The University of Texas MD Anderson Cancer Center, Houston.
Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA Oncol. 2023 Jul 1;9(7):971-980. doi: 10.1001/jamaoncol.2023.1175.
Thymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management.
To develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma.
Case variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. Variants and procedures were evaluated by the panel using modified Delphi methodology. Agreement/consensus was defined as less than or equal to 3 rating points from median. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures.
The ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs.
The ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.
胸腺癌罕见，由于前瞻性数据有限，其肿瘤治疗具有争议性。因此，多学科共识指南对于指导肿瘤治疗至关重要。
制定关于胸腺癌常见表现的多学科专家共识指南。
由 15 名多学科美国镭协会（ARS）胸部适当使用标准（AUC）专家组成员制定了涵盖 I 期至 IV 期胸腺癌谱的病例变体，以解决治疗争议。对 1980 年至 2021 年的英语医学文献进行了全面回顾，为共识指南提供信息。使用改良 Delphi 方法对变体和程序进行了小组评估。同意/共识定义为低于或等于中位数 3 个评分点。然后，ARS 执行委员会批准了共识推荐意见，并按照 ARS 的既定程序进行公开评议。
ARS 胸部 AUC 小组确定了 89 篇相关参考文献，并就胸腺癌评估的所有程序达成共识。由于胸腺癌具有浸润性，微创胸腺切除术被评为通常不适当（无论分期如何）。共识认为，常规分割放疗（每天 1.8-2 Gy）至 45-60 Gy 辅助剂量和 60-66 Gy 根治剂量是合适的，选择性淋巴结照射是不合适的。对于放疗技术，小组建议使用调强放疗或质子治疗（而非三维适形放疗），以减少心脏和肺部的辐射暴露。
ARS 胸部 AUC 小组制定了各种胸腺癌表现的多学科共识指南，或许是该主题中引用最多的指南。
