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1、NCCN org Version 2 2019 03 11 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Thymomas and Thymi
2、c Carcinomas Version 2 2019 March 11 2019 Continue Continue NCCN Guidelines Panel Disclosures NCCN Kristina Gregory RN MSN OCN Lydia Hammond MBA Miranda Hughes PhD Diagnostic Interventional radiology Hematology Hematology oncology Internal medicine Medical oncology Pathology Radiation oncology Radio
3、therapy Surgery Surgical oncology Discussion Section Writing Committee David S Ettinger MD Chair The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Douglas E Wood MD Vice Chair Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance Dara L Aisner MD PhD University of Colorado
4、 Cancer Center Wallace Akerley MD Huntsman Cancer Institute at the University of Utah Jessica Bauman MD Fox Chase Cancer Center Ankit Bharat MD Robert H Lurie Comprehensive Cancer Center of Northwestern University Debora Bruno MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer C
5、enter and Cleveland Clinic Taussig Cancer Institute Joe Y Chang MD PhD The University of Texas MD Anderson Cancer Center Lucian R Chirieac MD Dana Farber Brigham and Women s Cancer Center Thomas A D Amico MD Duke Cancer Institute Thomas J Dilling MD MS Moffitt Cancer Center Michael Dobelbower MD PhD
6、 University of Alabama at Birmingham Comprehensive Cancer Center Ramaswamy Govindan MD Siteman Cancer Center at Barnes Jewish Hospital and Washingtn University School of Medicine Matthew A Gubens MD MS UCSF Helen Diller Family Comprehensive Cancer Center Mark Hennon MD Roswell Park Cancer Institute
7、Leora Horn MD MSc Vanderbilt Ingram Cancer Center Rudy P Lackner MD Fred 141 694 701 2Ye B Tantai JC Ge XX et al Surgical techniques for early stage thymoma video assisted thorascopic thymectomy versus transsternal thymectomy J Thorac Cardiovasc Surg 2014 147 1599 1603 3Sakamaki Y Oda T Kanazawa G e
8、t al Intermediate term oncologic outcomes after video assisted thorascopic thymectomy for early stage thymoma J Thorac Cardiovasc Surg 2014 148 1230 1237 4Manoly I Whistance RN Sreekumar R et al Early and mid term outcomes of trans sternal and video assisted thoracoscopic surgery for thymoma Eur J C
9、ardiothorac Surg 2014 45 e187 193 5Liu TJ Lin MW Hsieh MS et al Video assisted thoracoscopic surgical thymectomy to treat early thymoma a comparison with the conventional transsternal approach Ann Surg Oncol 2014 322 328 6Friedant AJ Handorf EA Su S Scott WJ Minimally invasive versus open thymectomy
10、 for thymic malignancies systematic review and meta analysis J Thorac Oncol 2016 11 30 38 NCCN Guidelines Version 2 2019 Thymomas and Thymic Carcinomas Version 2 2019 03 11 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reprodu
11、ced in any form without the express written permission of NCCN Note All recommendations are category 2A unless otherwise indicated Clinical Trials NCCN believes that the best management of any patient with cancer is in a clinical trial Participation in clinical trials is especially encouraged NCCN G
12、uidelines Index Table of Contents Discussion Printed by Maria Chen on 3 25 2019 10 48 28 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved THYM B 1 OF 3 See Radiation Volume and Radiation Techniques THYM B 2 of 3 PRINC
13、IPLES OF RADIATION THERAPY1 2 General Principles Recommendations regarding RT should be made by a board certified radiation oncologist Definitive RT should be given for patients with unresectable disease if disease progresses on induction chemotherapy incompletely resected invasive thymoma or thymic
14、 carcinoma or as adjuvant therapy after chemotherapy and surgery for patients with locally advanced disease Radiation oncologists need to communicate with the surgeon to review the operative findings and to help determine the target volume at risk They also need to communicate with the pathologist r
15、egarding the detailed pathology on histology disease extent such as extracapsular extension and surgical margins The review of preoperative imaging and co registration of preoperative imaging into the planning system are helpful in defining treatment volumes Acronyms and abbreviations for RT are the
16、 same as listed in the Principles of Radiation Therapy for NCCN Guidelines for Non Small Cell Lung Cancer Radiation Dose The dose and fractionation schemes of RT depend on the indication of the radiation and the completeness of surgical resection in postoperative cases A dose of 60 to 70 Gy should be given to patients with unresectable disease For adjuvant treatment the radiation dose consists of 45 to 50 Gy for clear close margins and 54 Gy for microscopically positive resection margins A total
