A Focus on Current Therapeutic Management

摘要

Thymomas are rare intrathoracic malignant tumors. Com- monly used staging system is the Masaoka classification, based on peroperative and histopathological findings. Surgery is the corner- stone of the management of thymomas, initially being useful for precise histopathological diagnosis and staging, and in most cases ensuring the first step of the therapeutics simultaneously. After tumor stage, complete resection is the most constant and significant prognostic factor for progression-free and overall survival. Postop- erative radiotherapy is recommended in incompletely resected thy- momas. Completely resected stage II and III tumors may also benefit from adjuvant radiotherapy to reduce local recurrence rates but without impact on survival. In primary unresectable thymomas, multimodal strategy nowadays includes neoadjuvant chemotherapy, extensive surgery, adjuvant radiotherapy, and in some cases, adju- vant chemotherapy. The most popular chemotherapy regimens com- bine cisplatin, adriamycin, etoposide, cyclophophamide, or ifosf- amide. The management of thymomas is a paradigm of cooperation between clinicians, surgeons, and pathologists from establishing the diagnosis to organizing the therapeutic strategy and evaluating the prognosis. As a consequence of their rarity, no prospective random- ized trials are available and collaborative studies are warranted to evaluate and improve current therapeutic standards, taking into account recent improvements in techniques, such as robotic surgery, radiotherapy, and supportive treatments.