علاج سرطان الغدة الصعترية عندما لا يمكن تحقيق الاستئصال الكامل في البداية (مرحلة ماساوكا-كوغا III–IVA)

References

• Treatment algorithm for unresectable thymic tumour (Masaoka-Koga stage III–IVA, TNM stage IIIA–IIIB–IVA).
• If complete resection is deemed not to be achievable upfront on the basis of imaging studies, as it is frequently the case in Masaoka-Koga stage III/IVA tumours (classified as stage IIIA/T3, IIIB/T4, /IVA in the IASLC/ITMIG TNM proposed system), a biopsy should be carried out, followed by primary/induction chemotherapy as part of a curative-intent sequential strategy that integrates subsequent surgery or radiotherapy.
• Biopsy is required in all other clinical situations [IV, A]: approaches may consist of percutaneous core-needle biopsy or incisional surgical biopsy through mediastinotomy or mini-thoracotomy.
• Primary/induction chemotherapy is standard in non-resectable advanced thymic epithelial tumours [III, A].
• Cisplatin-based combination regimens should be administered; combinations of cisplatin, doxorubicin and cyclophosphamide, and cisplatin and etoposide, are the recommended options (Table 6) [III, A].
• Primary chemoradiotherapy with platin and etoposide is an option, especially for thymic carcinomas [III, B].
• Usually, two to four cycles are administered before imaging is carried out to reassess resectability of the tumour [III, A].