Les thymomes : proposition d'algorithme de prise en charge

Thymic epithelial tumours (TET) are rare but they comprise about 20% of all the mediastinal tumours and up to half of all tumours in the anterior mediastinum in adults. Most TET is indolent but they can be associated with systemic symptoms and autoimmune disorders. Thymic carcinoma comprises less than 1% of TET but patients are often symptomatic with a mediastinal syndrome or distant metastases. Computed tomography is the technique of first choice to characterize the mediastinal mass, invasion of neighboring structures and distant metastases. Magnetic resonance imaging gives information about the invasion of great vessels and fluorodeoxyglucose positron emission tomography is in the course of evaluation. Surgical resection is the mainstay of treatment for resectable thymomas. Completeness of surgical resection is the most important prognostic factor. Stage I Masaoka thymomas may not benefit from postoperative radiotherapy and it remains controversial for stage II. Locally advanced TET may benefit from a multimodal treatment with neoadjuvant chemotherapy, surgery and adjuvant radiotherapy. Treatment should be discussed in a multidisciplinary group of specialists, and patients should be enrolled in prospective studies to develop more effective therapies.