Title

The Management of Thymoma: A Systematic Review and Practice Guideline

Authors

Conrad B. Falkson, Kingston General Hospital, Kingston, ON
Andrea Bezjak, Princess Margaret Hospital, Toronto, ON
Gail Darling, Toronto General Hospital, Toronto, ON
Richard Gregg, Kingston General Hospital, Kingston, ON
Richard Malthaner, University of Western OntarioFollow
Donna E. Maziak, Ottawa Hospital, Ottawa, ON
Edward Yu, University of Western OntarioFollow
Christopher A. Smith, McMaster University
Sheila McNair, McMaster University
Yee C. Ung, Sunnybrook Odette Cancer Centre, Toronto, ON
William K. Evans, Hamilton Health Sciences, Hamilton, ON
Lung Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-Based Care

Document Type

Article

Publication Date

7-2009

Journal

Journal of Thoracic Oncology

Volume

4

Issue

7

First Page

911

Last Page

919

URL with Digital Object Identifier

10.1097/JTO.0b013e3181a4b8e0

Abstract

INTRODUCTION: Thymoma is a rare tumor for which there is little randomized evidence to guide treatment. Because of the lack of high-quality evidence, a formal consensus-based approach was used to develop recommendations on treatment.

METHODS: A systematic refview of the literature was performed. Recommendations were formed from available evidence and developed through a two-round modified Delphi consensus approach.

RESULTS: The treatment recommendations are summarized as follows: Stage I--complete resection of the entire thymus without neoadjuvant or adjuvant therapy. Stage II--complete resection of the entire thymus with consideration of adjuvant radiation for high-risk tumors. Stage IIIA--surgery either initially or after neoadjuvant therapy, or surgery followed by adjuvant therapy. Stage IIIB--treatment may include a combination of chemotherapy, radiation, and/or surgery, or if technically possible, surgery in combination with chemoradiotherapy (concurrent cisplatin based). For bulky tumors, consideration should be given to sequential chemotherapy followed by radiation. Stage IVA--as per stage III, with surgery only if metastases can be resected. Stage IVB--treatment on an individual case basis (no generic recommendations). Recurrent disease--consider surgery, radiation, and/or chemoradiation. Chemoradiation should be considered in all medically inoperable and technically inoperable patients.

CONCLUSION: Consensus was achieved on these recommendations, which serve to provide practical guidance to the physician treating this rare disease.