Thymic Neoplasms - A Comprehensive Review of the Diagnosis, Classification, and Treatment

Frank Detterbeck, MD, Attila Nemeth, MD, Edith M Marom, MD

Key Points

  • International collaborative organizations have dramatically expanded the knowledge base regarding thymic malignancies.
  • A reliable clinical diagnosis of thymic malignancy is usually possible for an experienced clinician based on demographic features, radiographic characteristics, and the clinical presentation.
  • All thymomas are malignant (but often only slowly progressive).
  • Thymomas are frequently associated with a wide variety of autoimmune and neurologic syndromes (most commonly myasthenia gravis).
  • Thymic carcinoma and Neuroendocrine tumors of the thymus are more aggressive than thymoma.
  • Complete surgical resection is the main treatment intervention.
  • Postoperative radiotherapy after R0 resection of stage I thymoma is not beneficial.
  • The role of postoperative radiotherapy in thymic carcinoma and stage III thymoma after an R0 resection is unclear.
  • Multimodality treatment (e.g., preoperative chemo(radio)therapy, complete resection, adjuvant radiotherapy) for thymic malignancies that are locally advanced or manifest pleural dissemination yields reasonable long-term results.
  • Several active chemotherapy regimens have been identified.
  • When possible, resection of recurrence (plus chemo- or radiotherapy) results in reasonable long-term outcomes.

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Last updated: October 6, 2023