Thymic Cancer....

Treatment of Thymus Cancers by Stage and Type


Stage I thymoma:

Most patients with stage I thymic cancer have their cancer surgically removed through median sternotomy as described earlier. Long-term survival following complete removal of a stage I thymoma approaches 100%.

Radiation therapy is not used in treating stage I thymomas except for cases in which complete removal is not possible (for example, in patients with other serious medical conditions who are unable to undergo a major operation). For these patients, radiation after partial removal, or radiation instead of surgery are options. However, the best outlook for cure is provided by complete removal whenever possible.

Stages II, III, IV thymoma:

Patients with stage II and III thymic cancer are typically treated with surgical removal of the thymus and, when possible, removal of any other tissues to which the tumor has spread. Postoperative (after surgery) radiation is then given to reduce the risk of recurrence and spread of the tumor, especially for stage III and IV.

Some stage III and most stage IV thymomas have spread too widely to be completely removed. For example, sometimes the tumor is wrapped around the major artery (aorta) or vein (vena cava) in the middle of the chest. These tumors are usually treated by radiation therapy.

Many doctors feel it is important to remove as much of the tumor as is possible in people with stage III disease (where the tumor has not spread widely). This gives the post-operative radiation a better chance of getting rid of the remaining cancer. For stage IV disease (where the cancer has spread more widely), some studies suggest that debulking (removing as much tumor as possible) before radiation therapy improves survival rates, but the value of debulking has not yet been proven.

Other options for unresectable (unable to be completely
removed) thymomas include chemotherapy, or chemotherapy plus radiation therapy. In some cases, neoadjuvant chemotherapy, given before surgery, will shrink a tumor enough so that it can then be completely resected. Even if chemotherapy before surgery does not shrink the tumor enough to permit complete resection, some studies suggest that it may improve survival. After the surgery, radiation therapy alone or together with more chemotherapy will usually be given.

A drug called octreotide has been successful in treating some patients with advanced thymoma. The drug is effective because thymoma cells often bind a hormone called somatostatin. The octreotide replaces somatostatin at the binding sites and causes the thymoma cells to stop growing or die. Results of one study suggest that the combination of octreotide plus prednisone is better than either drug alone.

Recurrent thymoma:

Treatment for thymoma that has recurred after initial treatment depends on what the original treatment was. For example, if you were originally treated with radiation, use of more radiation after recurrence might cause severe damage to normal tissues. In most cases, options for recurrent thymoma include radiation or chemotherapy. The value of surgery in this situation is debated, but some studies suggest that if recurrences are not too widespread, surgical removal offers the best chance of long-term survival. Usually chemotherapy is given and can be very effective in controlling the cancer.

Treatment of thymic carcinoma:

The usual treatment is removal of as much of the thymic tumor as possible, followed by radiation and chemotherapy. Sometimes chemotherapy is given before surgery.

Treatment of thymic carcinoid:

Complete surgical removal, when possible, is the main strategy. If complete removal is not possible, radiation therapy is given after debulking. Radiation is also used in treating local recurrences. Chemotherapy is sometimes used in treating thymic carcinoids with distant spread.