification. Radiat Med 2006; 24:171–181.

    Article  PubMed  Google Scholar 

  16. Sun YM Lee, KS, Kim T, Choi JY, et al. 18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups. J Nucl Med

    Google Scholar 

  17. El-Bawab H, Al-Sugair AA, Rafay M, et al. Role of fluorine-18 fluorodeoxyglucose positron emission tomography in thymic pathology. Eur J Cardiothorac Surg. 2007; 31(4):731–736.

    Article  PubMed  Google Scholar 

  18. Morrissey B, Adams H, Gibbs AR, et al. Percutaneous needle biopsy of the mediastinum: review of 94 procedures. Thorax 1993; 48:632.

    Article  PubMed  CAS  Google Scholar 

  19. Rendina EA, Venuta F, DeGiacomo T, et al. Comparative merits of thoracoscopy, mediastinoscopy, and mediastinotomy for mediastinal biopsy. Ann Thorac Surg 1994;57:992.

    PubMed  CAS  Google Scholar 

  20. Redina EA, Venuta F, DeGiacomo T, et al. Biopsy of anterior mediastinal masses under local anesthesia. Ann Thorac Surg 2002;74:1720.

    Article  Google Scholar 

  21. Kondo K and Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg 2003;76:878.

    Article  PubMed  Google Scholar 

  22. Crucitti F, Daghetto GB, Bellantone R, et al. Effects of surgical treatment in thymoma with myasthenia gravis: our experience in 103 patients. J Surg Oncol 1992;50:43.

    Article  PubMed  CAS  Google Scholar 

  23. Cowen D, Mornex RF, Bachelot T, et al. Thymoma: results of a multicentric retrospective series of 149 non-metastatic irradiated patients and review of the literature. Radiother Oncol 1995;34:9.

    Article  PubMed  CAS  Google Scholar 

  24. Trastek VF: Thymectomy, In Kaiser LR, Kron IL, Spral TL, editors: Mastery of Cardiothoracic Surgery. Philadelphia: Lippincott-Raven, 1998, pp. 105–111.

    Google Scholar 

  25. Yim AP. Video-assisted thoracoscopic resection of anterior mediastinal masses. Int Surg 1996;81:350–353.

    PubMed  CAS  Google Scholar 

  26. Yellin A. Video-assisted thoracoscopic surgery: thymectomy. Chest 1996;110:578–579.

    Article  PubMed  CAS  Google Scholar 

  27. Landreneau RJ. Dowling RD, Castillo WM, et al. Thoracoscopic resection of an anterior mediastinal tumor. Ann Thorac Surg 1992;54:142–144.

    PubMed  CAS  Google Scholar 

  28. Acuff TE, Mack MJ, Ryan WH, et al. Thoracoscopic thymoma resection. Ann Thorac Surg 1993;55:561–568.

    Google Scholar 

  29. Rea F, Marulli G, Bortolotti L, Feltracco P et al. Experience with the “DaVinci” robotic system for thymectomy in patients with myasthenia gravis: report of 33 cases. AnnThorac Surg 2006;81(2):455–459.

    Article  PubMed  Google Scholar 

  30. Savitt MA, Gao G, Furnary AP, et al. Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum. Ann Thorac Surg 2005;79:450–455.

    Article  PubMed  Google Scholar 

  31. Augustin F, Schmid T, Sieb M, et al. Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery thymectomy. Ann Thorac Surg 2008;85:S768–771.

    Article  PubMed  Google Scholar 

  32. Ruckert JC, Ismail M, Swierzy M, et al.: Thoracoscopic thymectomy with the Da Vinci robotic system for myasthenia gravis. Ann N Y Acad Sci. 2008, 1132: 329–335.

    Google Scholar 

  33. Maggi G, Casadio C, Cavallo A, et al. Thymoma: results of 241 operated cases. Ann Thorac Surg 1991;51:152.

    Article  PubMed  CAS  Google Scholar 

  34. Fang W, Chen W, Chen G, et al.: Surgical management of thymic epithelial tumors: a retrospective review of 204 cases. Ann Thorac Surg 2005; 80:2002–2007.

