Treatment of Locally Advanced Thymoma (Masaoka-Koga Stage III/IVA) When Complete Resection Is Not Achievable Upfront
This protocol addresses patients with Thymoma classified as Masaoka-Koga stage III or IVA — corresponding to TNM stages IIIA through IVA in the IASLC/ITMIG system — in whom complete surgical resection is deemed not achievable based on imaging at initial presentation. This is frequently the situation in locally advanced disease at these stages.
A biopsy is performed first, followed by primary induction chemotherapy using a cisplatin-based combination as part of a curative-intent sequential strategy.
After a course of induction chemotherapy, imaging is repeated to reassess whether the tumour has become resectable — enabling subsequent surgery or radiotherapy to complete the curative-intent plan.
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.
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].
Usually, two to four cycles are administered before imaging is carried out to reassess resectability of the tumour [III, A].
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