Treatment of Thymic Carcinoma When Complete Resection Is Achievable Upfront (Masaoka-Koga Stage I–III / TNM Stage I–IIIA)
This protocol addresses thymic carcinoma at Masaoka-Koga stage I–III (TNM stage I–IIIA) in patients for whom complete surgical resection is considered achievable upfront. This encompasses stage I and II tumours, as well as a subset of stage III disease classified as T3 in the IASLC/ITMIG TNM system.
In this setting, surgery represents the primary treatment step, and subsequent adjuvant decisions depend on stage and the completeness of resection achieved.
Following surgical resection, postoperative radiotherapy to the tumour bed is incorporated into management for most stages. The strength of the recommendation for adjuvant radiotherapy varies by stage — ranging from optional at earlier stages to recommended at more advanced stages. The approach also differs depending on whether resection was complete or incomplete.
Postoperative chemotherapy may additionally be considered in selected higher-stage cases, particularly when it was not delivered prior to surgery.
References
DOI: 10.1093/annonc/mdv277
- Treatment algorithm for resectable thymic tumour (Masaoka-Koga stage I–III, TNM stage I–IIIA).
- If complete resection is deemed to be achievable upfront, as it is the case in Masaoka-Koga stage I/II and some stage III tumours (classified as stage I, II, IIIA/T3 in the IASLC/ITMIG TNM proposed system), surgery represents the first step of the treatment [IV, A], possibly followed by postoperative radiotherapy and, less frequently, chemotherapy (Table 5).
- After complete resection of thymic carcinoma, postoperative radiotherapy is optional for stage I tumours [V, C], should be considered for stage II tumours [IV, B] and is recommended for stage III/IVA tumours [IV, B].
- Postoperative radiotherapy is recommended in case of microscopically (R1) or macroscopically incomplete (R2) resection [IV, B], to a total dose of 50–54 and 60 Gy, respectively, with a 10-Gy boost directed to areas of likely residual disease.
- Since thymic carcinomas do present with frequent and early locoregional and systemic recurrences after incomplete surgery, postoperative chemotherapy may be considered as an option in stage II/III/IV thymic carcinomas, especially if not delivered as induction treatment (Table 5).