Surgery is the main therapeutic approach for thymus cancers and may be followed by radiation or chemotherapy, depending on the stage of the tumor and the success of the surgery. In some cases, chemotherapy is used before surgery.
Surgery
When there is a tumor on the thymus, usually the entire thymus gland is removed.
Minimally invasive surgery is almost always used for thymus surgery, and our doctors have vast experience with this type of chest surgery. These surgical techniques use very small incisions. This decreases the chance of wound infections and lung infections, such as pneumonia. Patients also have less pain, a shorter hospital stay and return to normal activities sooner.
Three minimally invasive approaches are used for thymus tumors:
- Robotic Surgery: Using the da Vinci Surgical System®, the surgeon uses a console to guide robotic arms, which serve as a surgeon’s hands and eyes. A camera allows the surgeon to see inside the chest, and the flexible arms allow the surgeon to make precise, fine movements in a small space.
- Video-Assisted Thoracic Surgery (VATS): A small incision is made and a small video camera is inserted through the incision. Surgical instruments are also inserted through small incisions. Between one and four small incisions may be used.
- Neck Incision: Instead of approaching the thymus from the chest, the surgeon approaches from above when using a neck incision.
Radiation Therapy
The majority of thymus cancer patients — more than 90 percent — are diagnosed with early stage cancers and may not require radiation therapy after surgery. Whether or not you need radiation therapy will be thoroughly discussed as part of your multidisciplinary treatment planning.
The Right Tools
Roswell Park is equipped with the latest and most precise technology in radiation medicine. These innovative computer-assisted devices can deliver radiation more than 60 percent faster than conventional radiation therapy equipment:
- Varian True Beam Technology System: The True Beam machine with a beam accuracy of 0.7 mm is used for radiosurgery treatments on the spine.
- Trilogy Image-Guided Radiation Therapy Systems: The Trilogy is precise enough to pinpoint an area as small as one millimeter — about the width of a coarse grain of sand.
Roswell Park’s Radiation Medicine Department provides a full range of radiation treatments for thymus cancers, which include:
- Conformal 3-Dimensional Radiation Therapy (XRT): Three-dimensional (3D) conformal radiation therapy allows a precise radiation dose to be delivered to the tumor while minimizing the exposure to normal tissues.
- Intensity Modulated Radiation Therapy (IMRT): This advanced form of conformal radiation therapy links treatment planning software to the actual treatment machine using 3-dimensional imaging and different intensities of radiation according to the tumor’s size and shape.
- Volumetric Modulated Arc Therapy (VMAT): A more precise form of EBRT than 3D CRT, where the radiation dose and the field shape is changed continuously as the treatment machine moves, or arcs around the patient.
- Image Guided Radiation Therapy (IGRT): This treatment delivers sharply focused radiation, guided by up-to-the-moment images that capture the tumor’s exact shape and location. IGRT is used on metastatic tumors of the spine and tumors that are in contact with the spinal cord.
- Intra-Operative Radiation Therapy (IORT): Roswell Park is the only facility in the state outside of New York City with the capabilities to deliver radiation therapy internally during surgery. IORT delivers high dose radiation from a shielded, computer-controlled device and programmed so that the radiation source can be delivered into the patient by remote control.
Chemotherapy
Patients with thymoma or thymus carcinoma receive chemotherapy under the care of the highly-experienced, board-certified medical oncologists in the thoracic oncology clinic.
Several different drugs are used in chemotherapy. Some of these include:
- Cisplatin/anthracycline-based combinations
- Taxanes
- Etoposide
- Octreotide, in patients with thymoma who have a positive octreotide scan or symptoms of carcinoid syndrome
Some patients with thymoma may develop autoimmune conditions such as myasthenia gravis (MG), a disease in which antibodies made by a person’s immune system prevent certain nerve-muscle interactions. Symptoms may include difficulty climbing stairs, drooping eyelids, double vision, drooling, hoarseness, and trouble breathing. If a blood test reveals MG, a neurologist with experience in MG can help manage the condition.