This protocol applies to patients with thymic carcinoma at Masaoka-Koga stage III–IVA (TNM stages IIIA, IIIB, and IVA) in whom complete surgical resection cannot be achieved upfront and in whom there is no lymphogenous or haematogenous metastasis.
Masaoka-Koga stage III/IVA thymic carcinoma — classified as stage IIIA (T3), IIIB (T4), or IVA in the IASLC/ITMIG TNM staging system — is frequently unresectable at presentation on the basis of imaging findings. When upfront complete resection is deemed not achievable, a biopsy should be performed and the patient managed within a curative-intent sequential strategy. This protocol governs the treatment phase when the tumour remains unresectable.
For thymic carcinoma that remains unresectable at this stage, the primary therapeutic approach is radiation-based, with concurrent systemic options available depending on clinical factors.
Full regimen details, combination options, and the complete clinical algorithm are available in the structured protocol →DOI: 10.1093/annonc/mdv277
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.
If the tumour remains unresectable or R2: – Definitive radiotherapy (60 Gy) [IV, B] – Option: chemoradiotherapy – Option: concurrent chemoradiotherapy (platin and etoposide, 60 Gy)
View source ↗