Induction chemoradiotherapy for unresectable thymic tumors

Michael Lanuti


Curative treatment of locally advanced thymic neoplasms is challenging where optimal multi-modality therapy is not well defined. Thymic tumors that are deemed unresectable at presentation should always be re-considered for resection by a multi-disciplinary team after attempting an induction treatment strategy. Induction strategies have been evaluated in small single institution retrospective and some multi-institution prospective series with no superiority of chemoradiotherapy compared to chemotherapy alone. Despite less robust radiographic response rates compared to induction chemotherapy alone (often around 70%), combination chemotherapy + concurrent radiation therapy appears to increase the rate of complete resection (around 80%), but at the cost of increased perioperative morbidity and mortality. This review outlines the limited published literature addressing the role of induction chemoradiotherapy for “unresectable” thymic neoplasms and provides some insight into interpreting the data.