    Article  PubMed  Google Scholar 

  35. Curran WJ, Kornstein MJ, Brooks JJ, Turrisi III AT, et al. Invasive thymoma: the role of mediastinal irradiation following complete or incomplete surgical resection. J Clin Oncol 1986;6:1722–1727.

    Google Scholar 

  36. Ströbel P, Bauer A, Puppe B, Kraushaar T, Krein A, Toyka K, Gold R, Semik M, Kiefer R, Nix W, Schalke B, Müller-Hermelink HK, Marx A. Tumor recurrence and survival in patients treated for thymomas and thymic squamous cell carcinomas: a retrospective analysis. J Clin Oncol. 2004;22(8):1501–1509.

    Article  PubMed  Google Scholar 

  37. Singhal S, Shrager JB, Rosenthal DI, LiVolsi VA, Kaiser LR. Comparison of stages I-II thymoma treated by complete resection with or without adjuvant radiation. Ann Thorac Surg. 2003;76(5):1635–1641

    Article  PubMed  Google Scholar 

  38. Ogawa K, Uno T, Toita T, et al. Postoperative radiotherapy for patients with completely resected thymoma: a multiinstitutional, retrospective review of 103 patients. Cancer 2002;94:1405–1413.

    Article  PubMed  Google Scholar 

  39. Uematsu M, Yoshida H, Kondo M, Itami J, Hatano K, Isobe K, et al. Entire hemithorax irradiation following complete resection in patients with stage II-III invasive thymoma. Int J Radiat Oncol Biol Phys 1996;35:357–360

    Article  PubMed  CAS  Google Scholar 

  40. Latz D, Schraube P, Oppitz U, et al. Invasive thymoma: treatment with postoperative radiation therapy. Radiology 1997;204:859–864.

    PubMed  CAS  Google Scholar 

  41. Mangi AA, Wright CD, Allan JS, et al. Adjuvant radiation therapy for stage II thymoma. Ann Thorac Surg 2002;74: 1033–1037.

    Article  PubMed  Google Scholar 

  42. Rena O, Papalia E, Oliaro A, Ruffini E, Filosso P, Novero D, Maggi G, Casadio C. Does adjuvant radiation therapy improve disease-free survival in completely resected Masaoka stage II thymoma? Eur J Cardiothorac Surg. 2007;31(1):109–113.

    Article  PubMed  Google Scholar 

  43. Zhu G, He S, Fu X, Jiang G, Liu T. 2004 Radiotherapy and prognostic factors for thymoma: a retrospective study of 175 patients. Int J Radiat Oncol Biol Phys. 60(4):1113–1119.

    PubMed  Google Scholar 

  44. Suster S, Rosai J. Thymic carcinoma: a clinicopathologic study of 60 cases. Cancer 1991;67:1025.

    Article  PubMed  CAS  Google Scholar 

  45. Yano T, Hara N, Ichinose Y, et al. Treatment and prognosis of primary thymic carcinoma. J Surg Oncol 1993;52:255.

    Article  PubMed  CAS  Google Scholar 

  46. Hsu CP, Chan CY, Chen CL, et al. Thymic carcinoma: ten years’ experience in twenty patients. J Thorac Cardiovasc Surg 1994;107:615.

    PubMed  CAS  Google Scholar 

  47. Mornex F, et al. Radiotherapy and chemotherapy for invasive thymomas: a multicentric retrospective review of 90 cases. Int J Radiat Oncol Biol Phys 1995;32:651–659

    PubMed  CAS  Google Scholar 

  48. Ogawa K, Toita T, Uno T, et al. Treatment and prognosis of thymic carcinoma: a retrospective analysis of 40 cases. Cancer 2002;94:3115–3119

    Article  PubMed  Google Scholar 

  49. Hsu HC, Huang EY, Wang CJ, et al. Postoperative radiotherapy in thymic carcinoma: treatment results and prognostic factors. Int J Radiat Oncol Biol Phys 2002;52:801–805

    Article  PubMed  Google Scholar 

  50. Rosai J, Higa E. Mediastinal endocrine neoplasm of probable thymic origin related to carcinoid tumors. Cancer 1972;29:1061.

