Complete surgical resection is the standard therapy for thymic epithelial neoplasms. However, a proportion of patients with localized thymomas are not candidates for resection. That may be due to comorbidities that preclude operation or the advanced nature of their thymic masses, such as invasion of the vital organs.
In those situations, external beam radiotherapy with definitive intent may be considered, given with or without chemotherapy. Unfortunately, the retrospective data indicate high frequency of tumor relapse with sufficient follow-up duration (Kashima et al, J Thorac Dis, 2017).
For the 20 patients included in this study and treated with various combinations of radiotherapy and chemotherapy, the median progression-free survival was 20.0 months (95% CI, 10.9–23.0 months). More than 70% of patients experienced either relapse or death by 2 years of follow up.
Clinical Pearl: Definitive radiotherapy for thymomas is an option, but cannot be considered an alternative to surgery.
