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33 Cards in this Set
- Front
- Back
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Masaoka stage I
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macroscopically and microscopically completely encapsulated (5 yr OS 94-100%)
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Masaoka stage IIA
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microscopic transcapsular invasion (5 yr OS 86-95%)
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Masaoka stage IIB
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macroscopic invasion into surrounding fatty tissue or grossly adherent to, but not through, mediastinal pleura or pericardium (5 yr OS 86-95%)
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Masaoka stage III
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macroscopic invasion into surrounding organs such as lung, mediastinum, and great vessels (5 yr OS 56-69%)
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Masaoka stage IVA
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pleural or pericardial dissemination (5 yr OS 11-50%)
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Masaoka stage IVB
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lymphogenous or hematogenous mets (5 yr OS 11-50%)
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WHO type A
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spindle cell; medullary thymoma (5 yr OS 100%, 10 yr OS 95%)
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WHO type AB
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mixed thymoma (5 yr OS 93%, 10 yr OS 90%)
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WHO type B1
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lymphocyte rich; lymphocytic; predominantly cortical; organoid thymoma (5 yr OS 89%, 10 yr OS 85%)
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WHO type B2
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cortical thymoma (5 yr OS 82%, 10 yr OS 71%)
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WHO type B3
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epithelial; atypical; squamoid; well-differentiated thymic carcinoma (5 yr OS 71%, 10 yr OS 40%)
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is thymic carcinoma the same thing as invasive thymoma?
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nope
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what labs should you get if you suspect a non-seminomatous germ cell tumor?
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AFP and beta-HCG
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surgical techniques?
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- median sternotomy is the standard approach
- pre-op preparation (e.g. plasmaphoresis for patients with MG may be needed to avoid respiratory complications) |
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Indications for radiation therapy in thymoma
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(looko in NCCN guidelines)
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work up for mediastinal mass?
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- CT chest with contrast
- Serum b-HCG, AFP is appropriate (i.e. suspect non-seminomatous germ cell tumor) - CBC, CMP - PFTs - TSH, T3, T4 as indicated - MRI chest as indicated - PET scan optional |
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What is the surgery for thymoma?
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total thymectomy and complete excision of tumor
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What is done for tissue diagnosis in locally advanced, unresectable disease?
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core needle biopsy or open biopsy (biopsy should not violate the pleural space)
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treatment for R0 resection of thymoma, no capsular invasion, stage I?
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surveillance for recurrence with annual chest CT
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treatment for R0 resection of thymoma or thymic carcinoma, capsular invasion present, stages II-IV?
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consider PORT (category 2B, i.e. general consensus based on lower level evidence)
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treatment for R1 resection of thymoma?
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PORT
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treatment of R1 resection of thymic carcinoma?
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PORT + chemo
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treatment of R2 resection of thymoma?
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RT + chemo
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treatment of R2 resection of thymic carcinoma
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RT+ chemo
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treatment of locally advanced unresectable thymoma or thymic carcinoma
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chemo --> re-eval --> surgery f/b RT or RT +/- chemo
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what about MG before surgery?
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patients should be evaluated for signs and symptoms of MG and should be medically controlled prior to surgery
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what can be resected during surgery?
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pericardium, phrenic nerve (not both), pleura, lung, and even major vascular structures.
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what dose should be given for unresectable disease?
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60-70 Gy
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what dose for adjuvant clear/close margins?
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45-50Gy
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what dose for microscopically positive margins?
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54 Gy
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do we do elective nodal irradiation in thymoma?
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no, because thymomas do not commonly metastasize to regional lymph nodes
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preferred chemo for thymoma?
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cisplatin, doxorubicin, cyclophosphamide
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differential diagnosis for mediastinal mass?
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neoplasm: thymoma, lymphoma, thymic carcinoma, thymic carcinoids, thymolipomas, germ cell tumor, lung mets)
nonneoplastic: intrathoracic goiter, thymic cyst, lymphangioma, aortic aneurism |
