| Popis: |
Thymomas are rare, indolent, malignant tumors arising from epithelial cells of the thymic gland. Unlike other thymic malignancies, thymomas are treated quite different from lung cancer. Complete and extended resection is substantial even in advanced disease. The completeness of resection is also one of the most important prognostic factors. Complete thymectomy with resection of the surrounding mediastinal fat is recomended. Minimally invasive techniques, particularly robotic- assisted thymectomy, are getting more used, mostly for early-stage thymomas. However the standard procedure is median sternotomy, because there is still no evidence of the benefits of using minimally invasive approach. Chemotherapy and radiation therapy play an important role in the management of reccurent disease after R0 resection. Radiation therapy alone or chemoradiation is also well established in patients with positive margins. Chemotherapy can increase the possibility of complete resection of locally advanced disease if it is applied as neoadiuvant setting. Multimodality approach, including surgical resection, can be occasionally performed in patients with stage IV thymoma. In other cases with distant metastases, chemotherapy is the only treatment modality. So far, targeted therapy has achieved modest results in the treatment of thymic malignancies, especially in the treatment of thymoma. About one third of patients with thymoma has evidence of myasthenia gravis. To them a preoperative consultation with a neurologist is necessary. Because of their rarity, thymomas should be treated by a multidisciplinary team in experienced institutions. |
