Thymoma
ICD-10 D15.0 · ICD-11 4B40.Y

Treatment of Resectable Thymoma: Masaoka-Koga Stage I, II or Selected Stage III (TNM Stage I–IIIA) with Complete Resection Achievable Upfront

When complete resection is considered achievable from the outset, surgery is the first and central step of management in thymoma at Masaoka-Koga stage I, II, or selected stage III cases.

This protocol applies to Thymoma at Masaoka-Koga stage I/II and some stage III tumours — classified as stage I, II, or IIIA/T3 in the IASLC/ITMIG TNM proposed system — where complete resection is deemed achievable upfront. In this setting, surgery is the first step of treatment, possibly followed by postoperative radiotherapy and, less frequently, chemotherapy.

Treatment approach (partial overview)

The standard surgical approach involves complete thymectomy via median sternotomy; depending on stage, histology, and resection status, postoperative radiotherapy may be recommended or considered. The full indications, sequencing, and criteria are detailed in the complete protocol.

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References

DOI: 10.1093/annonc/mdv277

  • 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).
  • The standard approach is median sternotomy [IV, A], which allows the wide opening of the mediastinum and both pleural cavities, followed by evaluation of macroscopic capsular invasion, infiltration of perithymic and mediastinal fat, peritumoural and pleural adherences and involvement of surrounding structures.
  • Generally, complete thymectomy including the tumour, the residual thymus gland and perithymic fat is preferred because local recurrences have been observed after partial thymectomy when part of the thymus gland is left behind [IV, B].
  • Postoperative radiotherapy is recommended after complete resection of stage III/IVA thymoma, in an effort to prolong RFS and OS [IV, B].
  • Postoperative radiotherapy may be considered in case of aggressive histology (type B2, B3) or extensive transcapsular invasion (stage IIB) [IV, C].
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