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Review
. 2021 Apr;10(4):2088-2100.
doi: 10.21037/tlcr-20-458.

Radiotherapy for thymic epithelial tumours: a review

Krisztian Süveg  1 , Paul Martin Putora  1   2 , Markus Joerger  3 , Thomas Iseli  1 , Galina Farina Fischer  4 , Karlheinz Ammann  5 , Markus Glatzer  1
Affiliations
Review

Radiotherapy for thymic epithelial tumours: a review

Krisztian Süveg et al. Transl Lung Cancer Res. 2021 Apr.

Abstract

Thymic epithelial tumours (TETs) represent a rare disease, yet they are the most common tumours of the anterior mediastinum. Due to the rare occurrence of TETs, evidence on optimal treatment is limited. Surgery is the treatment of choice in the management of TETs, while the role of postoperative radiotherapy (PORT) remains unresolved. PORT remains debated for thymomas, especially in completely resected stage II tumours, for which PORT may be more likely to benefit in the presence of aggressive histology (WHO subtype B2, B3) or extensive transcapsular invasion (Masaoka-Koga stage IIB). For stage III thymoma, evidence suggests an overall survival (OS) benefit for PORT after complete resection. For incompletely resected thymomas stage II or higher PORT is recommended. Thymic carcinomas at any stage with positive resection margins should be offered PORT. Radiotherapy plays an important role in the management of unresectable locally advanced TETs. Induction therapy (chemotherapy or chemoradiation) followed by surgery may be useful for locally advanced thymic malignancies initially considered as unresectable. Chemotherapy only is offered in patients with unresectable, metastatic tumours in palliative intent, checkpoint inhibitors may be promising for refractory diseases. Due to the lack of high-level evidence and the importance of a multidisciplinary approach, TETs should be discussed within a multidisciplinary team and the final recommendation should reflect individual patient preferences.

Keywords: Thymoma; postoperative radiotherapy (PORT); radiotherapy; thymic cancer.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-458). The focused issue “Radiotherapy in thoracic malignancies” was commissioned by the editorial office without any funding or sponsorship. Paul Martin Putora reports research support and educational grants to the department: AstraZeneca, Celgene, Takeda. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Comparison between the Masaoka-Koga staging system and the TNM based (IASLC/ITMIG) staging system for TETs included in the AJCC 8th edition cancer staging system manual, adapted from Willmann et al. (17).
Figure 2
Figure 2
Treatment algorithm for resectable TET (Masaoka-Koga stage I-III) adapted from on the ESMO and RHYTHMIC network guidelines (25). R0, microscopically margin-negative resection, R1, removal of all macroscopic disease, but microscopic margins are positive for tumor; I-III, Masaoka-Koga stage; A, AB, B1−3, WHO subtype; PORT, postoperative radiotherapy.
Figure 3
Figure 3
Treatment algorithm for primary unresectable TET (Masaoka-Koga stage III-IVA) based on the ESMO and RHYTHMIC network guidelines (25).
See this image and copyright information in PMC

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