Chemotherapy in the treatment of thymic tumors
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REVIEW
Chemotherapy in the treatment of thymic tumors Marcello Tiseo • Andrea Ardizzoni
Received: 28 April 2008 / Accepted: 26 May 2008/ Published online: 26 June 2008 ©Springer-Verlag 2008
Abstract Thymic tumors, including thymoma and thymic carcinoma, are mainly treated with surgical resection. The majority of patients with thymic tumors present with early stage and are cured with surgical excision with or without post-operative radiation. For the patients who present with unresectable stage III or IV disease, or for the patients who experience recurrence, chemotherapy can play a significant role in ensuring long-term survival and offering palliation. Thymic tumors are chemo-sensitive with optimal responses achieved with cisplatin-based combinations. A multimodality approach including chemotherapy and post-operative
radiation can improve complete resection rates and longterm outcomes in locally advanced tumors. Patients with disseminated thymic tumors can have significant disease response and symptom palliation when treated with chemotherapy. Durable responses can be obtained both in metastatic and recurrent settings. Second-line treatments are available and novel therapies are currently being explored. This review provides an update of available evidence about the treatment of thymic tumors with chemotherapy. Keywords Thymoma • Thymic carcinoma • Chemotherapy
Introduction
M. Tiseo (Y) • A. Ardizzoni Division of Medical Oncology, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy e-mail: [email protected]
Thymic tumors, mostly thymomas, constitute 30% of anterior mediastinal masses in adults [1]. A review of Surveillance, Epidemiology and End Results program (SEER) data suggests that thymomas have an incidence of 0.15 cases per 100,000 [2]. Also more infrequent is thymic carcinoma that is characterized by a more aggressive clinical course and less chemo-sensitivity than thymoma [1]. Thymoma is an epithelial tumor generally considered to have an indolent growth pattern but malignant nonetheless because of potential for local invasion, pleural dissemination and even systemic metastases. One third of patients present with asymptomatic anterior mediastinal mass on a chest ×-ray, one third present with local symptoms (cough, chest pain, superior vena cava syndrome and dysphagia) and one third of cases are detected during evaluation of myasthenia gravis [3]. In 1999 the WHO Committee on the Classification of Thymic Tumors adopted a new system based on prognostic significance and on cytological similarities between normal
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and neoplastic thymic epithelial cells ones [4]. The terminology chosen is based on a combination of letters and numbers; there are two major types of thymoma depending on whether the neoplastic epithelial cells have a spindle/oval shape (type A) or whether they have a dendritic or epithelioid appearance (type B). The type B thymomas are further subdivided into subcategories B1, B2 and B3 on the basis of an increasing epithelial lymphocyte ratio and emergence of atypia. Thymi
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