Yamada Yoshito, Hamaji Masatsugu, Okada Harutaro, Takahagi Akihiro, Ajimizu Hitomi, Koyasu Sho, Sakamori Yuichi, Aoyama Akihiro
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Department of Thoracic Surgery, Kyoto Katsura Hospital, Kyoto, Japan.
Mediastinum. 2024 Jun 4;8:43. doi: 10.21037/med-23-70. eCollection 2024.
Thymic epithelial tumors (TETs), encompassing thymoma and thymic carcinoma, represent a rare and heterogeneous group of thoracic malignancies with varying prognoses and treatment strategies. Surgical resection is the cornerstone of therapy for localized stages, but the management of locally advanced or unresectable TETs often involves induction therapy, including chemotherapy and/or radiation therapy, as a neoadjuvant approach aimed at downstaging the tumor to facilitate subsequent resection. This review synthesizes current knowledge on the re-evaluation process and operative indications following induction therapy for TETs, highlighting the pivotal role of accurate assessment in guiding surgical decisions and optimizing patient outcomes. Induction therapy's efficacy is contingent upon precise re-evaluation methods to accurately gauge treatment response and assess resectability post-therapy. This review discusses the various modalities employed in re-evaluation, including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT), and the significance of tumor markers, underlining their strengths and limitations. The adoption of modified RECIST criteria for TETs by the International Thymic Malignancy Interest Group (ITMIG) underscores the necessity for standardized assessment guidelines to ensure consistency and reliability across studies and clinical practices. Furthermore, we explore the implications of induction therapy on surgical decision-making, emphasizing the criteria for determining the suitability of patients for surgical intervention post-therapy. The review addresses the challenges and future perspectives associated with the re-evaluation process, including the potential for advanced imaging techniques and the integration of molecular and genetic markers to enhance the precision of treatment response assessment. In conclusion, the re-evaluation of TETs post-induction therapy is a complex but critical component of the multidisciplinary management approach for these patients. Standardizing re-evaluation methodologies and incorporating novel diagnostic tools could significantly improve the prognostication and treatment stratification, ultimately enhancing the therapeutic outcomes for patients with advanced TETs.
胸腺上皮肿瘤（TETs），包括胸腺瘤和胸腺癌，是一组罕见且异质性的胸部恶性肿瘤，其预后和治疗策略各不相同。手术切除是局限性分期治疗的基石，但局部晚期或不可切除的TETs的管理通常涉及诱导治疗，包括化疗和/或放疗，作为一种新辅助方法，旨在降低肿瘤分期以利于后续切除。本综述综合了目前关于TETs诱导治疗后重新评估过程和手术指征的知识，强调了准确评估在指导手术决策和优化患者预后方面的关键作用。诱导治疗的疗效取决于精确的重新评估方法，以准确衡量治疗反应并评估治疗后的可切除性。本综述讨论了重新评估中使用的各种方式，包括计算机断层扫描（CT）、磁共振成像（MRI）、正电子发射断层扫描-CT（PET-CT）以及肿瘤标志物的意义，强调了它们的优势和局限性。国际胸腺恶性肿瘤兴趣小组（ITMIG）采用的针对TETs的改良RECIST标准强调了标准化评估指南的必要性，以确保各研究和临床实践之间的一致性和可靠性。此外，我们探讨了诱导治疗对手术决策的影响，强调了确定患者治疗后适合手术干预的标准。本综述讨论了与重新评估过程相关的挑战和未来前景，包括先进成像技术的潜力以及分子和遗传标志物的整合，以提高治疗反应评估的准确性。总之，诱导治疗后对TETs的重新评估是这些患者多学科管理方法中一个复杂但关键的组成部分。标准化重新评估方法并纳入新型诊断工具可显著改善预后和治疗分层，最终提高晚期TETs患者的治疗效果。
