Onkológia 6/2011

Conservative treatment of rare thoracic tumors – thymoma and carcinoid

Thymomas and thymic carciconams are rare malignant tumors. Thymomas are relatively sensitive to chemotherapy, thymic carcinomas are more resistant. Chemotherapy is indicated in stage III as a part of a multimodality therapy or as a single treatment modality in stage IV. The effective cytostatics in monotherapy are doxorubicín, cisplatin, ifosfamid, paclitaxel, etopozide, 5-fluorouracil. In combination chemotherapy best results are achieved by PAC (cisplatin, doxorubicin and cyclophosphamide) and ADOC (doxorubicin, cisplatin, vincristin and cyclophosphamide). Patients may often respond to multiple sequential therapies with single agents after progression on first line chemotherapy. Octreotide, alone or in combination with a corticosteroid may be a reasonable option for recurrent cases. Bronchial carcinoids account for 20 to 30 % of all well-differentiated neuroendocrine tumors, they are the second most common carcinoid tumors after gastrointestinal carcinoids. With an incidence rate of 1,35 per 100,000 populations per year, it accounts for approximately 1 to 2 percent of all lung malignancies. About 80 – 90 % of all carcinoids are typical and 10 – 20 % are atypical. Chemotherapy has modest activity, optimal combination is unknown. Possible choices include doxorubicin, stretozotocin, 5-fluorouracil, cisplatin with etopozide, temozolomide, sunitinib, everolimus, interferon, somatostatin analogs, radionuclides – more often [177Lu-DOTA0,Tyr3]octreotate.

Keywords: thymoma, thymic carcinoma, bronchopulmonary carcinoid, chemotherapy.