    Article  PubMed  CAS  Google Scholar 

  51. Wang DY, Chang DB, Kuo SH, et al. Carcinoid tumors of the thymus. Thorax 1994;49:33.

    Article  Google Scholar 

  52. Vietri F, Illuminati R, Guglielmi R, et al. Carcinoid tumor of the thymus gland. Eur J Surg 1994;160:645.

    PubMed  CAS  Google Scholar 

  53. Gibril F, Chen YJ, Schrump DS et al. 2003 Prospective study of thymic carcinoids in patients with multiple endocrine neoplasia type 1. J Clin Endocrinol Metab 88:1066–1081.

    Article  PubMed  CAS  Google Scholar 

  54. Asbun HJ, Calabria RP, Calmes S, et al. Thymic carcinoid. Am Surg 1991;57:442.

    PubMed  CAS  Google Scholar 

  55. Zeiger MA, Swartz SE, Macgillivary DC, et al. Thymic carcinoid in association with MEN syndromes. Am Surg 1992;58:430.

    PubMed  CAS  Google Scholar 

  56. Chaer R, Massad MG, Evans E, et al. Primary Neuroendocrine Tumors of the Thymus Ann Thorac Surg 2002; 74:1733–1740.

    Article  PubMed  Google Scholar 

  57. I. Fukai, A. Masaoka, Y. Fujii, Y. Yamakawa, T. Yokoyama, T. Murase et al., Thymic neuroendocrine tumor (thymic carcinoid): a clinicopathologic study in 15 patients. Ann Thorac Surg 67 (1999), pp. 208–211

    Article  PubMed  CAS  Google Scholar 

  58. Moran, CA, Suster, S. Neuroendocrine carcinomas (carcinoid tumor) of the thymus: a clinicopathologic analysis of 80 cases. Am J Clin Pathol 2000;114,100–110

    Article  PubMed  CAS  Google Scholar 

  59. Gal, A, Kornstein, M, Cohen, C, et al. Neuroendocrine tumors of the thymus: a clinicopathological and prognostic study. Ann Thorac Surg 2001;72,1179–1182

    Article  PubMed  CAS  Google Scholar 

  60. Tiffet O, Nicholson AG, Ladas G, Sheppard MN, Goldstraw P. A clinicopathologic study of 12 neuroendocrine tumors arising in the thymus. Chest 2003 Jul;124(1):141–146.

    Article  PubMed  Google Scholar 

  61. de Montpréville VT, Macchiarini P, Dulmet E.Thymic neuroendocrine carcinoma (carcinoid): a clinicopathologic study of fourteen cases.J Thorac Cardiovasc Surg. 1996 Jan;111(1):134–141

    Article  PubMed  Google Scholar 

  62. Filosso PL, Actis Dato GM, Ruffini E, Bretti S, Ozzello F, Mancuso M. Multidisciplinary treatment of advanced thymic neuroendocrine carcinoma (carcinoid): report of a successful case and review of the literature. J Thorac Cardiovasc Surg. 2004;127(4):1215–1219.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. *Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA

    Benjamin T. Gielda MD & Joy L. Coleman MD

  2. Section of Thoracic Oncology, Department of Surgery, University of California-Los Angeles, Los Angeles, CA, USA

    Rick Peng MD & Robert B. Cameron MD

  3. Department of Radiation Medicine, Oregon Health & Sciences Center, Portland, OR, USA

    Charles R. Thomas MD

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Correspondence to Charles R. Thomas MD.

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Gielda, B.T., Peng, R., Coleman, J.L. et al. Treatment of Early Stage Thymic Tumors: Surgery and Radiation Therapy. Curr. Treat. Options in Oncol. 9, 259–268 (2008). https://doi.org/10.1007/s11864-008-0080-2

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