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Thymic epithelial tumors

Key sources
The following summarized guidelines for the evaluation and management of thymic epithelial tumors are prepared by our editorial team based on guidelines from the European Society of Medical Oncology (ESMO 2015).
1

Guidelines

1.Screening and diagnosis

Diagnosis
Suspect thymoma as the first diagnosis in patients with a mediastinal mass associated with autoimmune disease.
B
Diagnose TETs based on the differential diagnosis with other anterior mediastinal tumors and non-malignant thymic lesions.
E
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2.Classification and risk stratification

Classification: classify TETs according to the WHO histopathological classification.
E
consider using the WHO classification for small biopsies, although it is designed for surgical resection specimens.
B

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  • Staging

3.Diagnostic investigations

Diagnostic imaging: obtain contrast-enhanced chest CT as standard imaging for thymic tumors.
B
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  • Laboratory tests

4.Diagnostic procedures

Biopsy and histopathology: do not perform a pretreatment biopsy if the diagnosis of a TET is highly suspected and upfront surgical resection is achievable.
D
perform biopsy in all other clinical situations.
D
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5.Medical management

General principles
Avoid performing therapeutic intervention in patients with a lesion < 30 mm given the low risk of progression or thymic malignancy.
D
Decide on the treatment strategy in patients with TETs primarily based on whether the tumor may be resected upfront or not.
B

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  • Adjuvant chemotherapy

  • Induction chemotherapy

  • Definitive chemotherapy

  • Targeted therapy

  • Management of autoimmune syndromes

6.Therapeutic procedures

Adjuvant radiotherapy, indications: do not offer postoperative radiotherapy after complete resection of Masaoka-Koga stage I thymoma.
D
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  • Adjuvant radiotherapy (technical considerations)

  • Definitive radiotherapy

7.Surgical interventions

Upfront surgery, indications
Assess resectability mostly based on the surgeon's expertise. Discuss indications for surgery in a multidisciplinary tumor board setting.
B
Perform surgery as the first step of the treatment if complete resection is deemed to be achievable upfront.
B

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  • Upfront surgery (technical considerations)

  • Debunking surgery

8.Follow-up and surveillance

Follow-up imaging: obtain a chest CT 3-4 months after surgery.
B
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  • Management of recurrence